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


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 , and buy the book here.

Welcome to Coiq, where you learnhow health innovators maximize their success. You're working on something big, something lifesaving, something world changing. Yet ninety five percent of health innovations fail andreal lives are on the line. That's why launching is not enough. Commercializationis the most critical, yet overlooked stage of the innovation process. Through candidconversations with health innovators, early adopters and influencers, you'll learn the five componentsof the COIQ early adoption strategy. So, if you want to change lives anddominate your market, why not give your innovation the best chance to succeed? I'm your host, Dr Roxy, founder of Legacy DNA and international bestsellingauthor of how health innovators maximize market success. And now let's join the conversation andmaximize your success. Welcome back to the show coiq listeners. On today'sepisode we have Dave Johnson with us. He is the CEO for for SightHealth and he's authored a book called the customer revolution and healthcare that just cameout a couple of months ago. Welcome to the show, Dave. Well, thank you. Delighted to be here. You meet all of your your audienceyes, so, you know, before we get started, tell folksa little bit about who you are and what you do? Sure. Well, I've got a little bit of an unusual background. Roxy I was anEnglish literature major in college and a Peace Corps volunteer in Africa and thought Iwanted to do international development for a career and went back and got a degreein public policy at Harvard and one thing led to another and I ended upas a healthcare investment banker, which would a surprised nobody more than my owntwenty five year old self. And that very successful healthcare investment banking career,working on behalf of large health systems from I bet your parents were surprised fromthe peak cords of that career, right. Yeah, yeah, yeah, youknow, when I was going to the Peace Corps my dad tried toevery way you could think of to talk me out of it, and soI'm just on our business track. I think he was secretly grateful. Andso I was very successful banking career, thirty billion in bond issues and soon. But you know, took twenty five years. But what I realizedwas I think what I really am as a journalist and some for the lastfive years have had my own company, forsight health, written two books andproduced a lot of thought leadership on market driven healthcare reform and in some waysthis complex nuance industry that we work in I think sometimes requires legit literary sensibility, cultural sensitivity, public policy acumen and market knowledge, and I use allthose prisons to think about and reflect and hopefully comment intelligently on the industry.Sure, yeah, absolutely. It's a very diverse background. So I'm yeah, I'm getting I'm excited about today's conversation. So how would you describe this rollercoaster of healthcare innovation these last few years? What's happening innovation? OneWay to look at is there are record amounts of investment from both private equityand venture funding going not only into healthcare services but into provider based services,and I think the smart money believes there's enormous opportunity to deliver the right care, right time, right place, at...

...the right price by being better,faster and smarter than the current providers in the system. One of the waysI look at it roxy is if you imagine a two by two grid withduration of care on the x axis, going from episodic to ongoing, andthen care uncertainty going from low to high. On the Y axis you end upwith the four boxes and lower left is high degree, low low risk, episodic, so high degree of certainty of a good outcome. That,to me is routine or commodity care, and probably seventy percent of health carefalls into that bucket. If you go up which is high risk but episodic, something like a heart transplant, Huh, you know that would be and thenupper right would be high risk and ongoing. That's the real solution shopkind of stuff, complex care, comorbidities, and then lower right would be thenon acute chronic care. And I think health systems and the industry overall, you know, sort of the traditional players are trying to be good atall of that and end up not necessarily being good at any of it.You've got pockets of excellence. So they're trying to be all things all patientsand I believe that what the market places is doing is picking spots where theybelieve they can outperform the current system, and it's a pretty low bar inmany cases. So you're seeing the rise of these enhanced primary care companies rougedcare companies that are really doing it better, faster, cheaper, with with withgreater customer service. He kind of think about that specialty care, theemergence of high volume focus factories, taking by Ame out of hospitals, puttingit into ambilatory centers with specialized expertise. Think of the lower right, whichis the non acute chronic and we're seeing all the big retail chains sort ofmoving in that direction, CBS, Walmart and so on, and then upperright is for the mail clinics of the world. But the kind of thequestion I always have as how many of those do we really need? Wehave where I am in Chicago, we have six places that do heart transplants. Only one does more than twenty five, most to single digits. I can'tthink of a less efficient way to do it with with worse outcome.So I think when you think about how the markets reacting, it's reorganizing itselfto sort of attack these buckets and the more that we change the payment forcare over to risk base models and multimately full risk models, the more importantefficiency price outcomes will become, which will put some of the drink which,as you know, put some of the ways, traditional ways that providers delivercare today at risk. You know, you won't be able to get awaywith doing a crappy job and then any quote, you know, paid moreto fix it. So Ye, true comple industries. Yeah. So oneof the things that I talk about often is this statistic that ninety five percentof innovations that are brought to market fail to reach any adequate level of customeracceptance or profitability. And that's really not in healthcare, that's just overall acrossindustries. And then you think about the additional complexity that that layers in healthcare. Why do you think some, you know, innovations fail and some succeed? Yeah, well, have you seen the you probably seen the curve ofinnovation. You got the early adopters and...

