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What If Most Care Happens At Home By 2050 · Taking The Supply Chain Pulse

• 0:03
  SPEAKER_00: Hello and welcome to another episode of Taking the Supply Chain Pulse.
• 0:07
  SPEAKER_00: I'm Megan with Seenart Company, and we're glad you're with us.
• 0:10
  SPEAKER_00: Today, Fred connects with Dr.
• 0:12
  SPEAKER_00: Reuben Pillet, Chief Innovation Officer at the University of Alabama at Birmingham.
• 0:17
  SPEAKER_00: Together they talk about the importance of thinking unreasonably to drive innovation, the role of technology in healthcare, what the next 50 years could look like, and the trend shaping what's ahead.
• 0:28
  SPEAKER_00: It's a fun, thought-provoking conversation that explores what's possible when healthcare leaders dare to imagine a different future.
• 0:35
  SPEAKER_00: Now here's your host, Fred Franz.
• 0:38
  SPEAKER_01: Today we have with us Dr.
• 0:41
  SPEAKER_01: Reuben Pillet of the University of Alabama, Birmingham, who, among other titles that he possesses, includes the Chief Innovation Officer.
• 0:51
  SPEAKER_01: Dr.
• 0:51
  SPEAKER_01: Pillet, thank you for joining us.
• 0:54
  SPEAKER_02: Thank you for having me, Fred.
• 0:55
  SPEAKER_02: Really appreciate being with you.
• 0:56
  SPEAKER_02: Appreciate the invite.
• 0:58
  SPEAKER_02: Yeah.
• 0:58
  SPEAKER_01: Uh could you I I didn't have enough paper to write down all the roles and titles.
• 1:03
  SPEAKER_01: Could you tell the folks just a little bit about yourself and some of the roles you uh you uh serve at uh UAB and other places?
• 1:11
  SPEAKER_02: Yeah, yeah.
• 1:11
  SPEAKER_02: I uh wear many hats at UAB.
• 1:14
  SPEAKER_02: Uh my primary role is is I'm of course I hold a professorship in uh in in medicine.
• 1:20
  SPEAKER_02: I'm also assistant dean at the School of Medicine here at UAB, which incidentally is one of the largest academic medical centers in the country.
• 1:29
  SPEAKER_02: I'm also chief innovation officer of the UAB health system.
• 1:33
  SPEAKER_02: Uh the UAB Health System is a fifth largest healthcare system in the USA.
• 1:39
  SPEAKER_02: Uh and you know, uh I'm also the executive director of the HISINC Institute for Biomedical Innovation, which is the home of our AI and digital technology uh operation within UAP.
• 1:57
  SPEAKER_02: And what that means is we have a combination of academic programming.
• 2:03
  SPEAKER_02: In fact, uh, we currently are the world's largest academic training center for AI in medicine, which is a pretty big deal.
• 2:11
  SPEAKER_02: Uh we also have our own AI lab where we build solutions uh internally for the health system and the departments as well.
• 2:19
  SPEAKER_02: So that's my formal job, which is, you know, uh I would say spans a lot of different responsibilities, which actually I think contributes to the success of what we do.
• 2:33
  SPEAKER_02: On a personal level, I frame myself uh more as somebody who works at the intersection of medical futurism, healthcare innovation, healthcare entrepreneurship, and technology and AI in healthcare.
• 2:51
  SPEAKER_02: And I think you know that kind of uh uh Trinity helps us not just uh take a peek into the future, but helps us understand how to execute on on that as well.
• 3:08
  SPEAKER_02: So yeah.
• 3:09
  SPEAKER_01: Great.
• 3:09
  SPEAKER_01: We're gonna get into a little bit of the futurism later.
• 3:12
  SPEAKER_01: Um when I when I looked at your LinkedIn page, I I saw this sort of uh thing behind you that said, thinking unreasonably to drive innovation in healthcare.
• 3:22
  SPEAKER_01: Can you can you tell us what that means?
• 3:24
  SPEAKER_02: Yeah, I I mean, you know, one of the quotes that I'm really fascinated by, and something that I either open my keynote with or close it, is a quotation by George Bernard Shaw.
• 3:41
  SPEAKER_02: And George Bernard Shaw said that the reasonable man or woman adapts himself or herself to the world, the unreasonable man or woman adapts the world to him, therefore, all progress comes from the unreasonable man or woman.
• 4:01
  SPEAKER_02: And I think you know that summarizes what healthcare needs.
