Health Innovators
Health Innovators

Episode · 2 years 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 how health innovators maximize their success. You're working on something big, something life saving, something world changing. Yet ninety five percent of health innovations fail and real lives are on the line. That's why launching is not enough. Commercialization is the most critical, yet overlooked stage of the innovation process. Through candid conversations with health innovators, early adopters and influencers, you'll learn the five components of the COIQ early adoption strategy. So, if you want to change lives and dominate your market, why not give your innovation the best chance to succeed? I'm your host, Dr Roxy, founder of Legacy DNA and international bestselling author of how health innovators maximize market success. And now let's join the conversation and maximize your success. Welcome back to the show coiq listeners. On today's episode we have Dave Johnson with us. He is the CEO for for Sight Health and he's authored a book called the customer revolution and healthcare that just came out a couple of months ago. Welcome to the show, Dave. Well, thank you. Delighted to be here. You meet all of your your audience yes, so, you know, before we get started, tell folks a 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 an English literature major in college and a Peace Corps volunteer in Africa and thought I wanted to do international development for a career and went back and got a degree in public policy at Harvard and one thing led to another and I ended up as a healthcare investment banker, which would a surprised nobody more than my own twenty 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 from the peak cords of that career, right. Yeah, yeah, yeah, you know, when I was going to the Peace Corps my dad tried to every way you could think of to talk me out of it, and so I'm just on our business track. I think he was secretly grateful. And so I was very successful banking career, thirty billion in bond issues and so on. But you know, took twenty five years. But what I realized was I think what I really am as a journalist and some for the last five years have had my own company, forsight health, written two books and produced a lot of thought leadership on market driven healthcare reform and in some ways this 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 all those 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 roller coaster of healthcare innovation these last few years? What's happening innovation? One Way to look at is there are record amounts of investment from both private equity and 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 ways I look at it roxy is if you imagine a two by two grid with duration of care on the x axis, going from episodic to ongoing, and then care uncertainty going from low to high. On the Y axis you end up with 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 care falls 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 then upper right would be high risk and ongoing. That's the real solution shop kind of stuff, complex care, comorbidities, and then lower right would be the non 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 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 patients and I believe that what the market places is doing is picking spots where they believe they can outperform the current system, and it's a pretty low bar in many cases. So you're seeing the rise of these enhanced primary care companies rouged care companies that are really doing it better, faster, cheaper, with with with greater customer service. He kind of think about that specialty care, the emergence of high volume focus factories, taking by Ame out of hospitals, putting it into ambilatory centers with specialized expertise. Think of the lower right, which is the non acute chronic and we're seeing all the big retail chains sort of moving in that direction, CBS, Walmart and so on, and then upper right is for the mail clinics of the world. But the kind of the question I always have as how many of those do we really need? We have 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't think 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 itself to sort of attack these buckets and the more that we change the payment for care over to risk base models and multimately full risk models, the more important efficiency price outcomes will become, which will put some of the drink which, as you know, put some of 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 then any quote, you know, paid more to fix it. So Ye, true comple industries. Yeah. So one of the things that I talk about often is this statistic that ninety five percent of innovations that are brought to market fail to reach any adequate level of customer acceptance or profitability. And that's really not in healthcare, that's just overall across industries. 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 of innovation. You got the early adopters and...

