Latest / StartUp Health NOW Podcast / Scott Powder Launches Advocate Aurora Enterprises to Build Health System Innovation Partnerships

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Scott Powder Launches Advocate Aurora Enterprises to Build Health System Innovation Partnerships · StartUp Health NOW Podcast

• 0:00
  [on-hold music] How can you be in one organization and be so ingrained in that and still find a way to be innovative?
• 0:17
  And I g- I got asked this a lot as chief strategy officer, 'cause my job was, and to some extent still is, sort of predicting the long-range future and trying to get our organization prepared for what are those trends that are, you know, and how do we, how do we address those to be successful and fulfill our mission.
• 0:35
  And e- and so my job was to always, always cry wolf. [upbeat music] Welcome to Startup Health NOW, the podcast where we celebrate the entrepreneurs and innovators reimagining the future of health.
• 0:52
  I'm your host, Logan Plaster. On this podcast, we like to interview a range of types of experts, from founders of startups to the chief innovation officers at insurance companies to health tech investors.
• 1:04
  But there's another category that's really important to us, and those are the heads of innovation at big health systems.
• 1:10
  That's because collaborating with a health system is such an important proving ground for any health startup. Our guest today, Scott Powder, knows all about that.
• 1:19
  He's the president of Advocate Aurora Enterprises, which is the new health tech investment arm of Advocate Aurora, the Midwestern health system that covers twenty-six hospitals and five hundred care sites.
• 1:31
  In our conversation, which was held in front of a live audience of founders from the Startup Health portfolio, Scott breaks down the Advocate Aurora Enterprises investment thesis, and we discuss best practices for startups who wanna link arms with an enterprise health system.
• 1:46
  Scott's advice is wonderfully candid and rooted in nearly three decades of health system strategy work. So I hope you enjoy.
• 1:53
  [upbeat music] So Scott, let's talk, uh, let's start with a brief history lesson. So Advocate Aurora Health was the result of a merger, I think, four or so years ago.
• 2:10
  And during that time, you were really leading strategy. So maybe you could pull back the curtain for us on that merger as a way of understanding Advocate Aurora and kinda what it's all about. Sure. So,
• 2:23
  um, as context, I've been with Advocate Aurora or predecessor organizations now for coming up on twenty-eight years. As of next month it'll be twenty-eight years. So- Uh, I was extremely young.
• 2:36
  Uh, I was an infant when I started. So, um- [laughs] And, uh, so the, the merger actually closed, uh, April 1st of twenty eighteen, so I guess a little over three years ago.
• 2:50
  And, uh, it, it was a merger of two relatively large, at the time, healthcare delivery systems, Advocate Healthcare in Illinois, which was where I came from, and Aurora Healthcare, uh, in Wisconsin, uh, just north of the border.
• 3:04
  So we're sort of contiguous to each other, but operated in separate states and generally separate markets. And, uh, when we came together, just a couple things I would say about that.
• 3:15
  Um, one is, um, we came together because we have a belief in scale and the need for scale a-around, uh, efficiency.
• 3:29
  Uh, and there's a huge body of literature around the correlation of, uh, scale and volume to better outcomes, uh, particularly in surgical and procedural activities, so we th-thought there was a potential to advance quality by coming together.
• 3:45
  Um, there's value to scale from a financial perspective, so we are... And, and one of the things that kinda makes Advocate Aurora relatively unique in the healthcare delivery space is our commitment to value-based care.
• 3:58
  So we take-- we have a huge portfolio of risk-based reimbursement, and scale is absolutely necessary and critical.
• 4:06
  We're, in effect, the third largest insurance company in the state of Illinois and probably almost the, maybe the third or fourth in the state of Wisconsin based on, even though we don't have a license, based on the amount of financial risk that we take.
• 4:21
  And as most of you know, if you're in the insurance business, the law of large numbers prevails, so scale is critical to managing volatility and managing risk, having balance sheet strength, et cetera.
• 4:33
  So, uh, we came together under, one, the belief of scale. The, the second reason we came together was this idea that we need to advance value-based care.
• 4:42
  We, we just believe philosophically that the fee for service, uh, system of care that, which is, what still finances some or b- depending on the market, you know, eighty to a hundred percent of all care is a fundamentally flawed model.
• 4:57
  Um, we also are not huge believers in, um, upside risk sharing, like shared savings type of stuff.
• 5:04
  We believe the only way to really align incentives is for the provider to have financial skin in the game around managing the total cost and quality of care.
• 5:13
  So, uh, in order to do that, we believe that's part of what we wanted to do, and we had a lot of alignment around, around that.
• 5:19
  And then the last thing I'd say, which is ultimately g- you know, something to think about as we, as we talk more about what Advocate Aurora Enterprises is,
• 5:27
  is this fundamental belief that while access to great care delivery is incredibly important to helping, uh, you know, advance people's health, it is but one of many factors that all...
• 5:40
  And actually in many cases is the least important factor in how healthy a person is.
• 5:45
  And we came together, both organizations were called, had healthcare in their name, and we took the word care out of what's now Advocate Aurora Health, not because we don't provide great care, but we said, "If we're truly going to fulfill our purpose, which is to help people live well, we need to address the broader health of the people we serve.Some of that is enabled by the fact that we have financial risk, so we have financial incentives to, you know, deal with things like wellness and preventative care and things of that nature, and we just believe that's the right thing to do.
• 6:18
  And, um, so that was... those are the reasons we came together. Um, as, uh, you know, Logan mentioned, I've been...
• 6:27
  I, I had been the Chief Strategy Officer for Advocate Healthcare and helped work on the deal that led to Advocate Aurora Health, and until, uh, April 1st of this year, uh, was Chief Strategy Officer.
• 6:42
  I recently stepped down to take on this role of, uh, leading Advocate Aurora Enterprises, which I know we'll talk more about.
• 6:50
  Scott, before I jump into, you know, discussions about the enterprise side, uh, the, uh, the investment side and, uh, get more technical, I just wanna sit on one thing a minute.
• 7:01
  You said you've been there twenty-eight years, and we talk a lot about long-term commitment and just the, the need to, uh, sort of raise your gaze of, of beyond the next quarter, and I wonder if you could just speak to what you gained by being committed to something for twenty-eight years.
• 7:18
  It's just not something that you hear a lot of in healthcare innovation. Yeah.
• 7:23
  Well, and I think there's a, there's a-- it, it raises an interesting question I don't have a great answer for it yet, which is, how can you be in one organization and be so ingrained in that and still find a way to be innovative?