...yeah, and they're willing to tryeverything and and he is to get to about twenty percent market share with whateverthe new innovation is. Yep. And what's what's hard about that is thatnext group is they're called pragmatists or early adopters, and they have to havea business. They are going to just do it because it's cool to dothey have to have a business reason to do it. And so most companiesthat fail tend to fail in what they call that trough of disillusionment. Youknow, we're the cat crossing the chasm. Yeah, you got crossing chasm.So you just can't get there. so that's writ large in in,you know, society or or cross industries. I think in healthcare in some waysit's even tougher because we don't necessarily have companies that are purchasing based onvalue. They're purchasing based on how do I optimize revenues and a fee forservice system right, and so navigate, you know, coming up with abetter solution, even if it's the best solution, doesn't necessarily mean you'll gainacceptance. And now, having said that, I did mention that record levels ofprivate equity and venture money or flowing into the space, and they're flowing. They're still flowing into device and farm up like they always have, butthe services and provider side are disproportionately benefiting. So I I think the market believesthere are all kinds of opportunities to improve. And one of the thingsI'm you know, you look like you're a millennial. My daughters twenty seven. Okay. Well, I just have really, really good genes. Youare going to live to a hundred and two like so, well, yourdaughter's generation then. You know, when you think about that group, halfof them don't have primary care physicians. They think hospitals are only for reallysick people. Yeah, they only want care when they need it and onlywhen they need it, and they want it to be on demand and aclick away and really convenient. So I think there are a number of sortof millennial entrepreneurs that are coming in to fill that space. And this isthe generation that taught us to ride with strangers and to stay in strangers housesand I think they're going to reshape the way we do completely. So thedigital natives, and so I I think there's a chance that healthcare could becomeor could exceed those rates just because there's so much room for improvement and theopportunity to take technologies that have worked in other industries for consumers and apply themto healthcare is so vast and people are doing it so and the current industryis not terribly good at it. So it's so it's a disruptive moment.So I one of the things that I think is really interesting, as youjust talked about the the technology adoption curve, the diffusion of innovation and is ascommon as it is. It's very rare that I come across a healthinnovator that is basing their targeting strategy on on that market segmentation. So it'sstill usually more of the traditional sense that they might be segmenting users versus,you know, the buyer or the doctor versus the health plan or the payer. But but I just I rarely see folks go that step deeper that reallybecomes a game changer and foundational to their strategy going forward of not looking atthe early adopters. And so they spend so much time with the pragmatist thatyou just talked about, trying to arm twist them and convince them that theyhave a problem that they can solve for them and it's just kind of amixed mismatch of problem in solution or awareness... interest to solve that problem atthat point of time. Yeah, they're two things I love about capitalism.The first is the ability to create something from nothing. So you're on ours. It's probably one of the highest forms of human achievement and it's if youknow, and people obviously gravitate to it sure, so that's that's that's great. I mean my company didn't exist six years ago and now it's, youknow, a reasonably good little company, Yep, hopefully gets bigger, andI'm that process of trying to figure out what the market place is, whatcustomers want, how to deliver it, how to price it, how torespond to setbacks, how to seize opportunity, how to not be overwhelmed by opportunity. All those things are remarkably invigorating, but they're also hard and I thinkthat one of the biggest things that entrepreneurs fail to recognize, and Isee this a lot, particularly with engineers and people on the tech side theyhelped, is it really doesn't matter how good your product or services, ultimatelyyou got to convince somebody to buy it. And I have, I do afair amount of advisory work for for early stage companies, and when I'mlooking at companies, I I'm now evaluating the CEO not only on their abilityto, you know, produce a great product, because I think most technicallyprovision people are good at design and their instincts are to make it better,but it's that marketing component. You know, can you put yourself in the chairof the person across the table, really understand the problem they're trying tosolve, figure out whether or not you can actually help solve that problem andif you can get them to agree to roll up their sleeves