• 4:06
  SPEAKER_02: I think for too long we have been a reasonable profession.
• 4:12
  SPEAKER_02: Uh and the reality is if you look at uh where we have come uh as a profession, uh it's not very far in terms of outcomes, in terms of cost, in terms of quality access, and all of the metrics you use.
• 4:29
  SPEAKER_02: So we really need a radical rethink of how things are done in healthcare.
• 4:36
  SPEAKER_02: Uh and the time has come for you know out of out-of-the-box thinking.
• 4:41
  SPEAKER_02: Uh, you know, what I call is uh inverting the problems, you know, not taking traditional approaches to solving it because it's really not helping us.
• 4:52
  SPEAKER_02: So that's what I mean by unreasonableness.
• 4:55
  SPEAKER_02: I I think we've got to adapt the future to us.
• 5:00
  SPEAKER_02: A lot of what happens in healthcare now is we're trying to fit into what the the legacy that we've already built.
• 5:07
  SPEAKER_02: So so that in principle is is is why that has kind of been my mantra.
• 5:13
  SPEAKER_01: So you're espousing creative rather than linear or incremental thinking.
• 5:19
  SPEAKER_01: Is that fair to say?
• 5:21
  SPEAKER_01: That's absolutely what it is.
• 5:22
  SPEAKER_01: Yeah, absolutely.
• 5:24
  SPEAKER_01: So it's gonna be it's gonna be the liberal arts free thinkers that are gonna shape the world instead of the engineers.
• 5:30
  SPEAKER_02: Well, a combination, uh, or at least, you know, uh getting engineers through to put on the to to see the world through a liberal arts lens, and getting the liberal arts folk to see the world through an engineer lens.
• 5:44
  SPEAKER_01: Absolutely.
• 5:45
  SPEAKER_02: I think that's what I'm trying to say is you you cannot get a healthcare leader or healthcare professional to see healthcare through the lens of healthcare.
• 5:55
  SPEAKER_02: And this is the problem with us.
• 5:56
  SPEAKER_02: I uh you know a lot of the challenges, Fred, that we face in healthcare have been solved by other industries.
• 6:04
  SPEAKER_02: Right.
• 6:05
  SPEAKER_02: So uh so you know, for other industries, what's reasonable would by default mean is unreasonable in healthcare.
• 6:15
  SPEAKER_02: But it it that's the kind of approach we need to take.
• 6:19
  SPEAKER_01: Very, very, very true.
• 6:21
  SPEAKER_01: So why don't you tell us what are the major challenges that you think we face in healthcare that force sustainability and and paint the current picture of healthcare as you see it?
• 6:32
  SPEAKER_01: So we have a starting point in this conversation.
• 6:35
  SPEAKER_02: So when you talk about sustainability, you mean about a sustainable healthcare system, or you're talking about sustainability from an eco point of view?
• 6:43
  SPEAKER_01: I'm talking about a sustainability healthcare system, one that one that would one that will serve uh serve um the population uh favorably instead of just transactionally.
• 6:55
  SPEAKER_02: Yeah.
• 6:55
  SPEAKER_02: I mean that you know clearly that's not a not a uh simple uh singular answer.
• 7:02
  SPEAKER_02: You know, it's it's multifactorial.
• 7:05
  SPEAKER_02: Uh I think um uh you know you let's start with the key problems that we face, and they they're huge problems.
• 7:14
  SPEAKER_02: You know, access is a major issue that we have in healthcare.
• 7:19
  SPEAKER_02: Cost is on an unsustainable trajectory.
• 7:23
  SPEAKER_02: Uh that's a major challenge.
• 7:26
  SPEAKER_02: The quality of care and the you know, the data specifically regarding quality of care is pretty scary.
• 7:35
  SPEAKER_02: If you look at outcomes, you know, if you look at patient error, if you look at you know uh debts attributed to care, if you look at outcomes like maternal mortality, child mortality, etc.
• 7:48
  SPEAKER_02: If you look at all of these outcomes and quality metrics, that you know they really don't reflect what I would call a high-performing industry.
• 8:01
  SPEAKER_02: So there we we have all of these issues, and I think so.
• 8:06
  SPEAKER_02: You can't attribute them to any particular reason.
• 8:11
  SPEAKER_02: Uh, you know, we require what I call a substantive business and operating model redo.