• 7:37
  And I'm not sure I, I'm not sure that I'm therefore, you know... I certainly can't comment. You could certainly ask my boss whether he views me as innovative or not. But, you know,
• 7:47
  uh, I actually did an interview with a, with a, a firm, uh, called Foresight Health.
• 7:52
  They publish, like, a weekly newsletter, and that was one of the questions they asked me is, "How can you be an insider and be innovative?
• 7:59
  Don't you get sort of embroiled in the day-to-day, and you sort of build a set of assumptions based on being in the same place for so long? How do you challenge those?" And it-- those are all good questions.
• 8:10
  So, and I don't have a great answer, but to your point about sort of stepping back, I mean, I...
• 8:17
  A-and I remember when I first joined what was actually pre-Advocate, was a company called EHS Healthcare, which was the predecessor that merged with another in Chicago to create Advocate in '95.
• 8:28
  And I remember when I joined in '93, that's how long ago it was, you know, I was in awe of all the people who had been there for twenty-five years and were like, "I remember be- when Medicare first was started and when DRGs came out in," I think it was 1983, if I'm not mistaken.
• 8:44
  And now I'm that guy going, "I remember when Bill and Hillary Clinton had healthcare reform." And, like, a bunch of the young people on my team are like, "Bill Clinton was president?"
• 8:55
  Yeah, [chuckles] so it's, it's very interesting to have that long-term perspective. So the one thing I would say is,
• 9:02
  um, and I g- I got asked this a lot as chief strategy officer, 'cause my job was, and to some extent still is, sort of predicting the long-range future and trying to get our organization prepared for what are those trends that are, you know, and how do we, how do we address those to be successful and fulfill our mission?
• 9:21
  And e- and so my job was to always, always cry wolf.
• 9:25
  You know, the world's gonna end, healthcare spending is unsustainable, it's all gonna be managed care, all the doctors are gonna be employed, um, you know, et cetera, et cetera, et cetera.
• 9:36
  And ev- you know, every three years we update our strategic plan, or even every five years, and everyone would sort of look at me and say, "Yeah, Scott, you said the world was falling and it ain't falling."
• 9:45
  Uh, so there is this, uh... A-and what I've told people is the reason I actually think the world we're living in today is different.
• 9:55
  Now, uh, you can debate the timeframe for fundamental change and transformation of the healthcare system, but I think the thing I always say is that the landscape of people participating in our industry is very different than it was five, ten, fifteen years ago.
• 10:12
  And actually some of the people, uh, on this call and who are part of Startup Health I think represent that. And I, I sort of... It's kind of bimodal.
• 10:19
  There's this whole group of what I'd call innovative, you know, earlier stage, I don't wanna say just startups, uh, but certainly startups, earlier stage companies.
• 10:30
  There's massive amounts of capital, um, that's flowing in to fund a lot of really interesting and innovative ideas. That's... We're in an unprecedented time.
• 10:40
  Fifteen years ago, healthcare venture capital almost didn't even exist, um. Right.
• 10:45
  Uh, and so to look at what we have today and the infrastructure of a Startup Health, and in Chicago we have Matter and a variety of other organizations.
• 10:54
  So that's one fundamental difference, the amount of capital and the amount of innovation and activity in startup and early stage.
• 11:02
  The other is the other side of that bimodal equation, which is the mega-scaled players, both on the technology side and in the care delivery and insurance and consumer health side, whether it's Google participating in healthcare, Apple participating in healthcare, Amazon clearly participating in healthcare,
• 11:23
  um, Aetna, CVS, United, Optum. You know, these are two hundred and fifty billion dollar enterprises or more.
• 11:33
  As I said to someone, United, Optum generates more free cash flow in a year than we generate in revenue in a year and a half. So the amount of resources available to essentially transform care is just...
• 11:47
  And, and the players who are scaled to do it, coupled with that other end, you know, the earlier stage and the capital going there, just to me means that there's no avoiding the, the transformation and the disruption in the industry.
• 11:59
  That, that's just my big picture take from twenty-eight years of trying to do this, and I think this is finally the time it's gonna happen.Yeah.
• 12:08
  Uh, what I'm hearing you saying is that longevity in the industry, it can be a challenge in terms of staying innovative, and yet it gives you this really important perspective, which I know, uh, you're applying in a lot of different parts of your business.
• 12:23
  Uh, I think it's a good segue to Advocate Aurora Enterprises. Let's talk about, uh, why this came to be now. I mean, you kind of set it up just now, uh, this being a unique moment in time.
• 12:34
  But what is it all about, and kinda what is your role there? Yeah. So Advocate Aurora Enterprises grew out of this belief, uh, that sort of
• 12:47
  the germination of the belief was creating Advocate Aurora Health, that our job is to...
• 12:51
  our purpose is to help people live well, which means not just providing great medical care, but ultimately providing access to a broader array of health services that, you know, and, and recognizing that people are increasingly investing in their own health.
• 13:06
  I mean, there's-- while there's a three trillion dollar healthcare economy tied to Medicare, Medicaid, and commercial carriers funding it, there's another trillion dollar economy around health where people are paying out of pocket to further their own personal health goals, whether it's your fitness club membership, how you shop for food, you know, nutrition and supplements, exercise, sleep, uh, activities, mental resilience.
• 13:32
  You know, there's a whole giant range of those things.
• 13:34
  And so what we sort of said is, if we're truly gonna impact how people, you know, people living well, we need to participate in that, what I call that consumer health and wellness ecosystem.
• 13:47
  Ninety-nine point nine eight percent of our revenue is tied up in traditional healthcare delivery, doctor visits, and, um, surgeries, and imaging studies, et cetera.
• 13:59
  And so if we're going to participate, uh, in that broader consumer health economy, which is very different, it's funded oftentimes out of pocket, although increasingly funded by health plans and employers, but it starts with sort of being an out-of-pocket, more retail-oriented industry.
• 14:17
  It's not an area that we necessarily had expertise in, so we said we need to create a separate division.
• 14:23
  That's what Advocate Aurora Enterprises is, is that separate division, you know, built to, again, assemble a portfolio of consumer health and wellness product services and companies.
• 14:34
  Um, and, and I'll just say that, you know, 'cause I get asked this all the time, so I'll kind of anticipate a question that might come up.
• 14:42
  You know, we are-- our job is not to simply serve the needs of our core care delivery system. And I acknowledge that that's, you know... We're a thirteen billion dollar healthcare system.