...yeah, and they're willing to try everything and and he is to get to about twenty percent market share with whatever the new innovation is. Yep. And what's what's hard about that is that next group is they're called pragmatists or early adopters, and they have to have a business. They are going to just do 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 of disillusionment. You know, 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 ways it's even tougher because we don't necessarily have companies that are purchasing based on value. They're purchasing based on how do I optimize revenues and a fee for service system right, and so navigate, you know, coming up with a better solution, even if it's the best solution, doesn't necessarily mean you'll gain acceptance. And now, having said that, I did mention that record levels of private 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, but the services and provider side are disproportionately benefiting. So I I think the market believes there are all kinds of opportunities to improve. 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 so, well, your daughter's generation then. You know, when you think about that group, half of them don't have primary care physicians. 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 want it to be on demand and a click away and really convenient. So I think there are a number of sort of millennial entrepreneurs that are coming in to fill that space. And this is the generation that taught us to ride with strangers and to stay in strangers houses and I think they're going to reshape the way we do completely. So the digital natives, and so I I think there's a chance that healthcare could become or could exceed those rates just because there's so much room for improvement and the opportunity to take technologies that have worked in other industries for consumers and apply them to healthcare is so vast and people are doing it so and the current industry is 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 you just talked about the the technology adoption curve, the diffusion of innovation and is as common as it is. It's very rare that I come across a health innovator that is basing their targeting strategy on on that market segmentation. So it's still 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 really becomes a game changer and foundational to their strategy going forward of not looking at the early adopters. And so they spend so much time with the pragmatist that you just talked about, trying to arm twist them and convince them that they have a problem that they can solve for them and it's just kind of a mixed mismatch of problem in solution or awareness...

...in interest to solve that problem at that 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 you know, 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, you know, a reasonably good little company, Yep, hopefully gets bigger, and I'm that process of trying to figure out what the market place is, what customers want, how to deliver it, how to price it, how to respond 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 think that one of the biggest things that entrepreneurs fail to recognize, and I see this a lot, particularly with engineers and people on the tech side they helped, is it really doesn't matter how good your product or services, ultimately you got to convince somebody to buy it. And I have, I do a fair amount of advisory work for for early stage companies, and when I'm looking at companies, I 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 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 chair of the person across the table, really understand the problem they're trying to solve, figure out whether or not you can actually help solve that problem and if you can get them to agree to roll up their sleeves and work with you on that. You know, too many people just say you look at my great widget and they haven't thought about how it fits into so those that do that, can can convince people to to buy what they're selling, have really crossed the big threshold. So you know, all these you know pre money 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 and that's that's a hard thing to do and I think that discipline is part of what 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 still doesn't guarantee success, right, not only way too many times. So this kind of leads me to my next question. So how what are some of the strategies that you recommend for health in invaders to rise above the noise, especially with earlier doctors? Yeah, well, I mean you just heard a dose of it, which is really try hard to put yourself in the position of the person across the other side of the table that you're trying to sell to and really understand what problem it is they're trying to solve and whether you have a Soluici. So when just a giving an exam. When I was a banker, I would for my first meeting, and maybe this is an indication that ultimately I was going to do turn more to journalism, but I would go to a first meeting with just a pad of paper and a Pencil and I would interview the person and,...

...if it was really important, I would write down what I thought the current status was and what they're trying to do, why they're trying to do it, with what the goals were, and then I would let that person read it and I you could usually get a five eighty percent of the way right and then get their input and then at that point we had a shared document that accurately reflected exactly because they had contributed and signed off on it, what did it was they were trying to do in terms of capital formation or acquisition or whatever it was. And then I would go back and think hard about whether we could help and if we could, I'd say, well, here's what we've agreed on, here's what I think we can help. I don't want to be adversarial. Why don't we get on the same side of the table, roll up or sleeves and go at it? YEA, and I you know, Roxy I could not get other bankers to do that. I mean they always wanted to take their pitch book and well, you know, and I'd say don't bring a pitch book and they were reporting to me right, don't be there's for we're going to have a conversation. Well, just in case, you know. So, I mean I almost can't over emphasize that part enough. I think the other thing is appreciate, particularly if you're trying to sell into a health system or not, that even if you got a great point solution, somehow it's got to integrate into everything else that's going on. I believe ultimately we're going to move toward platforming in the same way Amazon those that these companies will be somewhat 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 that you can they can design products that meet customer needs built around brand and customer experience. So, you know, having that narrow conversation without having a sense of how this could integrate into a broader service platform, I think is also a mistake that many fall into. Yeah, I think so, especially for the ladder part of the market, when the market is a little bit more sure that that whole product configuration and I didn't you know, you don't have to be the one to deliver the whole thing, but being able to have those partners and making sure that it's going to be able to be fully integrated is really, really critical. So it sounds like you've worked with large institutions that are trying to innovate within and then with some early stage startups that are innovating externally. How would you describe the differences between those in the challenges that they face and how they overcome them? Yeah, well, I call the the 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 challenge for the upstarts are what we've been talking about, which is getting access and sometimes resources. The incumbents, you know, are already market leaders. They have a whole different set of problems, usually related to the fact that what they'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's still 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 were very familiar with. Is Consumers are care system. I very rarely see a disconnect between what a what a small entrepreneeurial company, says it wants to do and what it's doing, that those are...