and work withyou on that. You know, too many people just say you look atmy great widget and they haven't thought about how it fits into so those thatdo that, can can convince people to to buy what they're selling, havereally crossed the big threshold. So you know, all these you know premoney companies or you know what, they're gone at it. Their 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 ofwhat makes capitalism work. Yeah, yeah, absolutely. You know, it's true. So many of the folks that we work with, you know,think that because their innovation is technically or functionally superior the wits in the market. Right, it's better, it's faster, it's more efficient or it's cheaper.And even even if they have demonstrated outcomes that it's better, it's stilldoesn't guarantee success, right, not only way too many times. So thiskind of leads me to my next question. So how what are some of thestrategies that you recommend for health in invaders to rise above the noise,especially with earlier doctors? Yeah, well, I mean you just heard a doseof it, which is really try hard to put yourself in the positionof the person across the other side of the table that you're trying to sellto and really understand what problem it is they're trying to solve and whether youhave a Soluici. So when just a giving an exam. When I wasa banker, I would for my first meeting, and maybe this is anindication that ultimately I was going to do turn more to journalism, but Iwould go to a first meeting with just a pad of paper and a Penciland I would interview the person and,...

...if it was really important, Iwould write down what I thought the current status was and what they're trying todo, why they're trying to do it, with what the goals were, andthen I would let that person read it and I you could usually geta five eighty percent of the way right and then get their input and thenat that point we had a shared document that accurately reflected exactly because they hadcontributed and signed off on it, what did it was they were trying todo in terms of capital formation or acquisition or whatever it was. And thenI 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 whatI think we can help. I don't want to be adversarial. Why don'twe get on the same side of the table, roll up or sleeves andgo at it? YEA, and I you know, Roxy I could notget other bankers to do that. I mean they always wanted to take theirpitch book and well, you know, and I'd say don't bring a pitchbook and they were reporting to me right, don't be there's for we're going tohave a conversation. Well, just in case, you know. So, I mean I almost can't over emphasize that part enough. I think theother thing is appreciate, particularly if you're trying to sell into a health systemor not, that even if you got a great point solution, somehow it'sgot to integrate into everything else that's going on. I believe ultimately we're goingto move toward platforming in the same way Amazon those that these companies will besomewhat agnostic about what they own and where they partner and where they outsource,but what they'll have in common as ability to mix and match attribute so thatyou can they can design products that meet customer needs built around brand and customerexperience. So, you know, having that narrow conversation without having a senseof how this could integrate into a broader service platform, I think is alsoa mistake that many fall into. Yeah, I think so, especially for theladder part of the market, when the market is a little bit moresure that that whole product configuration and I didn't you know, you don't haveto be the one to deliver the whole thing, but being able to havethose partners and making sure that it's going to be able to be fully integratedis really, really critical. So it sounds like you've worked with large institutionsthat are trying to innovate within and then with some early stage startups that areinnovating externally. How would you describe the differences between those in the challenges thatthey face and how they overcome them? Yeah, well, I call thethe smaller ones the up star. It's right and then you get yeah,I'm but and I like the the title of the book is the customer revolution. So it so we got upstart revolutionaries and incumbent revolutionaries, and the challengefor the upstarts are what we've been talking about, which is getting access andsometimes resources. The incumbents, you know, are already market leaders. They havea whole different set of problems, usually related to the fact that whatthey're getting paid to do is different than what they say they want to do. So say you want to you say you want to put patients first,but if I look at what you do rather than what you say, it'sstill takes a month to schedule an appointment. You don't have customer friendly software,you don't follow up terribly well. You know all the things that werevery familiar with. Is Consumers are care system. I very rarely see adisconnect between what a what a small entrepreneeurial company, says it wants to doand what it's doing, that those are...