• 8:21
  SPEAKER_02: If we're going to the current business and operating model, uh does not and will not address the challenges that we have.
• 8:29
  SPEAKER_02: In fact, you could argue is you know, which something that was the ideal business and operating model for care in the 19th century doesn't work in the 21st century.
• 8:44
  SPEAKER_02: So it worked then.
• 8:46
  SPEAKER_02: Uh and we have never changed that business and operating model in healthcare for centuries.
• 8:53
  SPEAKER_02: In fact, prisons have evolved more in the last two centuries than the business and operating model of healthcare.
• 9:02
  SPEAKER_02: And my my you know my take is uh we we can't be tweaking healthcare at the edges because the problems are so enormous that it's going to have to take a radical rethink, a radical redesign to achieve that.
• 9:22
  SPEAKER_02: And and we've never been, and this is kind of you know what's exciting for me in the role that I that that that I uh play.
• 9:32
  SPEAKER_02: We've never been better positioned to actually execute on that.
• 9:36
  SPEAKER_02: Okay now, you know, uh uh I buy it that that uh we we we never had the ability to transform the business and operating model or the or change the systemic issues that we face, but we have it now.
• 9:54
  SPEAKER_02: If we look at you know, the technologies like artificial intelligence and digital technology and communication technology and sensor technology and biotech and all of these kind of technologies that are now available and that are you know non-expensive, by the way, they're all coming together now to create this kind of perfect window of opportunity for us to transform.
• 10:24
  SPEAKER_02: So we now have.
• 10:25
  SPEAKER_02: So the question is you know, are we going to take advantage of this opportunity?
• 10:33
  SPEAKER_02: Are we going to capitalize on these uh these uh drivers to transform healthcare?
• 10:42
  SPEAKER_02: And and you know, uh I think it's time, you know, as I say to healthcare leaders, the problem is very few people in healthcare take big swings at the challenges and problems that we have.
• 10:58
  SPEAKER_02: They're all tweaking at the edges and making incremental changes, you know, either to improve efficiency of a hospital, to become a better researcher, to publish, to win more funds.
• 11:11
  SPEAKER_02: You know, that's just not going to cut it.
• 11:14
  SPEAKER_02: We've got to swing big and uh solve some of these big problems.
• 11:19
  SPEAKER_02: You know, we're seeing it happen, by the way, in other industries.
• 11:22
  SPEAKER_02: Look at space travel and look at what you know.
• 11:26
  SPEAKER_02: Elon Musk is a classic example, whatever you think of him, he's a classic example of somebody who swings big.
• 11:35
  SPEAKER_02: And what happens at the end of that?
• 11:37
  SPEAKER_02: You know, you start becoming transformative.
• 11:40
  SPEAKER_02: So he's a good example of unreasonable thinking.
• 11:44
  SPEAKER_02: The fact that thinking that you can commoditize space travel was unreasonable when he first pitched the idea.
• 11:53
  SPEAKER_02: But it's rapidly becoming mainstream, and you can argue from the time he set off on this part within two decades, it becomes commoditized and and transformative for society, not the industry, the societal transformation, you know.
• 12:12
  SPEAKER_02: So what's it gonna take?
• 12:17
  SPEAKER_02: It's gonna take policymakers and leaders who prepare to take big swings.
• 12:22
  SPEAKER_02: And and yeah, you know, so I I I was gonna say uh you gotta wanna.
• 12:30
  SPEAKER_01: And every every uh every every business in our country in my lifetime uh wants to maintain the status quo instead of creating the future.
• 12:44
  SPEAKER_01: And so I have to ask you this.
• 12:46
  SPEAKER_01: Do you think that healthcare leaders want to create the positive future?
• 12:52
  SPEAKER_01: Or do they when I say sustainability, do they want to sustain uh the meager existence that they're uh they're eking out right now as opposed to doing what you need to do to make things better?
• 13:05
  SPEAKER_02: Yeah, I'm not I'm I'm not gonna agree with you and say they're eking out in existence now.
• 13:09
  SPEAKER_02: The reason they maintain the status quo because it's more than eking out.
• 13:13
  SPEAKER_02: I mean, if you look at you know the big players like insurance companies and some of the big health systems, they're not eking out.
• 13:20
  SPEAKER_02: You know, they're the status quo is designed, uh uh is designed for their uh economic gain.
• 13:28
  SPEAKER_02: So, you know, uh it's going to have to be individuals who really are purpose-driven to do this.