...perfectly aligned. I often see a disconnect in healthcare between what a big and company, big incoming company, says it wants to do and what it's actually doing. So I yeah, observation, yeah, no, it's there is, by use of of love, the show Dallas. You probably remember it, and there was one episode, was long time ago, obviously, where Jr, the main character, was with scheming with his brother Bobby, back and forth, and finally Jad, you know, you know bobby. Once you give up your integrity, the rest is a piece of cake. And I think in health care we've got sort of this built in hypocrisy in a lot of what what happens, because you've got this kind of artificial way of paying for things, not related to value, just related to volume, and that's what 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 talked about all the value stuff they're doing. But you know, if you're ninety eight percent fee for service and you got one person working on social determinants of health, that's probably not going to get the job done right. Right. So I what I am on the incumbent side, what I've seen for really successful companies is this concept of dual transformation. Have you heard of this? So you've got to just existing business and then the new business. Oh yeah, and so so called the existing a and you run that as efficiently as possible. And then B is the whatever the new business is, and I'd say, broadly speaking, and health, healthcare is a and health is be. You know, if you're going to try and eat on health, that's very different than trying to compete on healthcare. And yet if we're going to go to population health models and vertical integration, going to have to compete on health. And then you got this sort of c level up above which kind of settles the jump balls and make sure resources. But essentially a does a and you don't mess with that and beat us be and you don't mess with that and let them go about their 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 operation center. They used to have six hundred ways of calling into fairview. Now there's on center, so one call does at all. They've also got some predicted analytics that sits in this this building where a bunch of screens they can anticipate where bottlenecks are going to occur and then they can send a nudge to a nurse or to get a discharge out earlier and bringing down like the state's improving. That is kind of classic a business. You know. How do you run it better? Yeah, yeah, and simultaneously they've created this company within a company to handle all the risk business. So they got a little bit of an insurance company. They've got physician groups, so all that care management activity isn't trying to succeed within the fee for service to kind of treatment environment. So they really are competing on healthcare and a and competing on health and be different budget, different culture, different goals. Yeah, absolutely completely understand. And so it's really hard to do. I mean, but I don'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 photography inside 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 the future of healthcare? I want that for every health innovator, which is why I invented Coyq and evidence based framework to take your innovation from an idea to start up to full market adoption. If you're not sure where you are in the 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 backs Flash Score. And now let's jump back into the conversation. So who are some of the health innovators out there? Both large are upstart that that you think are doing it. Well, Oh, there lots. There are lots of them. Are and crown. Yeah, well, I and some of some of the partnerships are kind of interesting to there's a company called grand rounds out 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. One of their employees would get sick, grand rounds would come in and look at the diagnosis and the treatment pattern and about two thirds of the time would change it, and usually change it in ways that were less intensive and that that's a great service, but they have now kind of migrated more into the primary care space and they have an algorithm that literally ranks every primary care physician in the country and what they've discovered is that higher performing Primary Care Physicians get the referral patterns right the first time and get the prescriptions right the first time. So, for examples, seven percent less opiate prescription, opioid prescriptions. So they grant. Rounds is now partnering with Walmart and they're going to roll out this service so when a walmart associate needs primary care, they will have their ability to look at all of the primary care physicians in that region and direct the associates these higher performing primary care physicians. And the belief is, and it's already started to prove itself out, that they will get better care and what we all want, you know, better outcomes, lower cost the better customer experience. Comcast is doing something with with a similar company. What different from 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 where they have a lot of people that have it. You know on site whether are 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 a long 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 buy healthcare, government and self insured employers, are starting to demand more value from the system. You know, demand driven Change Superhero for results. It's a little like, you know, McDonald's is experimenting with Kal Salads, not because they don't want to sell you more burgers, it's because some of their customers want some healthier options. Yeah, and...