...perfectly aligned. I often see adisconnect in healthcare between what a big and company, big incoming company, saysit wants to do and what it's actually doing. So I yeah, observation, yeah, no, it's there is, by use of of love, theshow Dallas. You probably remember it, and there was one episode, waslong time ago, obviously, where Jr, the main character, waswith scheming with his brother Bobby, back and forth, and finally Jad,you know, you know bobby. Once you give up your integrity, therest is a piece of cake. And I think in health care we've gotsort of this built in hypocrisy in a lot of what what happens, becauseyou've got this kind of artificial way of paying for things, not related tovalue, just related to volume, and that's what everybody does to sort ofkeep the machine going and earn a great living. But they know that's notthe right thing to do. So they talked about all the value stuff they'redoing. But you know, if you're ninety eight percent fee for service andyou got one person working on social determinants of health, that's probably not goingto get the job done right. Right. So I what I am on theincumbent side, what I've seen for really successful companies is this concept ofdual transformation. Have you heard of this? So you've got to just existing businessand then the new business. Oh yeah, and so so called theexisting a and you run that as efficiently as possible. And then B isthe whatever the new business is, and I'd say, broadly speaking, andhealth, healthcare is a and health is be. You know, if you'regoing to try and eat on health, that's very different than trying to competeon healthcare. And yet if we're going to go to population health models andvertical integration, going to have to compete on health. And then you gotthis sort of c level up above which kind of settles the jump balls andmake sure resources. But essentially a does a and you don't mess with thatand beat us be and you don't mess with that and let them go abouttheir business. And you know an example that would be the fairview health system, fair view university Minnesota Health System, which is just opened a system operationcenter. They used to have six hundred ways of calling into fairview. Nowthere's on center, so one call does at all. They've also got somepredicted analytics that sits in this this building where a bunch of screens they cananticipate where bottlenecks are going to occur and then they can send a nudge toa nurse or to get a discharge out earlier and bringing down like the state'simproving. That is kind of classic a business. You know. How doyou run it better? Yeah, yeah, and simultaneously they've created this company withina company to handle all the risk business. So they got a littlebit of an insurance company. They've got physician groups, so all that caremanagement activity isn't trying to succeed within the fee for service to kind of treatmentenvironment. So they really are competing on healthcare and a and competing on healthand be different budget, different culture, different goals. Yeah, absolutely completelyunderstand. And so it's really hard to do. I mean, but Idon't I think if you try to do both inside the same company it fails. It's just, you know, like when Kodak tried to do digital photographyinside the film business and film made digital for lunch and ultimately, you know, choked on it. So yeah, it's just one road block after another. Hey, it's Dr Roxy here with...

