Latest / The Advancing Healthcare Innovation Show / E182 | Michael Kopko: Grit, Incentives, and the Future of Senior Care

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E182 | Michael Kopko: Grit, Incentives, and the Future of Senior Care · The Advancing Healthcare Innovation Show

• 0:10
  Hello and welcome back to the Advancing
• 0:12
  Health Innovation Show. I'm your host,
• 0:14
  Michael Stamatinos, and if you're new to
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  watching it, if you're listening to it,
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  just please hit the subscribe button now
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  so that any new interviews come directly
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  to you. So, I'm I'm actually really
• 1:08
  excited about this conversation. We've
• 1:09
  been we've been talking about valuebased
• 1:11
  care for a long time. Uh, you know,
• 1:14
  better outcomes, lower costs, healthier
• 1:16
  populations, and on paper it makes makes
• 1:19
  perfect sense. Totally understand it.
• 1:21
  However, if you sit down with physicians
• 1:23
  across the country, um you hear a little
• 1:26
  bit of a different story. The idea of
• 1:28
  value based care is very compelling. Uh
• 1:30
  however, the reality of actually making
• 1:32
  it happen inside of a practice, it's
• 1:35
  it's a lot harder uh than most people
• 1:37
  can actually appreciate and like takes a
• 1:40
  ton of work. So, our next guest, Michael
• 1:43
  Copco, who's the CEO of Pearl Health,
• 1:45
  has a company that's focused on helping
• 1:47
  providers succeed in valuebased care,
• 1:50
  particularly in Medicare programs, where
• 1:52
  the operational complexity is is very
• 1:54
  real. Uh before starting Pearl, Michael
• 1:57
  spent years at Oscar Health, uh where he
• 1:59
  helped build the company's uh the
• 2:01
  company during its early stage growth
• 2:03
  and led major parts of the business,
• 2:05
  including one of the largest P&Ls inside
• 2:07
  of the organization. So prior to that, I
• 2:09
  think this is cool. Uh he worked at
• 2:11
  Bridgewater Associates uh you know the
• 2:13
  famous Ray Delio and um very well
• 2:17
  investment firm in the world and I think
• 2:19
  it's interesting to see how all of this
• 2:22
  permeates throughout Michael's career
• 2:24
  and we're going to focus on you know how
• 2:27
  do you give independent physicians data
• 2:30
  infrastructure and support they need to
• 2:31
  actually succeed in value based care so
• 2:34
  in the real world. So that's what I'm
• 2:36
  excited about exploring today. So,
• 2:37
  Michael, great to see you. Welcome to
• 2:39
  the show.
• 2:40
  >> Well, thanks for having me on. It's
• 2:42
  great to be here. Excited to talk about
• 2:44
  all the great changes that are
• 2:45
  happening. And I think the interesting
• 2:46
  word, painstaking, you know, progress
• 2:48
  does take some amount of pain. Uh
• 2:50
  believe it is happening, but I I think
• 2:52
  you've got to have the grit and the pain
• 2:54
  tolerance to make it happen. Very few
• 2:56
  things happen seamlessly.
• 2:58
  >> 100%. Listen, when I I want to start
• 3:01
  somewhere. So, I mean, when when people
• 3:02
  talk about value based care, I think it
• 3:04
  often it sounds really great, as I
• 3:06
  mentioned, but when you walk into a
• 3:08
  physician practice and they're trying to
• 3:10
  live it every single day, sometimes it
• 3:13
  might feel a little chaotic. Curious,
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  what's the first thing the physicians
• 3:17
  say to you, you know, when the cameras
• 3:18
  are off and they're just being honest?