• 14:53
  You know, we've got bi- we've been in the community in some cases for a hundred and fifty years. Um, so there's a lot of, you know, it's sort of like Jupiter with all the moons around it.
• 15:03
  There's a lot of gravitational pull that Jupiter has.
• 15:07
  But, you know, our goal is to be, you know, someday be the Saturn, you know, to, you know, so that we are on equal footing and our own enterprise that will benefit the core, but, um, but we're sort of our own enterprise.
• 15:22
  And so in twenty-five years, I hope I look back and say, "We've created our version of what Optum has become within United Health Group." So that's sort of what we're trying to do, um, in a nutshell.
• 15:33
  And again, the, the why now is, um, you know, I, I will say part of the why now is also the underlying economics of care delivery.
• 15:41
  It, it, for any of you, and probably a lot of you have had some experience with, you know, traditional healthcare, you know, whether it's hospital or physicians or other outpatient, it's a terrible business to be in.
• 15:52
  It's low margin. It's capital intensive. There's no technology, almost any technology, that's putting more business into the hospitals. All, almost all technology takes things out of the hospital.
• 16:05
  So your, our underlying utilization, despite the aging of the population and the increase in chronic disease burden, our, our underlying utilization of our core business is going down.
• 16:15
  Our costs are fundamentally going up and being exacerbated right now by workforce shortages, et cetera.
• 16:21
  You know, a lot of our suppliers have monopolistic pricing power, whether they're pharmaceutical, drug, uh, um, or device manufacturers.
• 16:28
  So we don't have a lot of control over our cost structure, um, and we have no control over our revenue.
• 16:35
  Uh, so part of this is also a, you know, financial diversification, uh, play, um, as in addition to sort of fulfilling this broader purpose of helping people live well.
• 16:47
  So I'll stop there, but Logan, pro- pro- you can probe that in- Yeah. Yeah... any way you want. Yeah. What I wanna know is really what are your primary focuses of investment?
• 16:56
  I mean, where do you see this going when you could, you could kind of focus anywhere? Yeah. 'Cause- I think you saw-... a trillion dollar economy is too big. That's a- Yeah... that's a giant ocean.
• 17:08
  Um, so we have boiled this, uh, our focus areas down to three for now. We're still, in some respects, we're also a startup.
• 17:18
  I mean, we're, as a, technically as a corporate entity, we're, we're only about eight months old under the name Advocate Aurora Enterprises.
• 17:25
  And in terms of having capital available from the parent company, we're only a year old, give or take. So we're sort of a startup. So w- so which means that we're fluid, so things will evolve.
• 17:36
  But at this moment, we've picked three areas within that broader consumer health ecosystem to focus on. And the, uh, consistent theme across all three of these is, one, uh,
• 17:48
  large market with growing demand generally, two, lots of unmet needs, uh, whether they're gaps in services or just a fragmented environment, um, et cetera, and, uh, areas where we think we have some capabilities in our core business that can be brought over and, uh, assist Advocate Aurora Enterprises and the portfolio that's assembling to be successful competing in these particular sectors.
• 18:16
  So we've got three. One is aging independentlyObviously, huge issue, huge unmet needs. You know, all the economics say we've got a massive issue with senior care over the long term, lots of it moving into the home.
• 18:31
  And, uh, you know, we're a, uh, national leader in geriatric care. We're a national leader in Medicare Advantage in the core. So these are-- we've got a lot of clinical backing and expertise.
• 18:41
  So we think we've got something there. Second area is, um, parenthood. So i-it's never-- And, and I've got, uh, two daughters. Uh, one is a rising senior in high school, the other actually just graduated from college.
• 18:56
  So, uh, and even now I look at, uh, people on our team who are s- who are raising kids and saying it's like ten times more complicated to raise a kid in twenty twenty-one than it was for me in, um, two thousand and one.
• 19:10
  And, uh, so huge unmet needs, lots of fragmentation. And again, we're a national leader in women's care.
• 19:17
  We have a nationally known children's hospital, got a lot of clinical depth, uh, in fertility and obstetrics, uh, and research. So we're thinking parenthood is an interesting place for us to participate.
• 19:28
  And then the third is what we call personal performance, which is sort of a catch-all that the idea of aligning mind, body, and nutrition so that individuals can achieve their peak performance.
• 19:39
  And again, we bring a bunch of interesting capabilities. So one, lots of growth.
• 19:44
  I mean, the explosion in any of you who are involved in digital mental health and behavioral health valuations are crazy because everyone knows there's gonna be huge growth.
• 19:53
  COVID, you know, uncovered lots of issues with mental resilience and, uh, things of that nature. So,
• 20:00
  you know, putting together a portfolio to address that and drawing on the capabilities, we have a, you know, pretty well-known behavioral health, um, service line.
• 20:09
  We have a lot of action in physical therapy and sports medicine and other aspects of exercise. We actually have a fitness business.
• 20:17
  That's part of that point o two percent of our revenue that's actually not pure care delivery.
• 20:23
  So again, lots of interesting capabilities that we wanna bring to bear, um- Yeah...around aligning, uh, mind, body, nutrition. So those are the three focus areas at this moment. Those, those are exciting areas.
• 20:35
  I mean, what I wrote down was just massive need, impact, and capability.
• 20:39
  You've identified just huge need, where can we really move the needle, and then, like, where do we also have some capability here and some, some pieces o-of the puzzle already in place. Yeah, I, I think that's right.
• 20:50
  You know, the, the-- maybe the one small thing I would say is as-- becau- I mentioned this, we're, we're trying, we wanna be fluid in this. So we took an ocean and, you know, I'm from the Midwest.
• 21:00
  I grew up on the shores of Lake Erie and now live on the shores of Lake Michigan. So we boil it down to three large Great Lakes.
• 21:06
  [chuckles] That's still a pre-- that's still, still pretty big, you know- It, it is...fishing hole. We're gonna-- These are gonna evolve.
• 21:12
  I suspect some of these get crystallized and narrowed down even, even further a little bit over time, but that's where we're at today. Awesome.
• 21:20
  Okay, Scott, I wanna get into sort of how you partner with, uh, startups, but before I do that, there are a few questions in the chat, so let's take a, a moment for those. Let's start with Samit Maniar from Wellbrain.
• 21:32
  Samit, you can come off mute and go ahead and ask your question. Yeah. [clears throat] Thanks. I think you answered some of the questions I, I had in the sense that
• 21:41
  one of, one of the key points I think you identified is the shift towards, uh, managed risk plans and also on this, uh, investment component of it.