I've been waiting for this for a long time, but I think the buyers are getting smarter and the only response many of the big systems have is to really use, you know, market leverage on pricing to keep them in net work. So as we get these new types of services like the to I just describe, that starts to break down. You know, your daughter's virtual care company will get her generation and you 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 good night. So they're started there disproportionately buying Medicare advantage, which is a capitated payment model, and ultimately, when you kind of get through it, you got 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 hearing AIDS, gym memberships, dental care, all this other stuff coming in, and I think the boomers will also redefine end of life care. And I could go to any of these segments and I you know. If you want to 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 in a coherent way, I could talk about that. If you wanted to know about a company that was figuring out how to pull data and put it on a platform so that, in a vative companies can write apps, I can tell you about that. They're all over the place. What's the pattern, Dave? What what? What is the if there is any? Because what I think is interesting is the first two that you described in detailed. You know, 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 to face if they were going into the traditional healthcare system. So what are you know, it is kind of you think about it. Are there any patterns to 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 for my little company, you know, like the little engine that could, is outcomes matter, customer count and valuables. So I think what all these companies have 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 things that you could worry about, and specifically on driving better outcomes and improving customer 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 to that in somewhere or another. I sometimes, if you can, you can tell I like to buy two grids. If you can imagine one, this one will be easier than the last one. Where you do it yeah, you got sort of market on the bottom, so you got bad market and good market, and then you got medicine on the Y axis and bad medicine and 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's just five hundred bucks, you don't need it. That's bad for you. Yep, Ye, so that would be over treatment. If you go upward left, so it's it's bad market but good medicine. That's you need an MRI, but you know your Pan Five Thousand Bucks for it. And those three over payment, fragmentation and over treatment...

...are the three faces of of modern American medicine right now. Good medicine, good market, convergence, what I call 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 far the exception, not the rule. So again, if you kind of come back to that, outcomes matter. Customers kind of value rules that you're driving up into that upper right quadrant. You know, we cannot healthcare cannot defy gravity forever and we're not going to continue as a society to pay for care that doesn't generate the type of return it should and has enormous ways associated with it. 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 a very progressive regulatory set of leaders at cms right now, seem a Verma and Alex Hays are, and they are doing everything they can to push transparency to level the COMMITTI. But you may have seen last week they just came out with 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. What they're dream to the industry is like having, you know, an apoplectic fit about it because they don't think they should have to reveal their prices. Will guess what, when you have pricing transparency, really empower people make better decisions or companies that act as proxies on behalf of people. Mum, so again kind of a long answer your question, but you know this is an industry that's again focus really on fee for service payment, turning volume, not really on 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 for episodic care and captation payments for population health and you got a fixed amount you got to work with. So how do you take that money and and provide great care and profit at the same time? So sure, yeah, so let's talk about outcomes a little bit. Sure, you know, thinking about a startup and they're funding and their relationship with their investors or their board and the amount of time that it takes to dim to develop a program that demonstrates 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? And you know, in just this conversation of you know, could take me a year or two before I have some demonstrated outcomes. I got to get some cash coming in. Chi Can. All right, yeah, no, it's well, my first advice to entrepreneurs is food strap for as long as you humanly can when you have to take the outside money. It's very expensive and they get a chunk of your company. And they have been too many cases where, because of a cash flow crunch, you know, an entrepreneur that's really created a company with a lot of value ends up with a lot less of the pie than they probably should. If so, bootstrap as long as possible husband resources. I think everybody's been a little bit kind of enamored of the Silicon Valley where, you know, they're just seem to hand out money like popsicles to two companies and...