• 3:21
  Well, I think people confuse that value
• 3:23
  based care is hard and I want to talk
• 3:26
  about that word because at some point I
• 3:27
  think we're gonna have to move on from
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  it in truth. But okay, I
• 3:30
  >> that should be separated from how being
• 3:32
  a provider being someone who works in
• 3:34
  healthcare is hard. So everything then
• 3:36
  therefore does it make it easier or not
• 3:39
  really becomes the bellweather and I
• 3:41
  think value based care is not making it
• 3:43
  easier enough yet and that's why you're
• 3:46
  not seeing like you see in a lot of
• 3:48
  other industries that technology
• 3:50
  flywheel that just takes it off but
• 3:53
  >> healthcare is a little different. It's a
• 3:55
  little bit longer compound cycle. The
• 3:57
  payout, the prize, the outcomes are very
• 3:59
  different. So what I'm going to try to
• 4:01
  make the case for during our discussion
• 4:03
  today is I think the progress is
• 4:05
  happening. You just when you compare it
• 4:07
  to things like social media or Tik Tok
• 4:09
  growth or whatever is your favorite
• 4:10
  growth market, you don't see it. But the
• 4:13
  fact that we call every provider, we
• 4:14
  talk about some of these outcomes and it
• 4:16
  is clear to them that this is where the
• 4:18
  world's going. And I think we're all in
• 4:19
  the debate of how. But very few people
• 4:22
  are down debating should we? And and if
• 4:24
  you think about the opposite of it,
• 4:25
  which is fee for service, more billing.
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  I've never been in a time in healthcare
• 4:30
  where it is clear to as many actors that
• 4:33
  we need to move on from a
• 4:34
  transactionsoriented environment where
• 4:36
  it's about how many services can I
• 4:37
  deliver to you and so I think that's
• 4:39
  progress that does not that is not an
• 4:42
  excuse for saying we we need to make it
• 4:44
  better still
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  >> and we're happy to talk about that today
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  what's working what's still struggling
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  but I I think when we think about the
• 4:50
  progress we made it's recognizing that
• 4:51
  we do need to move into a better care
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  model a better model for healthcare and
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  I think we're making our way H I always
• 4:59
  try to just think about the origin story
• 5:02
  behind the leader and I think when you
• 5:05
  were younger just were you naturally
• 5:07
  curious about like what were you
• 5:08
  naturally curious about? I mean were you
• 5:11
  always kind of tinkering with stuff
• 5:12
  taking systems apart evaluating things?
• 5:15
  I'm just trying to think about how that
• 5:16
  applies to what you're doing today and
• 5:18
  starting Pearl. I think in my youth I
• 5:21
  was um a reader and I was interested in
• 5:24
  mathematics, reading, business and
• 5:26
  genetics. Um so I was kind of more of a
• 5:28
  learner um and like a student. And then
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  as I got a little older I started to
• 5:33
  become an organizer uh building things,
• 5:36
  building like companies and people and
• 5:38
  initiatives and efforts. Uh and so as I
• 5:41
  was kind of yeah I was kind of trying to
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  create good experiences for like my
• 5:45
  team, my community, my people. And I
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  think now that I get the privilege to
• 5:49
  have resources and experience, I don't
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  think there's a better mission than
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  delivering better outcomes in
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  healthcare. And I think most exciting
• 5:57
  about this time is it's very rare when
• 5:59
  it kind of all starts to line up. Like
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  what we're trying to do, and I
• 6:02
  appreciate your opening comments that,
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  hey, is it going fast enough or is it
• 6:06
  successful? But if you if you go back to
• 6:07
  the premise like, hey, we can deliver
• 6:09
  better care because we know what's
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  happening to people. We can predict it.
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  We can be proactive.
• 6:14
  >> We're going to try to lower that cost.
• 6:16
  We're going to try to spend more of the
• 6:17
  money on those things versus the latest
• 6:19
  stage stuff that is really just disease
• 6:21
  compression and and sick care and we're
• 6:24
  going to kind of give your doctor the
• 6:25
  power of knowledge
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  >> and like intelligent care.
• 6:29
  >> I mean not a lot of people are voting
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  against that and so you know there are
• 6:32
  still some I admit you know it's not a
• 6:33
  perfect but a lot of people are saying
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  yes let's do it and then we got to do
• 6:36
  the thing that we always have to do in
• 6:37
  healthcare. You got to line up policy.
• 6:39
  You got to line up payments. You got to
• 6:41
  line up people. And so that's where
• 6:43
  technology, I think, and good leadership
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  really come to bear nicely. And that's
• 6:48
  why we're here.
• 6:50
  >> So, let's talk about incentives because
• 6:52
  you talked about about alignment. And I
• 6:54
  think healthcare is full of good
• 6:56
  intentions, but incentives definitely
• 6:58
  drive behavior. I guess what incentive
• 7:00
  inside the system do do you think still
• 7:03
  needs to to change in order for
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  this type of care delivery that you're
• 7:08
  focused on really truly to work?