...a quick break from the conversation.Do you want your innovation to succeed, to change lives, to shape thefuture of healthcare? I want that for every health innovator, which is whyI invented Coyq and evidence based framework to take your innovation from an idea tostart up to full market adoption. If you're not sure where you are inthe commercialization process, take the free assessment now at Dr Roxycom backslash score.Don't miss out on impacting more lives just because you have a low coiq score. The Free Assessment is at Dr Roxycom backslash score. That's Dr roxiecom backsFlash Score. And now let's jump back into the conversation. So who aresome of the health innovators out there? Both large are upstart that that youthink are doing it. Well, Oh, there lots. There are lots ofthem. Are and crown. Yeah, well, I and some of someof the partnerships are kind of interesting to there's a company called grand roundsout of San Francisco, Silicon Valley funded, and they started as doing second opinion. So they collected a network of top one percent specialists around the country. They would contract with employers who would pay per member per month. Oneof their employees would get sick, grand rounds would come in and look atthe diagnosis and the treatment pattern and about two thirds of the time would changeit, and usually change it in ways that were less intensive and that that'sa great service, but they have now kind of migrated more into the primarycare space and they have an algorithm that literally ranks every primary care physician inthe country and what they've discovered is that higher performing Primary Care Physicians get thereferral patterns right the first time and get the prescriptions right the first time.So, for examples, seven percent less opiate prescription, opioid prescriptions. Sothey grant. Rounds is now partnering with Walmart and they're going to roll outthis service so when a walmart associate needs primary care, they will have theirability to look at all of the primary care physicians in that region and directthe associates these higher performing primary care physicians. And the belief is, and it'salready started to prove itself out, that they will get better care andwhat we all want, you know, better outcomes, lower cost the bettercustomer experience. Comcast is doing something with with a similar company. What differentfrom grand rounds but another upstart company called Crossover that does on site clinics,nearby clinics and now virtual clinics. And comcast has a hundred eightyzero people nationwide. So they're going to run all of their employees for these crossover clinics wherethey have a lot of people that have it. You know on site whetherare reasonable number. It will be nearby and otherwise it will be virtual.But I'll be one platform integrated great care and you know, comcast for along time as had some of the best outcomes of any of the corporate buyers. So part of what I think is happening is that the people that buyhealthcare, government and self insured employers, are starting to demand more value fromthe system. You know, demand driven Change Superhero for results. It's alittle like, you know, McDonald's is experimenting with Kal Salads, not becausethey don't want to sell you more burgers, it's because some of their customers wantsome healthier options. Yeah, and...

I've been waiting for this for along time, but I think the buyers are getting smarter and the only responsemany of the big systems have is to really use, you know, marketleverage on pricing to keep them in net work. So as we get thesenew types of services like the to I just describe, that starts to breakdown. You know, your daughter's virtual care company will get her generation andyou know, I think the boomers to people more like me than you,but you'll get there eventually. Are Not going to go quietly into that goodnight. So they're started there disproportionately buying Medicare advantage, which is a capitatedpayment model, and ultimately, when you kind of get through it, yougot to take care of a group of people for a certain amount of money. That changes everything. You know, these MAA plans you get free hearingAIDS, gym memberships, dental care, all this other stuff coming in,and I think the boomers will also redefine end of life care. And Icould go to any of these segments and I you know. If you wantto know a creative hospice company, I could give you a handful of those. If you wanted to know a company that was thinking about patient navigation ina coherent way, I could talk about that. If you wanted to knowabout a company that was figuring out how to pull data and put it ona platform so that, in a vative companies can write apps, I cantell you about that. They're all over the place. What's the pattern,Dave? What what? What is the if there is any? Because whatI think is interesting is the first two that you described in detailed. Youknow, their business model involves the self insured employer group as the buyer,so they're able to circumvent a lot of the barriers that they might have toface if they were going into the traditional healthcare system. So what are youknow, it is kind of you think about it. Are there any patternsto those examples that come to mind that we can we can glean? Yeah, well, Roxy The little slogan for my company or the big slogan formy little company, you know, like the little engine that could, isoutcomes matter, customer count and valuables. So I think what all these companieshave in common is are those three things that they are focused on outcomes,not on process. They're focused on customers, not on any number of other thingsthat you could worry about, and specifically on driving better outcomes and improvingcustomer experience and value, you know, getting better outcomes for lower costs.So I would say every company that I would point you to is contributing tothat in somewhere or another. I sometimes, if you can, you can tellI like to buy two grids. If you can imagine one, thisone will be easier than the last one. Where you do it yeah, yougot sort of market on the bottom, so you got bad market and goodmarket, and then you got medicine on the Y axis and bad medicineand good medicine. So in the lower left, bad market, bad medicine, you got fragmentation, your pan too much, you know it's awful.If you're on the lower right, where you've got good market but bad medicine, that's like a reasonably priced MRI that you don't need, even if it'sjust five hundred bucks, you don't need it. That's bad for you.Yep, Ye, so that would be over treatment. If you go upwardleft, so it's it's bad market but good medicine. That's you need anMRI, but you know your Pan Five Thousand Bucks for it. And thosethree over payment, fragmentation and over treatment...