• 21:51
  And my question was, were you guys looking at real patient monitoring behavioral health in that? But my overall guiding question is:
• 21:59
  how does the-- how do these solutions that you potentially look at, uh, from an investment perspective look to drive your future profitability or revenue or other types of solutions? So y- And is there a goal?
• 22:14
  Because if you're more managed risks, how does that impact your profitability and, uh, wherewithal? So... Yeah. Le-let me try to parse that out a little bit. Yeah.
• 22:23
  And if I'm, if I'm not getting at it, you know- Sure...push back or crystallize or, or, or, you know, or probe. But, so [lip smacks] let me start with Advocate Aurora Health, the broad parent company enterprise.
• 22:36
  That's where we hold a ton of financial risk related to total cost of care and value-based contracts, Medicare shared savings, global capitation, Medicare Advantage, et cetera. Mm-hmm. And, um,
• 22:48
  so-- And that is where-- Uh, by the way, th-they are-- The reason why we think Advocate Aurora Enterprises can be successful, one of the reasons, is because in addition to acquiring, investing in consumer health companies that on their own merits can be profitable and have lots of growth, we think Advocate Aurora Health, because of its focus on population health and taking risk, will be a customer for-- of Advocate Aurora Enterprise and its portfolio.
• 23:17
  So we think there's a, a, you know, sort of flywheel synergy that we hope will occur. That doesn't mean that every company we pa- uh, participate in within Advocate Aurora Enterprises must serve the needs of the core.
• 23:30
  Mm. It's not a prerequisite. Okay.
• 23:32
  But it's sort of inevitable, um, that a lot of the solutions we're looking at, you know, are things that because we have so much financial risk in the quarter, they're gonna wanna access these.
• 23:41
  So I, I wanted to kinda make that clear, but, you know, the way the parent company manages financial risk and, uh, you know, is by being really good at population health, and we're really good at it.
• 23:53
  We're not perfect, and there are obvious areas where we, where we've got a lot to learn still. But, you know, the
• 24:01
  a- the-- one of the bases of the merger in twenty eighteen was that Advocate Healthcare in Illinois, you know, we pioneered back in the l- early two thousands clinical integration and a variety, and basically taking risk even though you don't have your own health plan.
• 24:18
  So we've got some pretty deep capabilities to manage the total cost of care, analytics, claims processing, clinical and medical management, utilization management, and, uh, you know, we're-- we continue to get better there.
• 24:31
  So that's our how we manage profitability at a high level. Mm-hmm.I'm not sure if that's quite what you're asking, 'cause you've got...
• 24:39
  I s- and I'm reading what was in your chat around, um, you know, digital health and things of that nature. That is where we are going. Okay. And that is where I think, that is sort of the,
• 24:51
  a little bit uncharted right now, um, is how, because to be honest with you, and this maybe gets to one of the broader reasons why we do this kind of fireside chat, you know, there are probably 100,000 digital- Right...
• 25:06
  solutions that can help manage care and, you know, probably 10,000 of them have tried to call us and, and, and get in with us.
• 25:15
  So, um, and there's, I'm sure there's another 90,000 who would like to get in with us, and it's just hard to sort through what's real, what's not.
• 25:22
  You know, solving a mi- a small issue is important, but, you know, we're like any, you know, when you've got a million and a half value-based lives, you sort of have to go where the big ticket issues are, which ultimately is, you know, diabetes, congestive heart failure, hypertension, and maybe a couple of other things, end stage, you know, ca- uh, renal disease and, and things of that nature.
• 25:45
  So, you know, finding a very small point niche solution to deal with, as an example, and this was a company that we talked to, how to take to deal with OB bundles, turns out wasn't that important to us.
• 25:58
  Like, you're, you know, we already manage OB and obstetric care pretty tightly. You know, we've got a pretty low, you know, premature birth rate, low C-section rate. Mm-hmm.
• 26:09
  You know, everyone's out of the hospital in under 48 hours unless there's a unusual complication. So, like, how are you gonna really manage that and make a difference?
• 26:17
  So it, that's, that's again a little bit of how we think on, maybe a little more on the core. Okay. So, Sumeet, I'm not sure I'm answering your question, but that's sort of how- Any follow-up, Sumeet? Yeah, yeah.
• 26:28
  Uh, no, no, I think this was, uh, good because I d- I asked the first question before not anticipating what else you were gonna say, so you answered some of those answers. But, uh- [laughs]... I think, uh, this is a, a,
• 26:41
  a g- good way. A- and one last, uh, follow-up is just, are you guys pushing for, or are, are hospitals...
• 26:48
  One of the things I'm seeing with, uh, behavioral health and, uh, s- what the CMS is doing, trying to move things away from at facility to off facility,
• 26:57
  but are you guys getting involved with that, remote patient monitoring, remote patient care? Yeah. Yeah. So, uh, yes, we are.
• 27:04
  One of our fundamental themes at the parent company and at AAE is the movement of care to the home, and the, the home ultimately being kind of the, the focal point- Okay... and platform for all future care delivery.
• 27:19
  Doesn't mean, obviously we're not doing neurosurgery in your bedroom tomorrow. Right.
• 27:23
  But, you know, technology has enabled and will continue to enable so much more stuff to be either done physically in the home with, you know, an in-home presence, or via technology remote monitoring.
• 27:36
  So we have an entire division, uh, we call it, it used to be called Home Health, and it became Post-Acute.
• 27:42
  It's now called Continuing Health, because at least 50% of all their care is not post-acute, it's pre-acute, and they keep, you know, they also, by the way, are sort of one of the national leaders in my opinion, humble opinion, a national leader in managing capitated care.
• 27:58
  So their job is, you know, make the home the focal point of care delivery, either in person or using remote technology, and they're doing everything from the highest end hospital at home, all the way down to, you know, some basic remote monitoring, um, and, uh, things of that nature.
• 28:16
  So yeah, we're... A- and by the way, the one thing we didn't do, um, because it's a very different business, is what we call in-home personal care.
• 28:25
  Um, so in-home personal care is typically not, although it's starting to be paid by Medicare Advantage plans, typically not paid, um, by traditional insurance.
• 28:35
  Some states have Medicaid waivers to pay for it, but most of it's paid for by people out of their own pocket. Mm-hmm. And, um, so that's a different business.
• 28:44
  We tried to get into that, like, 15 years ago and failed miserably. So I'm actually wearing that sweatshirt, uh, by the way. We, uh, one of the things AAE did is we acquired a company called Senior Helpers- Mm-hmm...