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  >> Well, I would say everyone kind of I
• 7:13
  think ultimately agrees with the outcome
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  and the destination. You know, how do we
• 7:16
  make a much more reactive intelligent
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  system? You know, I kind of share a lot
• 7:20
  of my thinking. Most things in
• 7:21
  healthcare, especially in senior care,
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  are predictable
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  >> and when something's predictable, it's
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  preventable. And you don't get a lot of
• 7:27
  resistance there. But what you do get is
• 7:29
  everybody in the healthare system has a
• 7:31
  set of incentives that rarely align to
• 7:34
  that purely. And so what we were going
• 7:37
  through is this huge behavior change
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  transformation a management consultant
• 7:41
  would call you call it but like
• 7:42
  transformation cycle.
• 7:44
  >> How do you do it? An easy way is
• 7:46
  incentives. Money you know whether you
• 7:48
  love it or hate it is a great tool to
• 7:51
  change behavior. We are somewhat animals
• 7:52
  of incentives. And so, you know, for a
• 7:55
  lot of folks, the easiest thing to say
• 7:56
  if you want to reduce hospitalizations
• 7:57
  or readmissions, you know, unnecessary
• 7:59
  hospitalization is why don't you pay me
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  for it? Don't like pay me two years from
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  now.
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  >> If I can do it and I can show you can do
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  it, why don't I get paid today? That's
• 8:06
  the that's the beauty of the fee for
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  service system. Yeah.
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  >> So, we're we're like studying and
• 8:10
  figuring out where those incentives
• 8:12
  work, how much do you need to invest,
• 8:14
  how much are they worth? Because the
• 8:16
  other problem is what what can you pay
• 8:18
  today that you can afford tomorrow? And
• 8:20
  we've seen a lot of our competitors wipe
• 8:22
  out because they got that math wrong.
• 8:23
  Oh, we can pay $1,000 today for those
• 8:26
  events. Oops, we mismeasured how many we
• 8:28
  were actually getting. We don't have any
• 8:29
  money left. We can't pay you. Sorry. So,
• 8:32
  you it's it actually it's a hard, you
• 8:34
  know, it's a hard problem. We are
• 8:36
  getting a lot better at it. The compound
• 8:37
  cycle on that's been quite long now with
• 8:39
  a good amount of competition. And the
• 8:40
  other great thing is the government,
• 8:42
  particularly CNMI, but CS, I think they
• 8:44
  understand this now, too. So, they're
• 8:46
  they're an ally. They're kind of
• 8:47
  thinking through how do you do it? And
• 8:49
  then you got to be just good at studying
• 8:51
  and developing a complex system. You
• 8:53
  know, what activities at what rates,
• 8:55
  what policy tools are available? And
• 8:57
  then where is this client or this
• 8:59
  provider? And what is actually a
• 9:01
  practical progression step? You know, a
• 9:03
  group that's let's call it all fee for
• 9:05
  service and all visits. You're not going
• 9:07
  to get them tomorrow
• 9:10
  slinging out a thousand unavoidable
• 9:12
  hospital calls. Like that's just not the
• 9:14
  right paradigm to take. It's let's let's
• 9:17
  start improving it on a on a slope. And
• 9:20
  I think that's another big part of this
• 9:21
  exercise is kind of setting up realistic
• 9:25
  but successful milestones to move groups
• 9:28
  to this better state.
• 9:30
  >> Give an example like what does that look
• 9:32
  like in real life in practice when
• 9:34
  you're managing these types of
• 9:35
  expectations? Are there any examples
• 9:37
  that you can kind of lean on? And I
• 9:39
  think a lot of it frankly comes down to
• 9:41
  like the contract because that's that's
• 9:43
  actually the manifestation of setting up
• 9:44
  the expectations. You're kind of making
• 9:46
  a promise to each other and you're like,
• 9:47
  "Hey, this is how we're going to
• 9:48
  transact." So it's it's a very real uh
• 9:51
  setup, but you know, it has a couple
• 9:53
  components to it that are just key. If
• 9:55
  we can do these things and measure them,
• 9:57
  we're going to just make payments today.
• 9:59
  Um, you know, and we can kind of get
• 10:01
  into the actual dollars and cents if
• 10:02
  that's of interest to your audience.