...are the three faces of of modernAmerican medicine right now. Good medicine, good market, convergence, what Icall revolutionary healthcare. Right care, right time, right place and right price. There are pockets of that in the country, but it's it's by farthe exception, not the rule. So again, if you kind of comeback to that, outcomes matter. Customers kind of value rules that you're drivingup into that upper right quadrant. You know, we cannot healthcare cannot defygravity forever and we're not going to continue as a society to pay for carethat doesn't generate the type of return it should and has enormous ways associated withit. So I think this is the way the market place is attacking it. The other thing that's happening is on the regulatory side. We've got avery progressive regulatory set of leaders at cms right now, seem a Verma andAlex Hays are, and they are doing everything they can to push transparency tolevel the COMMITTI. But you may have seen last week they just came outwith a new policy that says insurance companies and hospitals are going to have to, you know, make it very easy to see what they charge. Whatthey're dream to the industry is like having, you know, an apoplectic fit aboutit because they don't think they should have to reveal their prices. Willguess what, when you have pricing transparency, really empower people make better decisions orcompanies that act as proxies on behalf of people. Mum, so againkind of a long answer your question, but you know this is an industrythat's again focus really on fee for service payment, turning volume, not reallyon outcomes, not on value. And you know that's that's the old math. The new math is you're increasingly going to get kind of fixed payments forepisodic care and captation payments for population health and you got a fixed amount yougot to work with. So how do you take that money and and providegreat care and profit at the same time? So sure, yeah, so let'stalk about outcomes a little bit. Sure, you know, thinking abouta startup and they're funding and their relationship with their investors or their board andthe amount of time that it takes to dim to develop a program that demonstratesoutcomes the resources that are needed to back that. Let's just talk about thata little bit. What's your perspective on the money and the time that takes? And you know, in just this conversation of you know, could takeme a year or two before I have some demonstrated outcomes. I got toget some cash coming in. Chi Can. All right, yeah, no,it's well, my first advice to entrepreneurs is food strap for as longas you humanly can when you have to take the outside money. It's veryexpensive and they get a chunk of your company. And they have been toomany cases where, because of a cash flow crunch, you know, anentrepreneur that's really created a company with a lot of value ends up with alot less of the pie than they probably should. If so, bootstrap aslong as possible husband resources. I think everybody's been a little bit kind ofenamored of the Silicon Valley where, you know, they're just seem to handout money like popsicles to two companies and... know sort of the attitude thata will invest in ten, nine'll go bankrupt, but the one that wewill be a big winner. And Yep, so on what? I'm not surethose numbers are as little like gambling. You know, gamblers always tell youabout the time they have the big win. They don't tell you aboutthe ten times they lost. So I sometimes those people that said no toUber and air BMV because they thought strangers were not to ever come in someone'sboth. Are you weren't living in those cars? Yeah, whatever. Stillhasn't made any money, which is this kind of interesting. They I wasjust out at the big health conference in Vegas and which is kind of agot a tech investor focused to we're writing the report for the conference and justfinished the executive summery for it. And over and left where they're in abig way. Lift was a five star sponsor left help. Yeah, soyou don't think about, you know, what lift could do to the pairof transit industry or even the ambulance industry, to tell you the truth, absolutely. Yeah. So it's and they're already thinking about outcomes, the customerand value. That's not something that they're hand. There's DNA ar yeah,absolutely, in their DNA. So that's so that's, you know, again, he kind of keep coming back to the same concepts demonstrating value, creatingvalue it and then convincing others to pay you money to deliver it. It'sreally hard, but it's ultimately enormously rewarding and I think that's and and youknow, part of it is being lucky, right, like facebook was really luckybecause Yahoo was at yacht know who, but my space, maybe it wasFox, it was somebody bought my space and kind of ruined it right, right, and so they Zuckerberg and there'd been multiple attempts to try todo this type of social media connecting platform and facebook camera on along right atexactly the right time, when you know if they've been earlier, they probablywould have failed. If they've been later, there would have been somebody else otherthan facebook doing it. And timing is often as much a factor ashard work and ingineody and so on. Absolutely yeah, I mean again,I have a lot of friends in Seattle