• 28:55
  on April 1st of this year.
• 28:57
  They're in that business across 44 states, and the goal is it will be complementary to what we do in the h- traditional kind of Medicare certified home health space to augment what we're already doing.
• 29:08
  So we have a huge belief in the home- Got it... as the future of care delivery. Okay. All right. Th- Thanks. Th- thanks for the question, Sumeet. Yeah.
• 29:18
  Scott, the main thing I heard in there was neurosurgery in the bedroom. So I, you, you- Yeah. That's gonna be the headline of this blog post when this is turned into a story. Yeah, thanks.
• 29:26
  "Scott Powder says we're gonna be having neurosurgery in- Coming any day now. [laughs] I'll be the, I'm volunteering to be first. [laughs] In the home, neurosurgery. All right, we got a question from Dr.
• 29:34
  Alexandra Greenhill from Care Team. Um, come off mute and you can ask your question.
• 29:40
  Uh, you know, all of this conversation stimulated several, but, uh, the first one I wanted to wonder, uh, practically, what systems do you use in place right now? You talked about mergers.
• 29:50
  Does that mean multiple EMRs, or have we- Oh... coalesced on one? Yeah. Great question. Um, so we did coalesce on one. Uh, we're, we're an Epic shop.
• 30:00
  So, and v- very quick, uh, backstory is Advocate Healthcare, uh, in 2001 made a fateful decision to go with Cerner.
• 30:11
  Um, uh, and Cerner never really developed a strong outpatient physician EMR platform, with all due respect if anyone from Cerner's on this call.
• 30:21
  Uh, I think they've improved, but so we ended up, when we merged, Advocate was, uh, Cerner and Allscripts with a small outpost using Epic. To their credit, Aurora was all Epic.
• 30:34
  They had made the, they had made that move, uh, and integrated, you know, five years prior to the merger, so we went with Epic. We've finished that, uh, integrationThe end of last year.
• 30:45
  Uh, so, and that's been very helpful for, 'cause we are, by the way, we believe in scale, we also believe in integration.
• 30:51
  That's sort of, you know, two fundamental s- you know, beliefs that we, philosophies we have about better care. That's fantastic. And my other question, um, is, uh, related to some of the sort of inevitable challenge.
• 31:06
  I'm a physician, and I've spent m- you know, I'm not gonna say how many years now convincing my colleagues to adopt new ways of practicing, and I'm always interested, uh, about more best practices of how do you...
• 31:18
  Let's imagine the tens of thousands of startups. You choose one, and you say it's a go. How do you help or facilitate with the inevitable resistance at the frontline, especially now that everyone's exhausted post-COVID?
• 31:30
  Yeah. It is a fabulous question. So, uh, a- and I, uh, th- there's not a one great answer to this issue. It's, it's good just to even be aware of it.
• 31:42
  What I would say is one of the, one of the interesting startups that we've been talking to I think could offer a solution to all this, so I'm gonna give them a little bit of a shout-out.
• 31:55
  It's a company called Xelt, spelled X-E-A-L-T-H, so kinda like stealth, only Xelt with an X. And they are, uh, an interesting organization.
• 32:09
  Their goal is to, um, become the express, the Shurscripts, if you will, for all non-pharmaceutical prescriptions.
• 32:20
  So digital therapeutics, education content, related services, d- uh, you know, digital applications, even if they're not FDA-approved. Mm.
• 32:29
  And so what they've sort of built is this epic integration and what, ultimately, if everything plays out, you know, they've got, as everyone has nowadays, an AI engine.
• 32:40
  In theory, if you're the physician, what it should do is before I come to my appointment with you,
• 32:47
  this tool m- mines the, the, uh, EMR and identifies based on notes and past information a- and any other things that come up during the actual, uh, encounter, and it serves up in the, uh, EMR a set of, again, not pharmaceutical prescriptions, but it could be, hey, this person should go to Weight Watchers, or they should be using Ginger.
• 33:11
  I'm picking on, you know, a behavior health app. Or in our case, another company we've invested in, FoodSmart, which is a digital food and nutrition platform.
• 33:20
  And so, and it offer, it then makes it really easy inside the physician's workflow to prescribe, and I'm gonna use air quotes for prescribe, or at least recommend these apps or education or services to their patient, and it flows into the patient's portal with a link.
• 33:37
  And if the company has done API integration with Xelt, um, you know, you literally get to the sign-in page. And, um, so my dream,
• 33:46
  because we are now a, a, a significant investor in a com- in FoodSmart, which again, digital food and nutrition platform, I can tell you more about that if you want.
• 33:54
  But, uh, my dream is that every one of our clinicians, as we deploy Xelt across our entire enterprise, it's serving up FoodSmart as a, uh, prescription f- to, for every relevant patient that, you know, we have 3 million unique patients that we serve every year.
• 34:11
  We probably have 10 million primary care visits every year.
• 34:15
  A big chunk of them probably would benefit from a food and nutrition platform like FoodSmart, and if Xelt enables that to be served up and removes the friction for the physician, so you don't have to go educate the doctor about 8,000 digital apps.
• 34:29
  They just, you know, it's served up in the EMR. It removes a lot of, um, a lot of the friction to get clinicians... 'Cause I, I think while there's an acceptance issue, and you're better informed on this than me.
• 34:41
  I think there's, of course, there's an acceptance issue, but a lot of it is bandwidth, memory, and simply removing friction from the referral process.
• 34:48
  So if I have to educate and remind our 8,000 physicians about FoodSmart, it ain't ever happening.
• 34:54
  And by the way, they gotta remember FoodSmart and Omada and about 18 other apps just for food nutrition and diabetes prevention. Just never happen. But if Xelt automates that, I think that's sort of the holy grail.
• 35:06
  So that's my hope is companies like that start coming forward. Thank you, Scott. This was a great answer, and I'm a huge fan of Xelt on the physician side. Oh, good.
• 35:15
  I do experience the patient side, which is you get 18 recommendations, and you leave them alone because the day is busy- Yes... and when do I do this? And so care teams focus on that problem.
• 35:26
  But, um, you know, uh, I'd, I'll follow up with you afterwards, uh- Please... to discuss that further. Yeah, that'd be great. Thank you. Thanks for the question, Dr. Greenhill. Uh, let's go to Ben Lee from Fortius.
• 35:37
  Uh, Ben, why don't you hop off mute? Yeah, thanks. And, and thanks, Scott, so much for the, uh, for the great talk so far. Um, my, my, mine was more of a comment saying that I, I love the term you used, peak performance.