• 10:03
  But, you know, take a $100 and if you
• 10:05
  can just make this call and get an
• 10:06
  appointment, we'll just pay for the
• 10:08
  appointment being scheduled because we
• 10:10
  just know at the law of large numbers,
• 10:12
  we're mathematically reducing
• 10:14
  hospitalizations by 5%. And you're kind
• 10:16
  of just doing math. That's an example.
• 10:19
  So, one is like, let's get these
• 10:20
  activities going. The second is let's
• 10:23
  start measuring the outcomes with you
• 10:24
  because you don't want to be kind of on
• 10:26
  this fee for service wheel even in
• 10:28
  incentives. You actually I think most
• 10:30
  sophisticated groups want to be in the
• 10:32
  big equation and they they want to
• 10:34
  deliver care for their community. So for
• 10:36
  a lot of them actually invite them into
• 10:38
  the dollars and cents and the risk and
• 10:39
  all of that. And I think that's actually
• 10:41
  um for a lot of groups where they want
• 10:43
  to go longterm but probably the cycle is
• 10:44
  going to take a little bit more time.
• 10:46
  And then the last thing I think is
• 10:47
  frankly just laying out the outcomes.
• 10:50
  And I think people really underpric
• 10:53
  because it is a business and I I love
• 10:55
  and hate that part of it. But when you
• 10:56
  do the outcome side of this, we lowered
• 10:59
  uh readmissions and hospitalizations by
• 11:01
  5% across our population. So you're
• 11:03
  you're talking 5 10,000 fewer events.
• 11:07
  >> When a senior goes into one of those
• 11:09
  environments, their chances of dying
• 11:10
  triple. You can start converting that
• 11:12
  into life years saved. And I I I think
• 11:15
  most people are in the healthcare world
• 11:16
  that we work in woke up to do that work.
• 11:19
  And this whole system is this obnoxious
• 11:21
  layer in between to get to those
• 11:23
  outcomes. And so while we we're very
• 11:25
  intentional, we're very passionate about
• 11:26
  designing this. Well, I think it's often
• 11:28
  too often forgotten that this outcome,
• 11:30
  the lives saved, the hospitals avoided,
• 11:32
  the time with loved ones, the co-pays
• 11:34
  that don't put you into kind of a rears
• 11:36
  on your mortgage.
• 11:37
  >> Yeah.
• 11:37
  >> Those things actually are what motivate
• 11:40
  people. And I think we we could even
• 11:41
  tell, you know, this is more of a
• 11:42
  self-reflection. We could help tell a
• 11:44
  better story around that.
• 11:46
  >> Yeah. This isn't this isn't a job for
• 11:48
  you. This sounds like this is very
• 11:51
  meaningful for you.
• 11:52
  >> It I mean at at at non-scale at subscale
• 11:56
  one life saved and I know we've done it
• 11:59
  now in the hundreds
• 12:01
  >> is very meaningful. So then you get to
• 12:03
  build something every day with your time
• 12:05
  and you get to have a cool job and work
• 12:06
  with smart people and work in a
• 12:08
  fastmoving river and you get to do that
• 12:10
  at scale. I you know put me to that
• 12:12
  test. I love it. It's a great privilege.
• 12:15
  You said it earlier around look, we're
• 12:18
  making progress, but it takes time and
• 12:21
  running a company um in healthcare
• 12:24
  definitely requires patience.
• 12:27
  Um what mental model do you come back to
• 12:30
  when things get difficult?
• 12:36
  >> Uh you know, that's actually a really
• 12:37
  great question. I I I I think I think
• 12:41
  being able to tolerate things that are
• 12:43
  painful or aren't working as you expect
• 12:45
  is a a very important skill set for a
• 12:48
  leader. And so when I hit frustration or
• 12:50
  pain, I think first that this is
• 12:52
  probably some information being
• 12:54
  communicated to me. I try to be um have
• 12:56
  equinimity. Um a little bit comes from
• 12:58
  like meditation. I'm grateful to Rey for
• 13:01
  you know, frankly telling me like you
• 13:02
  got to go do this. But, you know, you
• 13:04
  kind of move to a place where I think a
• 13:06
  lot of people live their lives like this
• 13:08
  is bad, this is good. Uh-oh. Yes. And if
• 13:12
  you know, it's imperfect, but if you can
• 13:13
  get to a place of I'm just kind of in
• 13:16
  this um sea of information and if I can
• 13:19
  process it well, I can lead well and I
• 13:21
  can build well. Uh, and you kind of, you
• 13:23
  know, aspire to that state. When you hit
• 13:26
  these moments, you first start with a
• 13:27
  reflection like what is this telling me?