and I wish more of them wouldjust admit that they got lucky when they worked for Microsoft, and Microsoft it'sJunger, which is to say they weren't smart and didn't work hard. Butthere's a lot of smart people to work really hard. But not everybody youknow picks a winner that way. Sure, sure, luck is there's luck isa big part of life and recognized that. Try to get it tocome in your favor, although I have always liked that slogan that luck iswhere opportunity meets preparation. So you got to be ready to ready to getlucky right hands down, not really one without the other. So I sodo you've just one last question before we wrap up today. Most of ourlisteners are health innovators that are in the trenches right now with varying degrees ofsuccess and frustration. What advice do you have for them? Well, onthe on the frustration side, I mean I maybe recapsule some of what I'vesaid, which is bootstrap as long as you can. You know at somepoint you probably need to take some money, but hopefully that's when you got aproduct that works and you're going to build out a sales force that typeof Yep. The second is you got... be really concerned about the marketpositioning in the market messaging and the sales process. I can't spend all yourtime just making the product better and more beautiful and whatever. So that whatI said earlier about having some marketing jobs so that you can go out andconvince somebody to put a piece of their business in your hands. It drivesme in saying how many innovators spend millions of dollars on the product and thenthey want to invest about thirty FIVEZERO dollars and their communications and go to marketstress. Hey, yeah, there you go. I so when I wasa banker and we'd have these, you know, beauty contests, they usedto call where you're going to make a pitch? Yeah, oral presentation,and and you know you'd be one of three or one of five and somebody'sgoing to win and others were going to lose. Yeah, used to amazeme Roxy how how much time people would spend cultivating a client, writing aproposal, you know, doing all of that stuff, and then they wouldwould wing it in the oral interview. And I used to say to myteam it should be exactly the opposite. If your one of three finalists,you know your chance is a winning or at you know, all the thingsbeing equaled, or third if you over prepare for that, rehearse, figureout what message is going to be, be tight on your transitions, havegood graphics, all of that stuff chance. So you're going to win. aregoing to be much better than if you go you know, and people, I can't tell you how many times they went for the book like thisthat can they flip through pages and they lose noting and and wouldn't ask forthe job. This is hid and I you know that. I think thosesame lessons apply in any company which is that's got a product, a servicein a market and the point of sale. Those moments you got to have youra game on and you got to you know, you got to lookyour best and you gotta have candy and they'll you know, it's a matchmaking process. So and people that sort of don't either recognize that or don'tgive it credence are just not going to be a successful and they'll they'll befrustrated that others who are better at that that don't have as good a product. Absolutely. How is this possible? I I, my my product isbetter. Yeah, it's more efficient, it saves more money, but theytell a better story. The part said the world is not fair and hewas right. So that's true. That's true. Well, Dave, thankyou so much for sharing your wisdom with our listeners today. Yeah, Ican get a hold of you if you go to the website for sight helthcom. That's the number four, or like my nephew goes. He goes forsight. So number for Sidhtcha l thh for sight healthcom. You know youwant, you can sign up. We do regular produce a ton of thoughtleadership. There's a huge backlog of stuff that we've written. So there's there. You can also write to us there and and so on, and I'dencourage people. I hope I get a few new readers out of this.We also do podcasts like you do. And Yeah, well, this isI do like the video thing here. We only do it audios. So, but so, that's that's the best way to get ahold of us andand we're always eager to get receive feedback. And also, you know, tellyour telly, this is my edited...

...version right, because you can see, you got to promote the book. Yeah, by the customer revolution inhealthcare. It's it's doing really well and I think a lot of what we'vebeen talking about is baked into that, and so people will enjoy that aswell or maybe use it to I've gotten lots of compliments on this ability toanswer some of the questions that we've talked about today. That's great, that'sawesome. Well, thank you so much for joining me today. Thank you. Thank you so much for listening. I know you're busy working to bringyour life changing innovation to market and I value your time and your attention.To save time and get the latest episodes on your mobile device, automatically subscribeto the show on your favorite podcast APP like apple podcast, spotify and stitcher. Thank you for listening and I appreciate everyone who's been sharing the show withfriends and colleagues, see you on the next episode of Coiq.

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