Latest / StartUp Health NOW Podcast / Lee Shapiro and Glen Tullman Build Collaborative Partnerships to Achieve Health Moonshots

Transcript

Lee Shapiro and Glen Tullman Build Collaborative Partnerships to Achieve Health Moonshots · StartUp Health NOW Podcast

• 0:00
  [ on-hold music] Make no little plans. They have no magic to stir men's blood, and probably themselves will not be realized. Make big plans.
• 0:15
  Aim high in hope and work, remembering that a noble, logical diagram, once recorded, will never die. But long after we are gone will be a living thing asserting itself with ever-growing consistency.
• 0:31
  [ on-hold music] Welcome back to StartUp Health NOW, the podcast where we celebrate the entrepreneurs and innovators shaping the future of health. I'm Logan Plaster.
• 0:48
  Today on the show, we've got a special conversation with Lee Shapiro and Glenn Tullman, the dynamic duo behind Seven Wire Ventures, as well as Livongo and now Transcarent.
• 0:58
  These two have worked side by side as friends and business partners for more than 30 years, investing in startups, scaling businesses, and taking companies public.
• 1:07
  Now, in addition to all the rest, the two are backing a diverse portfolio of early-stage health startups through StartUp Health's Moonshot Impact Fund.
• 1:16
  When it comes to health innovation, Lee and Glenn have seen it all, but always through the lens of a collaborative partnership.
• 1:22
  Steven Krein, StartUp Health CEO and co-founder, leads the conversation today, which covers a range of topics from new market opportunities to practical strategies for working with your investors. I hope you enjoy.
• 1:33
  [ on-hold music] My name is Steven Krein. I'm joined today by Glenn Tullman and Lee Shapiro. I call them the dynamic duo.
• 1:48
  And rather than me do introductions of their incredible multi-decade partnership and careers and passion, I'm gonna let each of them do quick introductions of each other, because when we get done today's conversation, you're gonna really, I think, have a new appreciation for the success that both of them have had together is because of the relationship they've built over so many decades.
• 2:15
  Not just knowing each other on the personal side, but working together on the professional side as well.
• 2:21
  So starting with you, Lee, I'm gonna ask you to introduce Glenn, and then I'm gonna ask Glenn, you to introduce Lee. Well, Steven, thanks so much. It's great to be here.
• 2:30
  And, and I do think that you and, and Unity have cornered the label dynamic duo, and what a great job you do at StartUp Health. So thank you so much for hosting us today.
• 2:41
  Well, I'm, I'm pleased to introduce, um, my co-founder at Seven Wire, um, longtime friend, Glenn Tullman.
• 2:49
  Um, Glenn has been engaged in so many amazing activities over the course of, of his career, and it seems like it's gone by in a blur.
• 2:59
  Four public companies, uh, CCC Information Services, Enterprise Systems, Allscripts, and Livongo Health. He's currently serving as CEO of Transcarent, one of our portfolio companies.
• 3:14
  Um, Glenn isn't satisfied unless he's working at least two jobs at once, so he has a full-time job as managing partner of our fund, as well as his second full-time job running Transcarent.
• 3:26
  Um, in working with Glenn over the course of the years, what you come to appreciate is his passion.
• 3:32
  And whether it's his passion for building businesses and solving some of the major challenges that you described so aptly in your video in helping all of us to live healthier lives, and it also carries over into his personal life.
• 3:46
  His commitment to his family, his commitment to finding a cure for diabetes to help those like his son, Sam, and his niece, Ashley, um, as well as, as working tireles- tirelessly on behalf of all of us to make the world a better place.
• 4:01
  So I couldn't be more pleased to share the dais today with my partner, Glenn. Wow. Wow. Well, thank you, Lee. Um, that's the nicest- Did I, did I read that well? Did I read what you sent me okay?
• 4:13
  I, I, I was just gonna say, we didn't even have this planned. It w- I wanted to surprise you guys with it, but I'm now waiting for Glenn to kinda reciprocate here. Geez.
• 4:21
  [laughs] Well, well, that's the nicest string of things that Lee has ever said about me, which we'll come to later.
• 4:27
  But, um, look, I've been blessed to have Lee as a friend and a partner over the last 30-ish years, or he'll know the exact number. But Lee, by training, he calls himself a recovering, uh, lawyer, a recovering accountant.
• 4:45
  He has a skill set, uh, that's, uh, just amazing from a technical standpoint.
• 4:52
  But when you talk to people about Lee, you'll hear first and foremost about what an incredible father he is to his three children, what an incredible husband he is, and what an incredible person he is.
• 5:06
  And I think, uh, you know, that's kind of what's defined Lee first and foremost. Um, I think of him as an incredible partner as well, um, over the last years.
• 5:18
  When I first moved to Chicago, he literally began by helping me find a place to live, um, because he knew Chicago like the back of his hand.
• 5:29
  Then he trained me to run- And, and cleaning, and cleaning the place that we found. [laughs] Yeah. That too. And, uh- He wondered why it was so clean. He, he didn't realize you did that, Lee.
• 5:38
  He then, he then, uh, convinced me to run marathons with him. And, uh, there's a famous picture of us on mile 17 holding a, uh, what is it? Holding a piece of paper, and I'm pointing to it on mile 17.
• 5:53
  It was just a business meeting for us. We would run for hours, talk about the business.
• 5:58
  And, uh, and then, of course, we started investing togetherUm, over time and ultimately working together, which culminated in when Lee stepped out of a board meeting at Livongo, and the board said, "We need a CFO who can get all this done.
• 6:18
  What about Lee?" He was out of the room. We literally made him CFO. He came back in, and he kept saying, "You're kidding." And we said, "No, we really did this when you were out of the room."
• 6:29
  And, uh, he then, of course, led, uh, Livongo to our IPO, to a secondary offering, to a $500 million plus convertible, and the $18.5 billion exit all in 12 months, and that's what people don't appreciate.
• 6:46
  Um, but, uh, an incredible person. He knows... When Lee didn't show up at the HLTH show, people thought they were gonna cancel the show because he wasn't there.