• 13:29
  And I think in healthcare and I tell
• 13:30
  this to folks like if you're looking for
• 13:31
  the fast buck and the big impact big
• 13:33
  splash don't come into healthcare like
• 13:35
  you're just in the wrong culture. Yeah.
• 13:37
  That that is just not this business and
• 13:39
  it shouldn't be because it's human lives
• 13:40
  and you always going to remind people
• 13:42
  nobody wants to experiment with human
• 13:44
  lives at scale on some flashbang thing.
• 13:46
  It's okay if and no offense to like you
• 13:49
  know any failed business. It's all hard
• 13:51
  but like if a wei work disappears like
• 13:53
  there's going to be some desks at
• 13:54
  another place. You can't have 5,000
• 13:56
  humans disappear. It's unacceptable.
• 13:58
  unacceptable
• 14:00
  and so it takes longer for a good
• 14:02
  reason. You want to make sure it works.
• 14:03
  You don't apply things frivolously, but
• 14:06
  it's more meaningful, too. And so, I
• 14:08
  think you have to have a little more
• 14:09
  patience and you got to appreciate some
• 14:10
  pain. Um, because if you reflect on it
• 14:12
  well and you metabolize it well, you can
• 14:15
  move forward through it.
• 14:19
  I'm just thinking about your
• 14:22
  tours of duty that you've done
• 14:24
  throughout your career and how all of
• 14:26
  those sort of came together in that one
• 14:29
  answer and I'm just taking that all in
• 14:31
  was pretty it's pretty impressive.
• 14:33
  Yeah, I mean it's um we are kind of
• 14:36
  blessed by our prior experiences and you
• 14:38
  kind of take the gift
• 14:40
  >> uh and often many gifts from each of
• 14:41
  them and apply them well. Uh you know
• 14:43
  you've got such great
• 14:45
  >> ability to contribute and great rewards
• 14:47
  to get. So it's I mean it is a it's a
• 14:49
  beautiful world. I know it's fast
• 14:50
  changing. I know AI is craving all these
• 14:52
  things, but um we still really need
• 14:55
  people and we need people to apply all
• 14:57
  their lessons learned and it's a great
• 14:59
  place to be doing it in especially
• 15:00
  today. We'll call it value based
• 15:02
  healthcare for now, but I I think of it
• 15:04
  as senior care and I think of it
• 15:05
  ultimately as just more intelligent care
• 15:07
  delivery.
• 15:09
  >> Okay, so let's just call it intelligent
• 15:11
  care delivery to populations that are at
• 15:13
  higher, you know, more at risk.
• 15:15
  >> Yeah. Um,
• 15:18
  you could frame that however you want
• 15:20
  it. Package it and, you know, basically,
• 15:22
  you know, take that.
• 15:26
  Why are people still not doing this if
• 15:29
  we know that it's the right thing to do?
• 15:31
  I'm I'm still kind of baffled by it. I
• 15:35
  think we are doing it and I think I
• 15:38
  think it's not happening as fast. So, I
• 15:39
  think that's fair. But
• 15:42
  the you know between a bad now and a
• 15:45
  good tomorrow is a state of working
• 15:46
  through it and progress. And I think
• 15:49
  great leaders have to recognize that
• 15:51
  there is progress happening and you got
• 15:52
  to call that out and that's probably the
• 15:54
  issue because you can see so much bad
• 15:57
  but you know even if let's talk we can
• 15:58
  talk about the system in a second. Let's
• 16:00
  talk about what's happening in AI. The
• 16:01
  ability for a patient to now get a lot
• 16:03
  of interactivity on their data and
• 16:05
  what's happening with them.
• 16:06
  >> You go back in 10 years it's like we are
• 16:08
  just in a different planet now. I mean
• 16:09
  we are literally on a different planet
• 16:11
  of intelligence there. Uh when you go
• 16:14
  into actually medical innovation like
• 16:16
  the United States is still the place and
• 16:18
  I appreciate there are pockets in other
• 16:19
  places but if you have something serious
• 16:21
  happening to you you are trying to get
• 16:22
  to our shores. I can assure you and and
• 16:24
  that will be forever because the
• 16:25
  technology technological dispersion will
• 16:27
  happen fast but we're innovative. We're
• 16:29
  fast moving. I mean yes people wait for
• 16:31
  appointments. I totally appreciate that.