• 13:38
  SPEAKER_02: And you know, one of the things or one of the responsibilities I have uh as an academic is to ensure people who pass through my school and my institute develop a more purpose-driven mindset.
• 13:56
  SPEAKER_02: So they they see the forest and not just the tree.
• 14:01
  SPEAKER_02: Uh, and and you know, that's the kind of leader we need to cultivate now.
• 14:07
  SPEAKER_02: When they see that more than half the world doesn't have access to care, and that's a problem worth solving.
• 14:14
  SPEAKER_02: That's the big swing.
• 14:16
  SPEAKER_02: You know, not just the uh patient with diabetes who's non-compliant.
• 14:23
  SPEAKER_02: And uh, you know, uh we just don't have enough of that in healthcare, and and that's what it's going to take, you know.
• 14:33
  SPEAKER_02: Purpose-driven, unreasonable, uh yeah, take big swings.
• 14:39
  SPEAKER_01: Um this is an editorial remark, and I and you don't need to comment on it.
• 14:43
  SPEAKER_01: Yeah, but I I think that capitalism is a me-driven philosophy, and what you're talking about is a we driven approach, and that's a that that's a different thing.
• 14:52
  SPEAKER_01: Um Absolutely.
• 14:54
  SPEAKER_01: No, I agree with you.
• 14:55
  SPEAKER_01: I agree with you.
• 14:55
  SPEAKER_01: Yeah.
• 14:56
  SPEAKER_01: So um uh two things.
• 14:58
  SPEAKER_01: Number one, what approaches what what approaches must be taken, and what role will technology play in uh in building a positive future?
• 15:08
  SPEAKER_02: I I I think technology is the answer.
• 15:10
  SPEAKER_02: It's the answer that we've been waiting for patiently.
• 15:14
  SPEAKER_02: It is now here.
• 15:16
  SPEAKER_02: The question is, uh do we have uh people or sufficient number, critical mass of people who have the vision uh that's purpose-driven to embrace the technology to make transformative change?
• 15:34
  SPEAKER_02: Two.
• 15:34
  SPEAKER_02: That's the first thing.
• 15:36
  SPEAKER_02: Secondly, is uh you can have the vision if you don't have the resources allocated to that vision, if you don't have the uh appropriate uh organizational support, if you don't have the appropriate policy support, if you don't have the appropriate funding support, uh, then of course it's really difficult to achieve.
• 16:02
  SPEAKER_02: So I think uh one, we need people with these ambitious purpose-driven visions.
• 16:11
  SPEAKER_02: We need to support them from a policy framework, we need to support those from an organizational framework and resource framework as well.
• 16:21
  SPEAKER_02: So, you know, uh, as I said, always come back to you know, space travel as a really good example of, you know, an unreasonable vision that had the support either by individuals, but there was a lot of government backing on a policy space as well, you know, to democratize access to space travel and not make it NASA-centric.
• 16:47
  SPEAKER_02: So there was a lot of those back-end things going on to enable this.
• 16:50
  SPEAKER_02: That's what we need in health tech.
• 16:52
  SPEAKER_02: You know, healthcare is over-regulated, that's the problem, you know.
• 16:56
  SPEAKER_02: And regulation and innovation and entrepreneurship don't go together.
• 17:03
  SPEAKER_02: So, you know, we deen we need to deregulate healthcare to enable this.
• 17:10
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• 17:15
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• 17:18
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• 17:37
  SPEAKER_01: Yeah, there's almost there's almost uh a sort of a cut a contradictory thing there.
• 17:43
  SPEAKER_01: You know, regulation ostensibly comes about because uh if you don't regulate, you're likely to get screwed.
• 17:49
  SPEAKER_01: And uh and uh and uh you know left the the um thought being that left uh folks own devices, they're gonna optimize for themselves and not not take care of everyone else.
• 18:01
  SPEAKER_01: But you're right, the the regulation is is phenomenal.
• 18:04
  SPEAKER_02: Yeah, because I you know it's a double-edged sword, isn't it?
• 18:08
  SPEAKER_02: You you want to regulate to protect society, uh, but on the other hand, the supply side capitalizes on the regulation to maintain uh monopolistic or olig oligopolistic behavior.
• 18:20
  SPEAKER_02: So so uh we have to radically rethink how we regulate.
• 18:26
  SPEAKER_01: So so let's get into your role as healthcare futurist, okay?