• 6:57
  But he's the most connected person in healthcare, and, and it's a real privilege to have him as my partner in, in business and, uh, uh, you know, in, in virtually everything we do. Well, I, I really...
• 7:11
  You know, from, from our standpoint, you and I have always believed that our, the secret to our success is, uh, each other, and the idea that we've been able to build a team around us that has complementary unique abilities.
• 7:23
  And I think what I wanted to start with, with, um, with both of you in particular around this question of, in the beginning, when you began working together, and this is a question lots of entrepreneurs ask when they're launch- launching their companies or struggling to find fit.
• 7:40
  How did you know in the very, very beginning that there was a potential for a good fit between you guys working together? Well, I'll, I'll start. Um, so Glenn and I,
• 7:55
  we started investing together, um, in really early stage companies, um, frankly, because that's all we could afford at that point in time.
• 8:04
  Um, and because we didn't play golf or didn't play it well, um, in fact, our pictures are up in pro shops around the country banning us from their courses- [laughs]... based on how much damage we could do.
• 8:17
  Um, but we, we really loved this idea of, of building companies and thought that we had something to add.
• 8:24
  Um, Glenn from, you know, his background in terms of playing leadership roles at the companies that he was in from his time in Washington at Office of Management and Budget, um, and, and my, um, background from, from working in a law firm and, and helping to advise clients.
• 8:42
  We thought maybe we could help some of these early stage companies, um, grow.
• 8:45
  And so we would show up and meet with founders and, and as we started to spend time with them, we, we realized that there were a number of things that we each added.
• 8:56
  Uh, Glenn has a tremendous set of skills around sales and business development.
• 9:02
  Um, and, and I hope to, you know, provide things that are complementary in terms of saying, "Well, gee, how do we figure out a way to actually execute on some of these crazy ideas that Glenn has?"
• 9:13
  And we would work with companies to try and help them grow. And we saw that some of the things we did actually worked.
• 9:19
  We weren't sure in those early days, um, even with the companies we were working with, whether or not some of the advice that we were giving them made sense even to us.
• 9:29
  But we tried it and, and those founders tried it, and we had some success. But Glenn, what would you add? Yeah. I think there was also a sense of shared values. We wanted to work on things that mattered.
• 9:41
  Um, we weren't really-- It wasn't ever about the money for us. It was about doing things that mattered. It was about building great companies that would withstand the test of time.
• 9:53
  I mean, the number of possible, um, deals that we walked away with that we knew would be successful, but we weren't comfortable with the people or we didn't think that the mission, uh, it may have been important, it just wasn't important to us.
• 10:08
  So that mattered, and we both shared that. Uh, we also both loved the process of building, of, you know, that some people, Lee joked about all, but it's not really a joke.
• 10:19
  We love, for us, the process of building things, those challenges, um, were exciting to us.
• 10:26
  And, you know, one of the metrics we have is, is how many CEOs that we together have mentored and that we have worked with and have worked for us, and we keep count of that because that matters.
• 10:40
  So I think finding someone with shared values was really important, um, from the earliest days and, and that made it easy to do. Yeah.
• 10:51
  It, it's kinda like ho- hopefully choosing a spouse in looking for somebody who's got shared values and shared ambitions.
• 10:58
  Um, talk a little bit about, you know, it's one thing to have one success, in particular with Allscripts, but then the, the, the idea of a second and a third and hopefully a fourth and fifth and many, many more that you've had and will have.
• 11:13
  What do you think that... Or if you could recall a little bit about what was that conversation like around ambition? And you talk about having a shared passion, but ambition for achieving great things.
• 11:23
  I mean, Allscripts was doing what many companies are doing today, twenty or thirty or twenty-five, thirty years ago. But even then, you, there was this thing that you could frame as a health moonshot.
• 11:33
  And so I'd love to understand a little bit about the melding of the minds around your ambition to achieve what we now refer to as health moonshots, which again, are not just big goals, but collaborations that are possible because of the people that you wrap around them.
• 11:48
  Well, I think first and foremost, you know, there was, there was a Inc. article written, um, after leaving Allscripts that said, why would, would I in particular and then we, because Lee joined, why would we start over?
• 12:03
  You had a multi-billion dollar public company, thousands of employees, why would you start over? And the answer was-You know, there was more to do.
• 12:12
  There were real problems to be addressed, and we felt we had accomplished what we could at Allscripts, and now it's time for the next challenge. And those challenges are still here.
• 12:25
  We have great challenges in healthcare. It's the most important work we believe anybody can do. And so there was a challenge, and in particular, um, with Livongo, it was one that was near and dear to my heart.
• 12:38
  And, you know, Lee had also, in support of me, adopted that challenge of, um, finding a cure for diabetes and keeping people healthy until we did.
• 12:49
  And, you know, we had very upfront and close experience about knowing that we could do better.
• 12:56
  And, uh, I think ultimately, you know, I joke about it, I think Lee wanted to get me out of his hair day to day, and he said, "Glenn, go run this. You can make this better."
• 13:05
  [laughs] Little did he know that I'd drag him along, um, into that quest.
• 13:10
  But, you know, it's, it's interesting because at the end, um, when we announced the transaction at Livongo, the experience, uh, and the reaction of our people was interesting.
• 13:24
  There wasn't a lot of joy as you might expect. We made literally hundreds of millionaires, and people were more excited about the fact that we had more than a million users on our software.
• 13:36
  They were more excited about the fact that every day people would call in and say, "You changed my life." Um, that's what motivated them.
• 13:45
  And so from that perspective, I think that's really what it was, um, you know, what it's always been about.
• 13:52
  So, so, you know, I'm reminded, um, of a quote by Daniel Burnham, um, a- an architect who shaped Chicago, and, and it says, um, "Make no little plans.
• 14:05
  They have no magic to stir men's blood and probably themselves will not be realized. Make big plans, aim high in hope and work, remembering that a noble, logical diagram once recorded will never die.
• 14:19
  But long after we are gone will be a living thing, asserting itself with ever-growing consistency."
• 14:26
  And, and this notion of, of making no little plans, no small plans, is always the way that we've approached the things that, that we've done. When, when we come into a company, whether it's as investors or, or operators,
• 14:40
  we come in with the idea that there's an opportunity and someone's gonna succeed. Why can't it be us?