• 35:48
  Um, you know, I, I think that, um, you know, especially with the recent COVID pandemic, you know, here in Ontario, Canada, we've seen, you know, firsthand that a lot of healthcare systems are more so around just keep people alive or, um, you know, disease prevention rather than pr- than human optimization.
• 36:06
  So, you know, I, I love that concept you're taking.
• 36:08
  So, so my question is, I know you had mentioned some of these, you know, startups that you partnered with, but I'm curious, you know, when it comes to this idea of peak performance, how do you administer this to your, uh, to your clients?
• 36:20
  Yeah.
• 36:20
  Well, we're still trying to figure out the, I think the holy grail on this is at least our belief right now, a- and I'm not sure if this is where it's gonna go or not, but right now is, so there, the, the, the challenge is we believe kind of philosophy is you've got to align mind, body, and nutrition.
• 36:38
  Um, and so mind is mental resilience and, you know-Personal, um, you know, self-awareness and self-actualization, all that good stuff. The top o-of the Maslow's hierarchy.
• 36:51
  Obviously, it-- but if that's all you do and you don't, you know, you're not physically fit or, you know, physically challenged, or you're not eating the right things or getting the right amount of sleep, you're sort of never gonna fully optimize.
• 37:03
  So what we're-- our, our thesis is that we need to, that while lots of players are dealing with one or the other, no one's brought a portfolio together and then made it really seamless for customers to access those things.
• 37:18
  So you sort of have to kind of find them on a one-off basis. Now, I, I will confess, I have-- So I'm the least likely person to use any of these solutions other than the food and nutrition and the exercise stuff.
• 37:32
  Like, I'm, you know, try to take care of myself, and I run a lot, so. But, like, the mental resilience stuff, not my bag.
• 37:38
  And so the team, I, has-- I have not become fully convinced that, that part, that if we unify a platform around all this, that that's gonna somehow differentiate.
• 37:50
  Uh, so that's, but that's our working thesis right now is can we unify and bring a bunch of that stuff together or partner with someone to bring some of those things together.
• 38:00
  So we might bring the point solutions with a partner who can put a platform on top of it. So that way, again, you don't need to go and find this app for sleep and this app for your exercise management.
• 38:11
  And by the way, a lot of this is predicated on coaching, whether it's virtual or a, you know, AI-enabled coaching or even in person at some point. So again, all things we're still trying to figure out. Hmm. Interesting.
• 38:25
  No, that, that, that, that's, that's a great answer.
• 38:27
  I think, uh, what you're describing harkens back to the, uh, days of antiquity, you know, during classical education when, you know, you had to be mentally, intellectually fit, physically fit, and psychologically fit, so it sounds great.
• 38:39
  So I would love to connect with you later on, uh, just to talk more about this topic, but maybe, uh, we'll do that another time. So thank you, sir. Absolutely. Yeah.
• 38:46
  And by the way, just as a, uh, Logan, I, I'm-- you maybe, I, you know, I know we'll run out of time before we can get to everything and, uh, but, you know, it's worth one second, and you might have been going there for me to just say a little bit about, uh, so that way there's no false expectations, you know, our investment, uh, approach right now.
• 39:06
  Um, so first is I wanna encourage, I'm open if anyone wants to reach out from, to me, uh, and LinkedIn is a terrible way to do it.
• 39:14
  I like getting connected by LinkedIn, and it's okay to send me a message, but then I'll r- I'll route you back through my business email so that way, like, if we're gonna have a conversation, I can connect you with my assistant, otherwise we'll literally never talk.
• 39:27
  So that's one thing. I'm open to any outreach, and in some cases I might end up triaging to someone else, either in our or my team or back in Advocate Aurora Health and the parent company.
• 39:37
  But, you know, just in terms of us specifically, we, we do-- we, we try to invest, again, although I'm a startup, you know, I do have some audacious financial goals that I have to achieve for Advocate Aurora Health over the next five, six years.
• 39:53
  So we're not an, a, a VC or PE arm. We're not looking for exits, but we are looking to invest in companies that can generate a sustainable, recurring, and accretive, uh, EBITDA over time.
• 40:06
  Uh, so, uh, you know, we tend to focus on companies that are, you know, that we've got line of sight, like, very quickly to ten million in revenue, and ideally, you know, are gonna be EBITDA positive within a year or so.
• 40:21
  Um, so I just wanted you to be aware of that. So
• 40:24
  y-you know, again, there are gonna be exceptions to that, um, and as we build out our portfolio, we'll have more latitude to do some earlier stage things, especially if they kind of synergize with things that are in our platform.
• 40:36
  But, you know, our first couple of deals, you know, Senior Helpers was a buyout and, you know, they're, uh, they're making, uh, pretty, pretty nice EBITDA margins right now.
• 40:47
  FoodSmart is, you know, gonna, is gonna exceed ten million. They were kind of at ten million last year. They're gonna probably double that or come close to it this year.
• 40:56
  And so those are the kinds of deals we're kind of looking at at this moment, just purely from an investment standpoint. So I wanted that to be out there. That's helpful. But I still welcome all inquiries.
• 41:07
  I'd love to talk further with any of you, 'cause even if we don't do a deal this moment, one, there might be something to connect you into our core. Two, it could be that we wanna stay in touch.
• 41:17
  Three, there could be synergy with some of our companies or interesting other partnerships. Y-you know, you may not even be looking for, you know, cash at this moment or, you know, equity investment.
• 41:27
  So I, I am gonna welcome any and all, uh, outreach over time. Appreciate the question, Ben.
• 41:33
  We'll make sure, uh, Scott, that anyone on this call that wants to reach you has an avenue to do so, uh, and we can, we can help make sure that that's smooth. Yeah. Thank you.
• 41:43
  Um, you know, you've really laid it out nicely in terms of who you partner with a-and what that looks like.
• 41:49
  Um, what advice would you give to startups who are looking and saying, "Maybe that's not me today, but I wanna establish my, my business such that I'm gonna be able to partner with a large health system like Advocate Aurora in the future, and I'm, I'm really setting myself up for success early"?
• 42:07
  I mean, you did a lot of review of startups through MATTER, I believe- Yep... and you've seen all those decks. So what are some words of wisdom you have about kinda setting things up right from the beginning? Yeah.
• 42:18
  Well, maybe what I'll do is tell you what went wr- what's gone wrong [chuckles]- Perfect. [chuckles]... and maybe these are usually failures or at least snafus or better lessons learned. Um, so
• 42:30
  a-a-and yeah, the, actually drawing on what we did, uh, we've done, we're actually just wrapping up our third health tech venture challenge that we do with, uh, MATTER.