• 16:33
  But when you need something um I had an
• 16:34
  event with 911 for uh someone we care
• 16:36
  about. They were there in six minutes
• 16:38
  and they had us tracked on GPS and they
• 16:40
  had ambulances waiting with the service
• 16:42
  we needed. I mean, incredible. That's
• 16:44
  not everywhere that that happens. That
• 16:46
  was absurdly expensive, but you don't
• 16:48
  have a lot of places where that that
• 16:50
  level of care can be delivered that
• 16:52
  quickly in, you know, let's call it
• 16:53
  rural Connecticut where we happen to be.
• 16:56
  So, I think there is some progress that
• 16:58
  we should acknowledge first and then I
• 16:59
  think with the part that's like why not
• 17:01
  fast enough?
• 17:02
  It's a really big system. It doesn't
• 17:05
  it's not a single system. People have
• 17:07
  interests. People have jobs. People have
• 17:10
  to make decisions. Cycles you mentioned
• 17:12
  are years. We have policy. We have a
• 17:14
  three, you know, we have three big dance
• 17:16
  partners. Or if you're really being, I
• 17:18
  think, inclusive, you've got payers,
• 17:20
  providers, the government, patients. Um,
• 17:25
  that kind of change doesn't happen as
• 17:27
  fast as you might want it to. And it,
• 17:30
  you know, we can talk about whether it's
• 17:31
  good or bad, but I think more
• 17:32
  importantly, we should be objective.
• 17:34
  Which direction is it headed? and then
• 17:36
  how do we help it on its way and I have
• 17:38
  actually never been more optimistic than
• 17:41
  today on that the technology progress is
• 17:43
  there the policy and I you know don't
• 17:45
  want to get into politics but the policy
• 17:47
  makers I they want to solve this problem
• 17:49
  >> I met I met all of them on both sides
• 17:51
  this administration prior
• 17:53
  >> I have not met a person who's like I'm
• 17:55
  going to make this difficult for you
• 17:57
  it's the opp they're like we're trying
• 17:58
  to figure this out um and then the
• 18:01
  providers like then they just got to put
• 18:02
  food on the table and they got to they
• 18:03
  got to get paid right I mean like this
• 18:05
  is their job So they want to get there,
• 18:06
  but you got to you got to give them
• 18:07
  vehicles to do it. And so we're getting
• 18:10
  there, but I think of that kind of a
• 18:11
  change on a five or 10 year cycle. I
• 18:13
  don't think of that on tomorrow. And I I
• 18:16
  would say, look, we can we can talk in
• 18:17
  five years or 10 or sooner than that if
• 18:18
  you want. Yeah. But I think you'll say,
• 18:20
  well, it is different and it will still
• 18:21
  not be fast enough.
• 18:23
  >> Yeah. I think it's interesting that you
• 18:24
  talk about
• 18:26
  >> looking out in five 10 years. Um do do
• 18:29
  you have that luxury of looking that far
• 18:31
  out kind of given where you sit?
• 18:33
  >> I think you have to. I I think there are
• 18:35
  times where I feel I have that luxury.
• 18:36
  There are times when I don't have, you
• 18:38
  know, I have like the stress of we need
• 18:39
  to make things happen now. Um but I
• 18:42
  think to navigate um an innovation and a
• 18:45
  group of people and a technology and a
• 18:49
  community, you have to think in those
• 18:51
  time spectrums, especially in
• 18:52
  healthcare. Um because it that is often
• 18:56
  the cycle time for people to uh try,
• 19:00
  learn, iterate, repeat. You know, take
• 19:03
  reach. Breach was a fiveyear model. So,
• 19:05
  okay, MSSP, while it's been around for a
• 19:08
  while, um, you know, let's call it we've
• 19:10
  got 10 years of of game film really.
• 19:12
  >> And so, you're you're sitting here and
• 19:14
  you're saying, okay, now we're learning
• 19:15
  things and we're going to apply those
• 19:17
  learnings. And then sometimes, okay,
• 19:18
  some group doesn't want it. So, you got
• 19:20
  to wait a year or two, even though you
• 19:21
  know it's the truth, but, you know, it
• 19:24
  is turning in the right direction. I I
• 19:26
  still I still fundamentally believe
• 19:27
  that. That may be a bias at this point,
• 19:29
  but I I think I've got enough of the
• 19:30
  kind of artifacts and evidence to to
• 19:32
  back that up. Yeah, look, healthcare can
• 19:36
  feel pretty heavy sometimes. It's
• 19:37
  serious. So, I want to I want to lighten
• 19:39
  it up for a minute. Um, if Pearl Health
• 19:42
  was a sports team, what kind of team
• 19:45
  would you be?