• 14:47
  I mean, we're, we're gonna try, um, we're gonna work hard, and we're gonna give it our best, and if we fail doing it, so be it.
• 14:55
  But, but we approach this with our CEOs that we work with, and, and that goes also to our philosophy. We don't ever think about how quickly can we exit a company, how quickly can we grow it and sell it.
• 15:08
  Like, if we're involved, it's something that we wanna see grow and become the leader in their space. And as investors, there's nothing wrong with taking a return of investment out of cash flow.
• 15:19
  Like, it doesn't have to be sold. What a great thing if you're paid back your investment and you still own stakes in the business.
• 15:26
  It's, it's like that wonderful feeling you get if you've ever been at the gaming tables in Las Vegas, like you're picking up the chips, and you still have something riding, and you've already, like, taken some profit off the table.
• 15:38
  So that's great. And so when, when you think about, you know, what, what motivates us, we don't go in and we say, "Well, this company, this is going to be... You know, like, here's how they're gonna win."
• 15:51
  And when we came into Allscripts, it was a medication repackaging company. Wasn't in software at all. And when we first came there, we thought, "How can we grow the medication sales?"
• 16:02
  Because that's where we made our profits. We were reselling medications. And we listened, and we learned that doctors actually needed some help understanding what they had in inventory.
• 16:13
  So we gave them some technology to do that, where they could write a prescription right on a computer that could decrement the inventory they had in the office.
• 16:23
  We heard them say, "Well, we maybe have 80% of what we need in inventory, but 20% of the time we're writing prescriptions for things that you haven't supplied us, and we don't wanna change our workflow.
• 16:34
  Can you help us with electronic prescribing?"
• 16:37
  And so we started doing that, and we realized when the Institute of Medicine report came out, uh, To Err Is Human, talking about the equivalent of a 767 crashing every day in the US due to medication errors, we said, "We can do better."
• 16:54
  Um, and that's when Glenn said, "Gee, this software is so important. Every doctor needs it. Why don't we give it away for free?" And, and that's when I said, "You gotta be kidding me. You take that to the board, okay?"
• 17:08
  [laughs] Like, this is, like, this is not something that you're gonna build a great career around. And, and we said, you know, "But all right, let's figure it out. Let's say, 'Yes, if.' How can we do this?
• 17:19
  Not no because. No, because we can't make money. But yes, if we can find other ways to make money, if we can find other ways to support this effort."
• 17:27
  And so that's the way we interacted around those types of ideas to maybe build it to be something that could be big.
• 17:34
  But when we start, it might be something that we say, "Gee, this is a wonderful idea, but we can never make a penny doing this." And maybe it'll grow from there.
• 17:42
  You know, I'll, I'll just, I'll just add, uh, two things to that.
• 17:46
  One, 'cause we joke about it, and Lee mentioned it earlier, and that is when we're dealing with entrepreneurs and figuring out, you know, who do we wanna invest in, I always ask them, "What's your exit strategy?"
• 17:57
  And if they have one, we generally don't invest. We want people who are so in love with what they do that they could do it forever, and they'd be happy doing it forever.
• 18:06
  And people who say, "Well, in two years we're gonna do this," well, we've been around a long time. You have, too, and-You can't plan. You don't know what the market's gonna be. You don't know what's gonna happen.
• 18:16
  You don't know where the pivots are. And so consequently, we want people who are just engaged, who love what they do.
• 18:23
  And, you know, the other thing I'd say is that, you know, early, early on in, in the business, you know, Lee talked about giving away electronic prescribing for free because we knew we could save lives.
• 18:37
  Fast-forward, when the pandemic first started, we knew that there were behavioral health and mental health challenges, and we were at Livongo, and we had the industry-leading product.
• 18:49
  Um, and so we said, "We should give this away." And it was almost the same conversation. Lee said, "Do what? We just, you know, we just acquired this company, MyStrength. You wanna give it away?"
• 19:02
  And ultimately, we said, "Well, here's what we'll do. We'll make it available."
• 19:05
  First, we started with our existing clients, then our prospects, then anybody who wanted it for three months because we thought maybe this is a three-month thing.
• 19:16
  It turned out that people started using it, they wanted more capability, and it ended up driving sales. And some of those people, we gave it to them for six months.
• 19:25
  And other people said, "We're just gonna buy it," and led to one of our largest deals in the company's history, um, in part because we tried to do the right thing at the right time.
• 19:36
  And so there was some risk, and we went back and forth a lot, but it reminded me, and I think Lee may have said, "20 years, 30 years later, you haven't learned a damn thing."
• 19:45
  [laughs] And, uh, the reality was, it was the exact same conversation. We ended up at exactly the right point, and we did the right thing, and it worked out great for the business.
• 19:55
  Uh, I, I have, like, six different topics I wanna touch on that you both just mentioned, but you've just said something that I think is gonna resonate with a lot of entrepreneurs, which is, if they have an exit strategy, you're out because of the notion that they're short-term thinking and not thinking about the long potential impact they can make.
• 20:12
  We believe, of course, that at StartUp Health and believe in the long-term, um, aspiration of making impact.
• 20:18
  And if you get, i- things happen along the way, great, but the idea is go all in as though you're gonna work on it for the next 25 years.
• 20:24
  Tell me how you think about what I think is a very counterintuitive thing to talk about in a meeting with a potential investor when the standard kind of verbiage should be, "Here's my exit strategy.
• 20:39
  Here's who could buy us," et cetera.
• 20:41
  Whiplash of the entrepreneur getting different, uh, response from you with that question versus somebody else and how you kinda bring them over because I think they're scared to say oftentimes what you're describing as, "I'm all in," because so many VCs and so many investors wanna hear the opposite.
• 20:59
  Can you talk about that a little bit? I'll, I'll start with a quick comment, and that is, I think, especially today, you can get money from anywhere.
• 21:08
  And, um, so I would advise entrepreneurs to say, understand who you're partnering with. Make sure they have the same objectives you do.
• 21:17
  Make sure they're people who you'd love to go and have a, a, you know, a, a water with or a beer with or whatever your, your choice is.