• 42:39
  And, and by the way, we, we'd welcome doing some of this, some of these things with StartUp Health as well, and we're, you know, we're kinda one of the founding investors in StartUp Health, so have a lot of respect for what StartUp's been doing.I didn't mention that, Scott, at the top of the hour, but it's, it's...
• 42:56
  I, I know it's been a, a fantastic working relationship- Yeah... having A- Advocate Aurora as an investor and a partner all these years. So- Yeah.
• 43:04
  And, and to give credit where credit's due, this really, Aurora did the deal, uh, to invest in StartUp Health before our merger, and I just inherited the relationship.
• 43:14
  I went to my first StartUp Health festival and, you know, right around the JPMorgan a couple years ago, and I was, I was actually kinda shell-shocked, 'cause there was, like, thousands of people and lots going on.
• 43:24
  I'm like, "I don't even know what to do." So I'm, I'm getting better at navigating that, that, that- Great... and I hope we come back together.
• 43:30
  But, um, a- and again, th- but this is just the lessons learned or, or things that didn't work well. So, and, and some of this is just lessons learned on our end.
• 43:38
  So, yeah, the, the company that we s- uh, that won our first, uh, health tech venture challenge, this is going back three or four years, really interesting company, kinda, uh...
• 43:49
  And we liked what they were doing, and we started partnering with them.
• 43:53
  And then, like all good founders, and I'm learning this from, you know, kinda running my own startup now, they changed their strategic direction, uh, opportunistically.
• 44:02
  Um, and therefore no longer, they were no longer interested in pursuing the things that we wanted to pursue with them, because they'd found a new opportunity. It was related, but it wasn't in our wheelhouse.
• 44:15
  So I don't... I, I think my lesson there is just if you're still fluid with your, what you're trying to accomplish or the means by which, you know, you're gonna achieve your growth and, and your vision, I think
• 44:32
  being upfront with the health system about that. C- and again, it's, it is... I don't think health systems, we are not used to changing direction quickly. We're not used to changing direction, um,
• 44:43
  a- and generally at all. And so, you know, we sort of felt like we got burned a little bit because these founders, you know, by the...
• 44:51
  And by the way, the other thing is you, and, and I always tell people, try not to have a business whose main source of revenue is selling to health systems.
• 44:58
  Now, probably all of you have some aspect of that, but, you know, someone once said the sales cycle to get into a health system is typically longer than your Series A and B rounds. Um, so
• 45:11
  it's just a very difficult process.
• 45:14
  So, but again, so one lesson learned, you know, again, founders can be fluid, and they should be, and that's part of being a startup, but that's not aligned with what big health systems are used to.
• 45:25
  And so that fluidity, uh, can, can be a challenge. I'd say one of the other things that, you know, I think we... This has certainly been something. Like, I,
• 45:38
  our jo- You know, we are a little bit, even though we're typically tax-exempt, we are a little bit like for-profit companies who have to, uh, you know, who basically have to make earnings forecasts and live up to those.
• 45:52
  Um, w- I have, you know, my, surprise, surprise, every single company that we've ever looked at investing in has a management presentation with, you know, quadrupling of revenue in two years, and then quintupling it in three, and getting from, you know, 3 million this year to 100 million in three years with, you know, 30 million in EBITDA.
• 46:15
  And surprise, surprise, n- not o- there's 100% failure rate on that. So I don't really know what to do about that. There seems to be a general acceptance of completely, you know,
• 46:30
  I guess, you know, un- un- believable management projections, and maybe the VCs are just used to that, and they sort of ease going into that. What is that, Scott? Maybe, maybe you could unpack that for us.
• 46:40
  What is that, the desire for that over- overly confident, uh, expression, and yet the knowledge that you're, you might be overreaching? Yeah. Well, I, I, I'd love to hear from the folks on this call.
• 46:52
  I mean, I think it's a, I think pro... You know, it's a competitive market for capital, and so you wanna put, you know, within some level of believability. And quite frankly, there's a buyer beware.
• 47:03
  You know, that's why VCs are generally pretty good at diligence.
• 47:06
  Um, you know, and PE guys are probably even better at financial diligence, and that's one of the reasons we like to partner with institutional investors in certain cases, 'cause we're not sure we're always the best at that.
• 47:18
  But, so maybe that's just the name of the game. But I will tell you, um, at least for us, it's the challenge, and maybe this is insight as you think, you know, down the road. The challenge for us is,
• 47:30
  you know, we've got a... You know, my job is not just, uh, strategic. It, that's the first and foremost thing, is to fulfill our strategy and our purpose, and that's why we're doing what we're doing.
• 47:42
  But if I only fulfill our strategic objectives and not our financial objectives, I'm a failure. If I've only fulfilled financial objectives but not advanced strategic objectives, that's also a fail.
• 47:53
  And on the financial side, you know, I need to
• 47:56
  be, I need to be contributing to the financial health of a low margin, generally declining business, which means the, I can't go out and invest in a bunch of companies that all say, "We're gonna be at 100 million," and tell my board, "These guys tell us they're gonna be at 100 million," and, and then every one of them fails to even come close to meeting expectations.
• 48:14
  Again, in, in a Wall Street world, you know, you get punished by stock price, and that's what holds you accountable- Mm-hmm... um, to sort of underpromise and overperform. So
• 48:25
  that is an incredibly important, for me, seeing some credibility, uh, with management projections actually gives me comfort that we're talking to people who are w- willing to be reasonable and realistic and transparent about the state of their business.
• 48:41
  That's a great point, Scott. I got a, a comment here from Jeanann from Unaliwear about projections. Jeanann, you wanna hop off mute?Sure. So, so Scott, um, Unaliwear is a wearable OnStar for people.
• 48:55
  Um, so that's, that's what we do. And, um, my background also includes decades in corporate in addition to my entrepreneurial world.
• 49:05
  And I'll tell you, what, what the VCs do is they actually decimate your forecast internally. Yeah.
• 49:10
  And so what happens is, right, so y- you've got the people right out of business school who actually, you know, take the deal flow information in, and then they fill in the little database grids.
• 49:21
  They take that 100 million, they turn it down to one million, and that's how you go into the internal grid, right? And I guess it would be 10 million. But anyway, uh- Yeah...
• 49:30
  you know, th- that's how you go into the grid. But if you were to give them a realistic forecast, when they decimate it, you don't have a forecast that's interesting enough for anybody to ever follow up with you.