• 19:48
  >> It's a good question. I've actually
• 19:49
  never been asked that question, Michael.
• 19:50
  That's good. Um, we're definitely um not
• 19:54
  an individual sport. So,
• 19:56
  >> I think of us as um
• 19:59
  >> maybe it's like a soccer team and I
• 20:01
  don't know if I have a name for the
• 20:02
  team. I like to think the Yankees
• 20:03
  because I'm a Yankees fan and I think
• 20:05
  they're great and it's excellence. Um
• 20:08
  and maybe some combination of baseball
• 20:10
  and soccer in that it it's a long game.
• 20:13
  It can feel like a long game.
• 20:14
  >> Yeah.
• 20:15
  >> And you have to pay attention all the
• 20:16
  time and and sometimes you see the
• 20:18
  action and sometimes like you don't. But
• 20:21
  you have to um you have to pay attention
• 20:23
  to the details and you have to think
• 20:25
  through the next couple moves and
• 20:28
  it's I don't feel like we're that comp
• 20:30
  you know it's a competitive world but
• 20:31
  you know the one thing I would make a
• 20:32
  comment on maybe I'm not getting as
• 20:33
  lighthearted as you'd like. the people I
• 20:36
  thought were gonna be our competitors,
• 20:38
  you know, like, "Oh, we're gonna beat
• 20:39
  you." Man, they do they become your
• 20:41
  collaborators real quickly. Like when
• 20:43
  we're like we we're trying policies
• 20:45
  you're trying to work through. I mean,
• 20:46
  people work as friends
• 20:48
  >> and you know, we will also go and
• 20:50
  compete hard on the field,
• 20:52
  >> but you know, in like there's no locker
• 20:54
  room in our business, but if you know,
• 20:55
  you meet somebody at a restaurant or on
• 20:56
  the street, you're like, "Hey, yeah,
• 20:58
  it's tough." Yeah. Oh, yeah. How can I
• 21:00
  help? Yeah. We're working through this.
• 21:02
  What are you working through? And so I I
• 21:04
  like the collegiality of of of
• 21:07
  healthcare more broadly. It is a very
• 21:09
  interconnected business. Players move
• 21:10
  teams. Uh people get traded. People know
• 21:13
  that like this won't be my last team
• 21:15
  probably, so I should be empathetic to
• 21:17
  the other one. And and I think it's a
• 21:19
  very it's an incredibly unique industry
• 21:20
  in that sense.
• 21:23
  >> Uh I'm a soccer player, so I would I
• 21:24
  would air on the side of, you know,
• 21:26
  football loving it. Uh where do you feel
• 21:28
  like you guys are most well equipped,
• 21:30
  you know, as a as as a team? best
• 21:33
  attributes
• 21:35
  >> I would say right now it is um kind of
• 21:38
  talent and positioning in that we've
• 21:41
  really for our stage and phase and age
• 21:44
  we have great people and every leader I
• 21:46
  know you know has the bias of it but I
• 21:48
  think it's true I think it's battle
• 21:49
  tested and I think we have to build a
• 21:51
  fairly lean team so in kind of like a
• 21:54
  saber metrics model like we don't have
• 21:56
  the Yankees budget um we have um an
• 22:00
  intentional one and we're we're serious
• 22:02
  about recruiting professionals, paying
• 22:04
  them and all of that, but you know, we
• 22:06
  are we are kind of doing a David versus
• 22:08
  Goliath battle and we have every person
• 22:10
  in their position is great position
• 22:12
  player and you're you're always like
• 22:14
  making tweaks and changes and
• 22:16
  adjustments and can but I feel really
• 22:18
  well equipped for that.
• 22:20
  >> That's really interesting. Before we
• 22:22
  wrap, I just want to make sure that you
• 22:25
  share with the audience a bit more about
• 22:28
  where they can follow you, your work,
• 22:31
  the work of Pearl, like just kind of
• 22:33
  give a little commercial just so we make
• 22:35
  sure we hit that.