• 21:26
  But, you know, those are the kind of people we wanna be with, and I think that's the best choice.
• 21:32
  Also, make sure you're choosing people who will help you build your business because the money's easy, and, uh, you know, from that standpoint, we wanna make sure there's alignment.
• 21:42
  So we miss out on some deals and, you know, we've seen a trend recently where people are taking money out, um, in early rounds, entrepreneurs. You know, we never grew up that way.
• 21:53
  I don't think it's really a great thing to do. It's different to take a million dollars out to pay your mortgage, okay? But, you know, we're seeing entrepreneurs take out large amounts of money early in the process.
• 22:04
  I'm not sure that's the best thing for the business, um, you know, because, you know, basically, we want people to be all in.
• 22:13
  And, uh, that doesn't mean like in the very old days when you had to mortgage your house to do the business. But on the other hand, I think, you know, we're, we're there.
• 22:22
  When we're in, we're all in, and, uh, you know, that's what we want, um, the people we work with to be. But Lee, you can- What does that, what does that conversation sound like, Glenn? And maybe I'll let Lee answer this.
• 22:33
  What does that conversation sound like with co-investors who don't, who don't in- initially share that philosophy?
• 22:40
  Well, you know, we, we've been fortunate to have some great co-investors that we've worked with across multiple companies and, but we haven't had, you know, major disputes around these issues in the boardroom when they understand the approach that, that we have and that the founders buy into, which is, how do we build the best company as possible for the long term?
• 23:02
  We do find some situations, and we've been involved in a few, where there's, are some investors who may be tired.
• 23:09
  Um, what we try to do is actually work to find ways to help them exit the business and find others who wanna join in building something bigger.
• 23:18
  Um, and we've been involved in a couple of recap situations where I think we've helped the, the leadership team move forward.
• 23:26
  Um, there's also been situations, and, um, Glenn and I can probably give an example of one, where we've had some CEOs who think that they're doing a fantastic job, um, but the business is growing really, really slowly.
• 23:39
  But for them, they're saying like, "Well, doubling every year is really great." But if you're doubling every year in a market that's growing by 10 times, you're not doing all that great.
• 23:50
  And so how do you also make sure that you're resetting the expectation of the founder?
• 23:55
  And I think that, look, it comes down to, Steven, what, what you mentioned, you know, early on and, and what I know that, that you and the StartUp Health team focus on.
• 24:05
  It's building that trust, e- especially as early stage investors, and you have to have that relationship where you can be very direct, very open with one another as investors, as founding teams.Um, we don't wanna come into the boardroom and, and hear that, "Everything's wonderful.
• 24:22
  We're meeting everything according to plan. Thanks for showing up for the board meeting." Like, we know there's issues. Like, we've, we've lived in businesses.
• 24:30
  We know if it's not, if it's not people issues, if it's not client issues, if it's not product issues, like, there's other things that are happening.
• 24:38
  So let's talk about the issues and get the issues out on the table and work with you to address them.
• 24:43
  And the one that you highlighted in terms of these conflicting objectives, we do have founders who come to us and say, "I'm hearing something from you. I'm hearing something else from, from...
• 24:52
  Mom's telling me one thing, Dad's telling me the other." We say, "Let's get everybody on the same page. We don't wanna make you the middleman. Let's get her or him on the phone, and let's get it resolved." Yeah. Yeah.
• 25:04
  I think it's- No, go ahead... also I would, I would just add, and I wanna do a kind of maybe a little commercial. So we've been fortunate. General Catalyst was a, uh, a big investor in Livongo.
• 25:14
  They came into every round. Um, they were there when we went public. You know, they didn't sell right away. They stuck with it.
• 25:22
  They were willing to do whatever we asked, and I think they're very, you know, ethical, aligned investors with us. And even when the transaction came along, they said, "If you wanna do it, do it.
• 25:33
  If you don't, we'll supply the capital to build the business in other ways."
• 25:38
  And we had other investors who right at the IPO, you know, sold, and that actually hurt the stock because initially when we did the IPO, um, we were a new category. People didn't know where to place us. Were we tech?
• 25:53
  Were we healthcare? You know, what was this category? How do we fit you into a box? And so initially after a great IPO, the stock went down, and Lee used to go...
• 26:03
  He used to start every single meeting by saying, "We are not our stock price. We are not..."
• 26:09
  And he'd make people repeat it, the whole company, "We are not our stock price," 'cause everybody was focused on, "Wait, what happened to the stock price?" He said, "Just deliver. Focus on the business. It'll come back.
• 26:20
  We'll teach the market this new category called consumer digital health." And, and we did that. But along the way, some of our investors said, "Uh-oh," and they sold.
• 26:30
  And those investors who sold at $18 and, [laughs] you know, and obviously, you know, they left 10X the amount of money on the table or whatever the number was.
• 26:41
  Um, but others were there with us, and they doubled down, and they were supportive. And so you learn that lesson, and you look at what investors do. And by the way, I don't fault them.
• 26:53
  People have different plans, but just know who your investors are. You know, ask those investors those tough questions, and then make your decisions. Yeah.
• 27:02
  We, we talk about the framework of entrepreneurs being buyers, not sellers. In other words, buying...
• 27:08
  They're looking for investors that meet their criteria, their core values, and their ambition, not the other way around, 'cause you miss that message oftentimes.
• 27:17
  Um, I wanna circle up to unique ability, and you talked a little bit about your teamwork. But there's a lot of people wondering how not only you work together so well but how you build teams around you.
• 27:29
  We call it unique ability teamwork, right? Everybody does what they're great at, what they love, and enables them to kind of build a whole team around them that have complementary unique abilities.
• 27:39
  How do you guys both think about each other's unique abilities?
• 27:42
  And then what are the most important things when you look at a new early stage company to make sure it's a well-rounded core team that you're building a company around?
• 27:54
  So with, with regard to team build, especially because we invest early, oftentimes the team is really small. And in that situation, you need utility players.
• 28:05
  Everybody's wearing lots of hats and needs to be in a position where they're, they're selling because in our world, everybody sells. That's just kinda part of the skill set you have to have.