• 49:41
  Yeah, I agree. So that's what's going on there. Yeah, it, it re- yeah. A- and by the way, we, you know, we do a haircut analysis. We call it the haircut analysis as well, but...
• 49:50
  And I get it, and, you know, I'm a, an advisor for a, you know, for a pretty reputable venture capital fund, uh, in, they're based in San Francisco and Nashville, and I sort of see what they, what they're up to.
• 50:02
  And, and, and we're investors as an organization, we're an LP in a handful of VC funds. So I get it. It is sort of a weird rat race, and it's sort of a self-fulfilling cycle.
• 50:12
  And, um, I think that is one area where perhaps, you know, we can be different. Uh, I hope, you know...
• 50:18
  O- one of the things we're, we are s- gonna struggle with, and it's already come up, is we're sort, we're a strategic investor.
• 50:25
  Like, a lot, the venture capital investors get really nervous about us 'cause they know as a strategic, they assume our ultimate goal is to take control of the company, and if they lose, if we have control, we can limit their upside in the event of a liquidity event.
• 50:39
  So that's an interesting, uh, dynamic, um, that we face, for what it's worth. But yeah, I, I understand the root cause of it. Uh, I, um,
• 50:53
  and, uh, I will just say that at least we w- we are trying to be a little bit different, um, 'cause, you know, we, we don't, we just are. Uh, and that, you know, we look at, I think we wanna get realistic numbers and,
• 51:08
  uh, and have the conversation and, and then decide. And by the way, our, we start with is it strategically aligned? That's our first goal. Then we'll deal with the numbers.
• 51:17
  Um, so anyway, it'll be, it's gonna be interesting how we evolve relative to the VC world. I mean, in, in, in one sense you do the same thing, you know, internally, right?
• 51:29
  When you're, when you're actually setting what are your financial goals that you're gonna get your bonus payments on, you, you set them as, as low as you can, and, you know, your management sets them as high as you can, and then you guys [laughs] I mean, it's no different.
• 51:42
  Know the drill. It's the same thing. Yeah. Except that the multiples are so much bigger from what it is you have to show a VC. That's right. That's fair. That's good. Yeah. Um, we got a couple more comments.
• 51:53
  We might not get to them. Well, you know what? W- we're just gonna make these our sort of final insights for the conversation. I wanna get as many voices as possible. So Sumeet, why don't you share your thought here?
• 52:04
  Oh, no. I mean, it's a similar comment in the sense the last three VCs I spoke to this past week, as they're in the middle of round, it's like, "We wanna see the billion dollar valuation," right? So and I'm like...
• 52:15
  So I've [laughs] been around the block, and I know. I've, I've done it backwards and inside out, and as, uh, the previous person, I've tripled the costs, and, uh, you know, one third the revenues.
• 52:26
  Then, then it doesn't fit into their equation, right?
• 52:28
  So they wanna say the high thing, and then Su- and then they told me, Sumeet, it's like, "Let us do that stuff on the back end, but just show us the sexy stuff so it sounds sexy." Yeah. It's an interesting conundrum.
• 52:39
  [laughs] And, and Dr. Greenhill, your, your last note. Well, just, uh, Scott, it's wonderful to deal with people who know the realities of how complicated and messy it is and yet still persevere in changing the world.
• 52:53
  And so I think your comments about, um, exaggerating, like, I do have an impatience and a frustration with a lot of the pilots in healthcare that are aiming to change the life of 1,000 patients, and some of the successes we've had with COVID is like, look, a million people use this app.
• 53:10
  And you're like, you do realize it's 330 million Americans, and so a million's not even a percentage.
• 53:16
  And so c- can we somehow meet in the middle and increase the size of programs and expectations and achievables without going as crazy as some of the VCs wants us?
• 53:27
  That would be my plea for the entire industry of healthcare. Yeah. I think that's, that's really good. Y- you know, the one other thing I would say on that note is
• 53:38
  the, the reason, now wh- while I, I hate businesses, you know, and I say this in, as an investor right now, you know, I, whenever our team brings up a company that ultimately is dependent on revenue by selling to health systems, I get really scared 'cause I know how hard it is from being on the other side.
• 53:54
  And I've done my share of slow nos, and you've probably all experienced that as well. But I would say that of all the places where you can actually make a difference, the health system is the place. Because- Mm...
• 54:08
  you know, while we are still not nearly as scaled as we need to be relative to a United or, um, an Aetna CVS, you know, Advocate Aurora, as an example, I said we serve 3 million people a, a year, unique lives, 10 million visits.
• 54:23
  So, like, if we can, if you can get a couple of, if we could get more health systems to come together, um,
• 54:30
  and work in a consor- and we're doing this a little bit more now in a, a consortium manner, where we can try these things, uh, and do it at scale and start impacting 20 million, 30 million people, to your point, Doctor, that gets interesting.
• 54:45
  So that is where, that is the promise of the health system. It's just you gotta crack, cracking the code of a health system is really hard, and there's,
• 54:54
  and they're not eq- they're equipped to run day-to-day operations, not to kind of field phone calls from really interesting startups. It's just, it's the way we're kinda built.
• 55:03
  So that, I, if we, if StartUp Health can help figure out how to crack the, the health system entry code, that could get really interesting. And I'm, I'm glad to be a resource. I, again, 28 years I've watched- Mm...
• 55:19
  a lot of things flounder through our system, and I've, I've let things flounder myself, so I know exactly what happens. Well, Scott, I think that is a, a great, uh, moment to end on.
• 55:30
  W- we're up to the top of the hour here. Scott, thank you so much for taking the last hour with us and being so candid.
• 55:36
  My pleasure, and, uh, I, I just commend all of you for the work you're doing and for your commitment to, uh, trying to improve health for [gentle music] the world and for our country.
• 55:45
  So thank you for what you do, and thanks to StartUp Health as well. It's, uh, it's really, it's noble work that we're doing. [upbeat music] Thanks for listening to StartUp Health NOW.
• 56:00
  StartUp Health invests in health transformers from around the world who are committed to achieving audacious health moonshots.
• 56:06
  If you wanna learn how you can join this community of entrepreneurs, or if you wanna connect with one of our 350 companies, go to startuphealth.com.
• 56:14
  If you'd like to learn how you can invest in our Health Moonshot Rolling Fund in collaboration with AngelList, go to healthmoonshots.com. Thanks for listening to StartUp Health NOW. We'll be back next week.