• 22:36
  >> I appreciate that. Well, I was I was out
• 22:38
  with our colleagues, you know, about one
• 22:40
  in 200 seniors that, you know, we are
• 22:42
  probably supporting them. Um, so we're
• 22:44
  kind of this like you have never heard
• 22:46
  of us, but we're kind of in the
• 22:48
  background trying to make their
• 22:50
  healthcare experience better. You can
• 22:52
  follow us, um, you know, our website,
• 22:54
  pearlhealth.com. We're trying to do a
• 22:56
  lot of thought leadership work more
• 22:57
  broadly that often is on LinkedIn. I
• 23:00
  think a lot about how do we contribute
• 23:02
  to this community. So we'd love to just
• 23:04
  engage you there and um, you can just
• 23:07
  reach out to me. I mean, we we love uh
• 23:10
  interacting with smart people who are
• 23:11
  ambitious from talent, partnerships,
• 23:14
  whatever it is. We're um you know, we're
• 23:16
  collaborative and we know we got to work
• 23:17
  with a lot of people to get this mission
• 23:18
  accomplished.
• 23:20
  >> My last question is, if you had to start
• 23:22
  rural health all over again today, would
• 23:25
  you do anything differently? And if so,
• 23:26
  what?
• 23:28
  >> It's such a great question and like
• 23:30
  there are some like mistakes along the
• 23:32
  way that I would have done a little
• 23:34
  differently.
• 23:37
  I might have started it a little sooner
• 23:39
  because we would have gotten the license
• 23:41
  that we took a year to get.
• 23:42
  >> Yeah.
• 23:43
  >> And
• 23:45
  I might have tried to go a little No, I
• 23:48
  I I think we played it pretty right on
• 23:49
  sizing. Like the big debate in the early
• 23:50
  stage with your capitalized is how big
• 23:52
  do you get? Yeah. So you kind of get the
• 23:53
  weight
• 23:54
  >> and I think we played that pretty well.
• 23:57
  Maybe I could have just invested in
• 23:58
  technology even more. Like I think it
• 24:00
  took us a little while to get our tech
• 24:02
  team humming and I could have um
• 24:04
  partnered up with somebody who would
• 24:06
  have helped me get there even faster.
• 24:08
  I'll give like a quick shout out to Alex
• 24:10
  Atala who's just this entrepreneur.
• 24:12
  Mario is another one of these. Mario
• 24:13
  Schlasser like you know together we'd be
• 24:16
  a dynamic duo and Mario's not available.
• 24:18
  He's crushing it at Oscar. Alex is
• 24:20
  crushing it at Open Router. But I think
• 24:22
  with a really great partner like that we
• 24:24
  would have
• 24:25
  >> we probably we could even 10 times the
• 24:27
  size right now.
• 24:30
  I think what I've really appreciated the
• 24:32
  most from our conversation today is how
• 24:34
  radically transparent you've been. You
• 24:37
  just been very rigorously honest and um
• 24:40
  yeah, the work is hard and yet you know
• 24:43
  that it's hard work, but like there is
• 24:45
  progress being made and just having that
• 24:48
  understanding and then being able to
• 24:50
  transmit that to your team like hey this
• 24:51
  is hard work and we're making progress
• 24:55
  like where we were five years ago, four
• 24:57
  years ago. like we are actually farther
• 25:00
  ahead. So I just I think that's a good
• 25:02
  true you know northstar to have um baked
• 25:05
  into your sort of operating system. So
• 25:07
  for those that have kind of tuned into
• 25:08
  this conversation today, if you uh if
• 25:11
  you found it helpful, if you found it
• 25:12
  useful, make sure you share it, like it,
• 25:15
  give it to your network to use. Um and
• 25:18
  if there are other folks that you want
• 25:20
  us to kind of have come on the show,
• 25:22
  explore or leader you want to hear from,
• 25:23
  make sure you drop us a note, let us
• 25:25
  know. We do read the comments. Um yeah,
• 25:28
  our platform is it's it's it's not just
• 25:30
  content like this is an interactive
• 25:32
  community. It's a living breathing
• 25:33
  ecosystem. You give and you take. So
• 25:36
  thank you for listening and uh keep
• 25:38
  building with purpose. We'll see you
• 25:40
  next time on the Advancing Health
• 25:41
  Innovation Show.