• 28:17
  Um, but also has to do a lot of work in terms of maybe it's some HR work internally. Maybe it's some work in terms of helping with other tasks like customer service that have to be done, and it's a small team.
• 28:30
  As businesses scale, you can start bringing in folks to specialize. Early stage companies don't need a VP of HR when there's, like, six people, right? You can bring someone else on as the team starts to grow.
• 28:43
  But until that happens, someone really has to be the keeper of the culture, to tell the stories, to get people to really buy into the mission.
• 28:51
  And so that oftentimes comes from the founders who are probably involved in every single hire.
• 28:57
  Um, we expect that, you know, great leaders are probably spending close to 50% of their time just in that team build process as they're growing the companies to start.
• 29:08
  As you start looking at, at skills and complementary skills, I, I think the word complementary sometimes is overused. You need diversity. You need diverse opinions. You need diverse thoughts.
• 29:19
  You need to be thinking about ways to build out diverse teams. If you're in an echo chamber, that's really not gonna be great in terms of building the company.
• 29:27
  And the culture has to support having dissenting views, but also the type of approach that allows for consensus to be built so that people aren't sulking if, if their particular position isn't the one that carries the day.
• 29:41
  And that, again, falls on the founders to make sure that this is the right type of discussion to have, but now we have to make some decisions, and we all have to get behind it, and let's move forward.
• 29:52
  And, and I think that's also an important part of it. Glenn? Yeah.
• 29:56
  I would just add, you know, one, throw hard objects, not sharp objects, I think is, you know, one of the, one of the quotes that came out of a recent book.
• 30:05
  And, and, you know, the idea is, look, we are very honest with people. We're very direct about, you know, what needs to happen. We're very direct about performance. So, you know, it's kind of legendary.
• 30:17
  But after every meeting, and this has happened for the last 30 years, um, I come out of a meeting, and Lee hands me a little piece of paperAnd a little piece of paper says what I did wrong and how I could get better.
• 30:30
  And so I was speaking at HIMSS once, w- you know, and I was main stage. It was enormous audience. And we've all had this situation where w- it just hits.
• 30:41
  People laugh at your bad jokes, you know, you know you did it well. And I come off stage, I'm feeling really great, and there's Lee, and I can see the piece of paper in his hand. I can see it from a distance.
• 30:54
  He's walking up, and I said, "Lee, just once, just once, try saying good job before you hand me the piece of paper. See how that feels." And he says, "Listen, you don't pay me- [laughs]... to say nice things.
• 31:07
  You pay me to make you better. Here's the paper." And that was it. [laughs] Not a, not a word wrong. And we try to teach when we leave meetings, you know, and this is, this is picked up at Transcarent now.
• 31:20
  Instead of saying, "How'd I do?" 'Cause Steve, if you say to me, "How'd I do?" What am I gonna say? You did great. If you say, "Tell me two ways I could have done better."
• 31:30
  And then somebody will still, we're so scared of giving feedback, somebody just says, "No, no. You did great." No, I wanna know how can I get better, and if everybody does that to each other.
• 31:41
  Well, the second thing is that requires a lot of trust, and you gotta trust that people are there to help you get better, not to attack you, not to get your job, you know. That's what we built.
• 31:55
  I think the other thing, and this is a touchy topic, but look, we've been fortunate to build a lot of companies, and the team that you start with isn't always the team you end with.
• 32:05
  Um, at Livongo, I think we went through two or three CFOs until we found Lee, um, a few marketing folks, and that wasn't because they were bad folks. They were exactly the right folks for that stage of the business.
• 32:20
  But there's a wonderful article, it's an old article called Necessary Losses. It's by a woman named Sally Tessine. It's probably 15 years old.
• 32:29
  Talks about how hard it is for an entrepreneur to let go of some of those people who were there and helped him or her during those tough times early in the business.
• 32:39
  And yet if you can't make those hard decisions, those really hard heart-wrenching decisions, you'll never get to where the business needs to get to.
• 32:49
  And that, I think, you know, people don't like to discuss it, but it's a different team that g- you know, that you exit with at 18 and a half billion than you started with. And, um, you know, we have a rule.
• 33:01
  We say hire low, fire high. What we mean by that is we don't ever want somebody coming to our business because we're the highest bidder for their services. Um, and Lee makes sure that's never the case.
• 33:14
  [laughs] Um, but we want them to come 'cause they believe, 'cause they're in. And but if we have to part ways, we wanna be overly generous. And the reason is it's hard.
• 33:25
  It's hard when you part ways, and they're gonna end up somewhere else, and so do the right thing. Take great care of them. It'll come back to you. So hire low, fire high, but you gotta do that.
• 33:38
  You've gotta do that to build great businesses because we all run into it. You outgrow people. Sometimes you can find a spot for them, but if it's not real, they know it, the whole business knows it. Yeah.
• 33:50
  You'll never get to where you need to be.
• 33:53
  Um, excel- I wanna, I wanna use that to shift gears a little bit towards your personal schedules, and in particular, there's a lot of noise out there, more now that it feels like than ever before, um, noise of other people raising money, noise of, you know, global and economic p- and geopolitical issues.
• 34:14
  Staying focused on a daily basis, how do you both think about your 24 hours in a day?
• 34:21
  And perhaps whether you do the same or not, how do you manage the, you know, waking up to sleep and, and, and addressing sleep as well?
• 34:29
  Because I think that's an important part of doing this for multiple decades like you both have, as though it's day one.
• 34:36
  Well, this is, you know, this is, uh, training for a marathon and, and not a sprint, and so you do have to put in the long hours in terms of making sure that you're doing the right thing.
• 34:47
  And so, you know, when I think about sleep, I probably get twice as much sleep as Glenn, which is six hours.
• 34:54
  Um, and, uh, and Glenn, you know, is known to not sleep and not need sleep, although I do have some great photos of him that I'm happy to share of sleeping on his computer, um, in various places that we've been around the world.
• 35:08
  Um, and but what you, you know, what you need to do in terms of, of understanding, you know, what it is you need to get done, you really do have to be maniacally focused on your priorities because you can get pulled in a lot of directions.