...you know sort of the attitude that a will invest in ten, nine'll go bankrupt, but the one that we will be a big winner. And Yep, so on what? I'm not sure those numbers are as little like gambling. You know, gamblers always tell you about the time they have the big win. They don't tell you about the ten times they lost. So I sometimes those people that said no to Uber and air BMV because they thought strangers were not to ever come in someone's both. Are you weren't living in those cars? Yeah, whatever. Still hasn't made any money, which is this kind of interesting. They I was just out at the big health conference in Vegas and which is kind of a got a tech investor focused to we're writing the report for the conference and just finished the executive summery for it. And over and left where they're in a big way. Lift was a five star sponsor left help. Yeah, so you don't think about, you know, what lift could do to the pair of 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 customer and 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, creating value it and then convincing others to pay you money to deliver it. It's really hard, but it's ultimately enormously rewarding and I think that's and and you know, part of it is being lucky, right, like facebook was really lucky because Yahoo was at yacht know who, but my space, maybe it was Fox, 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 to do this type of social media connecting platform and facebook camera on along right at exactly the right time, when you know if they've been earlier, they probably would have failed. If they've been later, there would have been somebody else other than facebook doing it. And timing is often as much a factor as hard 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 would just admit that they got lucky when they worked for Microsoft, and Microsoft it's Junger, which is to say they weren't smart and didn't work hard. But there's a lot of smart people to work really hard. But not everybody you know picks a winner that way. Sure, sure, luck is there's luck is a big part of life and recognized that. Try to get it to come in your favor, although I have always liked that slogan that luck is where opportunity meets preparation. So you got to be ready to ready to get lucky right hands down, not really one without the other. So I so do you've just one last question before we wrap up today. Most of our listeners are health innovators that are in the trenches right now with varying degrees of success and frustration. What advice do you have for them? Well, on the on the frustration side, I mean I maybe 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 to build out a sales force that type of Yep. The second is you got...

...to be really concerned about the market positioning in the market messaging and the sales process. I can't spend all your time just making the product better and more beautiful and whatever. So that what I said earlier about having some marketing jobs so that you can go out and convince somebody to put a piece of their business in your hands. It drives me in saying how many innovators spend millions of dollars on the product and then they want to invest about thirty FIVEZERO dollars and their communications and go to market stress. Hey, yeah, there you go. I so when I was a banker and we'd have these, you know, beauty contests, they used to 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's going to win and others were going to lose. Yeah, used to amaze me Roxy how how much time people would spend cultivating a client, writing a proposal, you know, doing all of that stuff, and then they would would wing it in the oral interview. And I used to say to my team 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 things being equaled, or third if you over prepare for that, rehearse, figure out what message is going to be, be tight on your transitions, have good graphics, all of that stuff chance. So you're going to win. are going 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 this that can they flip through pages and they lose noting and and wouldn't ask for the job. This is hid and I you know that. I think those same lessons apply in any company which is that's got a product, a service in a market and the point of sale. Those moments you got to have your a game on and you got to you know, you got to look your best and you gotta have candy and they'll you know, it's a match making process. So and people that sort of don't either recognize that or don't give it credence are just not going to be a successful and they'll they'll be frustrated 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 is better. Yeah, it's more efficient, it saves more money, but they tell a better story. The part said 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 listeners today. Yeah, I can 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 for sight. So number for Sidhtcha l thh for sight healthcom. You know you want, you can sign up. We do regular produce a ton of thought leadership. 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'd encourage people. I hope I get a few new readers out of this. We also do podcasts like you do. And Yeah, well, this is I 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 and and we're always eager to get receive feedback. And also, you know, tell your telly, this is my edited...

...version right, because you can see, you got to promote the book. Yeah, by the customer revolution in healthcare. It's it's doing really well and I think a lot of what we've been talking about is baked into that, and so people will enjoy that as well or maybe use it to I've gotten lots of compliments on this ability to answer some of 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 know you're busy working to bring your 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 subscribe to 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 with friends and colleagues, see you on the next episode of Coiq.

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