• 35:22
  And when you think about what we do, whether it's managing a portfolio of companies, you have to be adaptable because on any given day, it's a little bit like that game Whack-A-Mole.
• 35:33
  Something will pop up that you didn't expect, and you need to be able to pivot and be able to address it because it's, it's critical. It may be a crisis.
• 35:41
  Um, but I try to start my day kind of catching up on, on things that I, I need to get done before the day starts, organize myself, lay out my priorities for the day.
• 35:53
  Kind of best laid plans sometimes go awry, but you, you do your best to say, "This is what we have to get accomplished."
• 36:00
  Um, make sure I'm reviewing the calendar and seeing what we have to be ready and prepared for and make sure that everybody else is on board with that.
• 36:08
  Um, and then at the end of the day, I always try and check back and say, um, "Did I do my best at..." and then fill in the blank. You know, did I do my best at being present for whatever meeting it was?
• 36:21
  Did I do my best at, at managing my time with my family when we take a break for dinner?One, one side benefit of not traveling as much during the pandemic is being able to have more time at home with family, and so you can block out a certain amount of time to have that dinner and the like, but then you can go back and, and finish up the things you need to get done.
• 36:43
  So I would say, um, in terms of just maybe some key takeaways, um, make sure that you are maniacally focused on the most important things and don't get distracted by the pile of email.
• 36:56
  Clearly Glenn knows how to do that well, 'cause he's still answering email from 2017.
• 37:00
  [laughs] Second, second, make sure that you're constantly looking at the types of things that are going to make a difference in terms of, of setting those priorities.
• 37:11
  Um, ask yourself if you did the best at what you possibly can do, and if you didn't, then make a resolution to think about ways you can, can make that better.
• 37:20
  And lastly, when you do have time with your family, make sure you're focused on them. Yeah, I would, um... So I'd say a few things. First, um, let me start with sleep.
• 37:31
  So I don't sleep that much, um, but when I sleep, I'm instantly in deep sleep, and the reason for that is, you know, I don't carry anything with me.
• 37:41
  There's people who sleep eight hours, and they don't sleep well, and they keep waking up, and they're worried about something, and I have none of that. Um, I just, I work as hard as I can every day. I go to sleep.
• 37:52
  I have my ice cream before I go to sleep. I'm out, and then I wake up. I just wake up, and I'm ready to go. And so everybody should get as much sleep as they need.
• 38:02
  I don't think it's forcing people to sleep a certain amount. You, you sleep when you need. There's legendary stories about me when I f- when I'm out of energy, I fall asleep.
• 38:12
  I could be talking to somebody, especially Lee, and I fall asleep- [laughs]... and he takes a picture of me, and he makes fun of me, but I just go.
• 38:21
  I don't like to sleep, because the world has so much to do, and every moment I'm awake, I... You know, everything I do, I wanna do, and I'm excited about doing, so I feel very fortunate.
• 38:33
  So it's not a recipe for, for everybody. I would say if you need sleep, you should sleep, and if you don't, don't. Sleep as much as you need to feel energized and ready to go for the day.
• 38:45
  In terms of starting my day, I know Lee feels the same way. We both try to exercise every day. I think that's important from a health perspective.
• 38:53
  I think we try to eat well, um, and not, you know, uh, do a lot of junk eating and stuff. So we, we try to take care of our bodies, 'cause taking care of your body and keeping an alert mind is important.
• 39:06
  Um, I do a few things. I measure lots of things, including how many clients I've talked to every single day, including Saturday and Sunday. Um, so I like to talk to people.
• 39:18
  I like to know what my clients are doing and thinking. Sometimes it has nothing to do with business, okay? It just has to do with I run across something that I know they're interested in. I take a picture.
• 39:28
  I send it to them. I'm excited for them. You know, these are not just clients for me. They're friends. It's where I spend hours of my life.
• 39:37
  So, so from that standpoint, I measure every day, 'cause it's easy for us to get stuck in issues and forget that we're here to serve our clients. So I love to talk to them every day, lots of clients.
• 39:50
  Second, talk to your own people. It's amazing how little we communicate with our management teams, and I talk to, I talk to Lee multiple times every day. Maybe that's a problem, but that's... We, we do that.
• 40:03
  But I also talk to lots of my leadership, um, almost every day, almost every one of them. And, uh, you know, and it's just a check-in, but we keep in sync with each other.
• 40:15
  And then I like to communicate randomly, skip levels, and go down. So lots of communication, lots of measurement, and like Lee said, what are the two or three things that I have to get done today?
• 40:28
  And sometimes you have to, you know, be relentless and be ruthless.
• 40:33
  Relentless about getting them done, ruthless about saying, "I'm not gonna allow these other things to distract me, because I have to get these two things done today." So those are, those are kind of...
• 40:45
  It's a lot of discipline, um, in terms of staying on track and really measuring yourself to say, "Did I produce something of value today?" And that's the standard. If you do that, your team does that.
• 40:58
  Steven, just quickly- Yeah... 'cause Glenn is, he has a, a legendary reputation for keeping lists, and, like, he will find something that was on a list if...
• 41:09
  Like, you say you're gonna do something, and he'll keep it on a list. And then, like, he'll come back to it a month and a half later, and he'll say, "You know, you... There it is."
• 41:19
  And, and so a month and a half later he'll say, "You know, I'm just following up. You know, was this done?
• 41:24
  'Cause you told me you were gonna have this done, you know, within three weeks, and I haven't gotten back to you yet." And, like, you know, that follow-up is, like, just something that is relentless on his part.
• 41:36
  And then every day, like, something that didn't get done on one list, he'll cut it out from the day prior's list, and he'll tape it on to the next day's list. Okay.
• 41:45
  And so he's actually the single largest user of Scotch tape in the entire country- [laughs]... um, because of what he does. Sadly, that's not a joke. Sadly, that's not a joke. So, so I... We could spend hours talking.
• 41:58
  I wanna get to Transcarent and 7Wire and how best for entrepreneurs to think about how to collaborate with you and make it easy by teeing opportunities up for both organizations.
• 42:09
  Before I do, a question came in in the Q&A around, is there a system, any, like, EOS or OKRs or others that both of you either use or suggest startups use or companies use as they're building their companies, either early or later?Just quick answers 'cause I wanna get to the Transcarent and Lamar.
• 42:29
  Yeah. Yeah, no, we're, we're, we're, we're believers in, in using OKRs. Um, a lot of our companies, um, have taken that on as well. It, it works really, really well.
• 42:41
  I think that the key to making any type of system like that successful, um, is to be very clear with regard to what objectives you're setting out.
• 42:52
  And, um, and as Glenn mentioned with regard to measurement, what those key results are need to be defined the right way. I mean, are they really key?
• 43:01
  You can keep track of a lot of things, and it can create a lot of busy work for people, but measure the things that matter, that's critical.
• 43:08
  And if you do that, then regardless of what system you're using, um, you'll be able to find a pathway towards making your business better. Okay. So again- And I would on- I would only...
• 43:20
  No, I would just add that whether you call them OKRs or anything else, just set out very clear goals and know what they are for each individual and for the company. I mean, we have those very clearly at Transcarent.
• 43:31
  Here's what we wanna do before the end of the year, and, and we know them, we know what they are.
• 43:37
  I look at them every single day, and I do, I copy them over to the top of my schedule every single day, so I make sure I'm staring at them every day. What are we doing to get to those goals? Excellent. Quick question.
• 43:49
  Favorite business book that you've either read or will always recommend? Well, there's-- So I listen. I don't read books anymore.
• 43:58
  I listen to books on tape at one and a half or 2.0 speed, depending on how I'm running and what the book is and how dense it is. There's a new book that, a recent book called Upstream I like a lot.
• 44:10
  It's about, you know, solving problems. There's a lot of good business books. There's a great book on cyber called, uh, This Is How They Tell Me the World Ends.
• 44:20
  It's an important book to understand what's going on in that space. But Upstream's a, a recent read that I like a lot about how you get upstream of problems instead of just keeping focused on the problem. Wow.
• 44:34
  Um, so, you know, I've, uh, I've listened to a lot of, uh, books as well. Um, Ride of a Lifetime by, uh, Bob Iger was, you know, a really fun book to listen to.
• 44:46
  Um, I, you know, think that other books, um, you know, one that I would think is probably a, another good one and, and a classic, um, that, that comes from, um,
• 45:00
  oh my gosh, uh, Stephen Covey, uh, The 8th Habit, um, because he goes over, you know, the seven great habits and, but the eighth habit is really important as well. Um, so those would be two that come to mind right away.
• 45:13
  Excellent. All right. I wanna, I wanna shift to Seven Wire and Transcarent.
• 45:17
  And if I could tee up, um, for everybody listening today who wants to connect with either organization, and I know one is about investing and one is about accelerating what entrepreneurs and startups and companies can do to help people faster.
• 45:33
  Um, maybe Glenn, you could take the Transcarent path, and Lee, you could take the Seven Wire path, even though you're both involved in both organizations.
• 45:41
  But if you would talk about the ideal email you'd love to get from an entrepreneur or a company about working together and why you should be collaborating, what would you tell them to prioritize and make sure they communicate in reaching out to you?
• 45:57
  Well, Transcarent is really about how we create a new and different health and care experience that puts people back in charge of their care.
• 46:08
  And so the idea is, if you think about there's, you know, in, in our view, and it's a different view than most people have, there's only two people who are important.
• 46:17
  There's health consumers, um, all of us who consume care, and those who pay for care, and, and that's us and it's our employers, and on the other side, there's people who provide care.
• 46:27
  Everything in the middle is friction. And so we want to eliminate that friction in the middle.
• 46:33
  And think about best, quickest example is Travelocity, which said, rather than going through a travel agent, we can give you unbiased information, trusted guidance, and allow you to book your own tickets and do it from your home twenty-four hours a day.
• 46:47
  And everybody loved it, and that changed the industry. And that's what we wanna do in healthcare. So the perfect email is someone who comes and says, "Look, we figured out how to streamline,
• 46:59
  um, this particular part of the existing healthcare process, um, so it makes it unbelievably easy and makes the experience great for people, and it focuses on measurable quality on the other side."
• 47:14
  'Cause we're not interested in just cutting costs. It's about how do you improve the quality and reduce the cost. So it's all about taking that middle out.
• 47:21
  So that's the email that we would like to get and, you know, we're getting lots of them, and people are getting on board and saying, "We have to transform this industry."
• 47:30
  And Glenn, you might just, you know, in helping to put some perspective around it, just maybe mention a little bit about the mission of Transcarent, because when you think about helping individuals to really understand what choices, what options they have to get-
• 47:47
  Yeah... the best care at the best price, right? There's, there's probably some companies that are listening today that could be great partners. Yeah. I...
• 47:54
  Look, at the end of the day, if you survey people, they say three things are happening in healthcare.
• 48:00
  One, it's more confusing than ever, it's more complex than ever, and it's more costly than ever, and it's getting worse. That's what consumers say.
• 48:08
  If you go to large self-insured employers, they say, "Look, we've been promised for twenty years that we'll get a high quality product that costs less, and we have a low quality product that our people don't like that costs more every year."
• 48:21
  So everybody's unhappy with it. And so we said, what if we could align with the people who pay for care, all of us and the employers, and provide a high quality product?
• 48:33
  So the idea is when you go out to get care, there's three things we all want. It's the same if we're buying a car or anything else. What are my choices?Tell me from an instructed source, an expert, what should I do?
• 48:49
  And last but not least, where should I go to get it? And so, you know, we all get the calls that say, "This happened. Uh, I need knee surgery. You know, what are my options? Where can I go for it?
• 49:02
  What's the best place to get it? What would you suggest? And, hey, can you get me in?" And what we've done is we've provided that.
• 49:09
  You know, if you look at healthcare today, the single largest cause of consumer bankruptcy in the United States is healthcare, and it's specifically co-insurance.
• 49:20
  People go out and they get a surgery, and they don't realize that the 10%, even on a good policy, they have to pay is 5 or $10,000, and they don't have that.
• 49:29
  And, you know, what we're trying to say is, "Look, we'll eliminate that. We'll do these surgeries with no co-insurance, no co-pay.
• 49:38
  We'll get you meds and insulin and other things at dramatically lower prices by taking the middle out. And in doing that, we'll provide a high quality solution to the problem."
• 49:50
  So again, in any of those areas, when we talk about delivery, Lee talked about a new investment that we made today.
• 49:57
  I'll let him talk about it, but again, it's about how do we meet people where they are to deliver care, and increasingly that's not just at the hospital.
• 50:05
  One of the things we learned from COVID is we can deliver a lot of care more effectively, more efficiently using digital, not 100%, but a lot more. And by the way, digital creates abundance.
• 50:20
  We can do it in inner city and in rural, and all of these avenues open. That may be the only good thing that comes out of COVID, which is an understanding that consumer digital health works.
• 50:32
  So Glenn, last comment about this, 'cause I want to get to Seven Wire in the remaining time that we have.
• 50:37
  What's the collaboration model with startups and companies, and in particular, I'm fascinated by the new movement towards platforms where others can plug in quickly and get to patients and make an impact quicker.
• 50:48
  What's the collaboration, ideal collaboration model? Well, I think the collaboration is, one, what people want is they want one comprehensive place to go.
• 50:58
  So when you use your iPhone, you don't have 20 separate logins and payment systems.
• 51:03
  You have great access, and it's a double click on the side of the phone, and people like that, and that's kind of the model that we're creating.
• 51:11
  It has to be a simple, um, connected, integrated experience for the people who use it.
• 51:17
  That said, the people behind the scenes, we wanna make all the best services available, and so that's what it is, but it has to fit into that same kind of structure, model, security. Excellent. Thank you, Glenn.
• 51:31
  Uh, Lee, turning to Seven Wire, what's the ideal email and either introduction or direct email that would lay out on a silver platter what you'd love to invest in?
• 51:41
  So our approach at, at Seven Wire is really built on, on common sense, and that's because that's about all that we can muster, um, which is, how do we all better access care?
• 51:55
  How do you solve the challenge and hassles that we all face as consumers of healthcare? That's a real target-rich environment because there's so many problems that we all face in terms of getting care.
• 52:06
  Uh, Glenn mentioned an announcement that we made today of an in- investment in a company called MedArrive that's meeting people at home.
• 52:14
  They're showing up, and they're doing house calls, but especially for people who need those services. They can't get out. They may not have transportation.
• 52:23
  They may have health issues that are keeping them in place, and so they can deliver COVID vaccines at home.
• 52:28
  They can deliver, um, uh, services that you might need, like, like lab tests and draw blood at home as opposed to you coming in to the hospital.
• 52:37
  They can provide home assessments that help health plans understand what those needs are. And so we look to try and find ways to take friction out of healthcare.
• 52:47
  And so if you're coming to us and saying, "We know that there are some big challenges and problems that are faced in this particular area," then, and we can solve a big problem that way that's gonna help a lot of people, um, we are all over that.
• 53:02
  And the other thing that I'd say is that even if it's not necessarily spot on with this consumer orientation, uh, we love meeting people. We love talking to companies.
• 53:13
  I think you'll find that when you come to Seven Wire, even if it's not the best fit for an investment for us, we try to give you a few ideas or make a couple of introductions and, and pay it forward because next time you as a founder are doing a company, you might think of us and come to us, uh, to help solve a problem that we face as consumers.
• 53:32
  And so we love to try and find ways to be of service to the community.
• 53:36
  Well, I, I think this was the warm-up act for having both of you at the 2022 Startup Health Festival, where we'll be doing this on stage and expanding on all of this.
• 53:46
  Because for the last several decades, well before many of the people who are building companies today were even alive, you guys were hard at work on transforming healthcare.
• 53:56
  And as you know, we call the entrepreneurs in startup health health transformers because they're like superheroes that are anti-fragile against all the resistance and able to overcome and achieve impossible things that many believe, [laughs] and still believe, are almost impossible.
• 54:13
  But you seem to believe and, and gather followers and people who, like you, believe that it is going to be a long-term road, but we can do it if we do it together.
• 54:23
  So first of all, thank you both for spending the day today with us. Thank you for sharing your wisdom. Um, we sincerely appreciate, the entire community appreciates you.
• 54:33
  We also are appreciative of you being partners in our impact fund, um, on this mission that we all have to really achieve health moonshots.
• 54:41
  There are two no, there are no two better people to hold up as examples of the mindset and the fragil- and the anti-fragile approach to being able to achieve anything.
• 54:54
  So thank you, thank you, and I'll leave you each with a word to close, uh, Lee, and then Glenn, and then we'll wrap up. Thank you. Well, thanks so much for having us.
• 55:03
  I know there were a number of questions posted in the chat, in the Q&A. Uh, my email is lee@sevenwireventures.com. Feel free to shoot a note.
• 55:12
  We're happy to get to them offline, and apologies if we couldn't address them all. And to each of you, stay true to your mission. Um, we believe in you, and, and Godspeed.
• 55:23
  And I would just say, you know, I like to say innovation begins by doing something, and it's not talking about it. It's going out and doing it. So, you know, to steal a phrase from Nike, just do it.
• 55:34
  Go out, start your dream. Get started. That's the most important part. And again, Lee gave you his email. Send it to him, 'cause I don't do email all the time.
• 55:44
  [laughs] But he will see it in, in- He'll get to it in about four or five years. [laughs] That's right. Um, thank you, everybody. Thank you. Thank you, Lee. Thanks so much for having us. Thank you, Glenn.
• 55:53
  Great to see you. Thanks again. All right. Thanks, Unity. Thanks, Stephen. You, too. Bye-bye. Take care. [upbeat music] Thanks for listening to Startup Health NOW.
• 56:02
  Startup Health invests in health transformers from around the world who are committed to achieving audacious health moonshots.
• 56:08
  If you wanna learn how you can join this community of entrepreneurs, or if you want to connect with one of our 380 companies, go to startuphealth.com.
• 56:16
  If you'd like to learn how you can invest in our Health Moonshot Impact Fund in collaboration with AngelList, go to healthmoonshots.com. Thanks for listening to Startup Health NOW. We'll be back next week. [upbeat music]