• 18:32
  SPEAKER_01: Um, and I I generally believe, just listening, that you probably have an optimistic viewpoint of uh of the future.
• 18:40
  SPEAKER_01: So tell us this won't apply to me because I'm 80 years old, but uh tell me what you what healthcare will look like in 2050.
• 18:49
  SPEAKER_02: Yeah, I I think it's uh for sure, you know, it's not going to be what it is today.
• 18:57
  SPEAKER_02: Uh and technology is going to to to to kind of radically reframe and redefine healthcare.
• 19:06
  SPEAKER_02: We're kind of starting to see, I think if you if you're if you're tracking the changes uh in healthcare at the moment, you're starting to see the kind of canary in the coal mine, uh, you know, hints in terms of where it's going to.
• 19:21
  SPEAKER_02: Uh the first hint is a shift towards prosumerization of care, meaning that patients are now becoming producers of their own care.
• 19:36
  SPEAKER_02: Okay, you're starting to see that.
• 19:38
  SPEAKER_02: You know, not so long ago, you had to see a physician or a nurse to take a blood pressure, to get your blood glucose checked, to run basic, you know.
• 19:46
  SPEAKER_02: Today, technology has enabled patients to perform a lot of those functions.
• 19:54
  SPEAKER_02: Okay, it's starting.
• 19:56
  SPEAKER_02: So I coined the term prosumerization for that.
• 19:59
  SPEAKER_02: So I think by 2050, prosumerization would be the primary business model.
• 20:05
  SPEAKER_02: I I think 70% of all health care will be delivered by individuals, and they and that will happen at home.
• 20:16
  SPEAKER_02: So you could see the challenges that we face today in terms of cost being reduced to almost zero.
• 20:24
  SPEAKER_02: Wait times are going to be reduced to almost zero, exclusion rates are going to be reduced to almost zero.
• 20:31
  SPEAKER_02: So all of the big challenges that we're grappling with today should be eliminated.
• 20:37
  SPEAKER_02: And prosumerization to me is this vehicle to eliminating the challenges that we face.
• 20:45
  SPEAKER_02: I think the other big shift that we're starting to see now is kind of automation.
• 20:52
  SPEAKER_02: Medical automation is going to become mainstream.
• 20:55
  SPEAKER_02: And you you kind of see, you know, you hear about robotics doing surgery with assisted uh by humans, etc.
• 21:04
  SPEAKER_02: But but this combination of robotics and artificial intelligence is going to transform the future of healthcare.
• 21:12
  SPEAKER_02: Has consequences for the profession, but but as a system, I I think uh you're going to find a lot of services going to become automated.
• 21:22
  SPEAKER_02: You know, automation ranges from ATM-like medicine to autonomous robots doing surgery.
• 21:32
  SPEAKER_02: And when automation kicks in, what happens?
• 21:35
  SPEAKER_02: Productivity in healthcare goes up, and theoretically, costs should come down.
• 21:40
  SPEAKER_02: You know, one of the reasons, Fred, that each one of us has two cell phones, two cars, and two of everything, and three of everything is because those industries have automated, okay, and productivity has gone up.
• 21:53
  SPEAKER_02: And productivity generally manifests itself in terms of uh quality.
• 22:00
  SPEAKER_02: Living.
• 22:00
  SPEAKER_02: Okay.
• 22:02
  SPEAKER_02: Healthcare is unique, was unique in the sense that is.
• 22:06
  SPEAKER_02: In the sense that whenever you introduce a technology in healthcare, two things happen.
• 22:11
  SPEAKER_02: Access goes down and costs go up.
• 22:13
  SPEAKER_02: Okay.
• 22:15
  SPEAKER_02: And uh so somebody is skimming off that uh uh demonetization that should and deflation that should come with automation.
• 22:25
  SPEAKER_02: But I think that's going to change.
• 22:26
  SPEAKER_02: So that's gonna be a huge shift in 2050.
• 22:29
  SPEAKER_02: You're gonna see a lot of automated care delivery.
• 22:33
  SPEAKER_02: I I think a lot of care is going to be uh uh what I call uberized, or well, today not even uberized, way more fine.
• 22:42
  SPEAKER_02: You know, it's uh essentially you'll be able to access care, uh AI-driven care, like you would an autonomous cab from anywhere in the globe and get real special quali specialist quality health care.
• 22:56
  SPEAKER_02: We're already building solutions here now that I think will be mainstreamed in the next decade, where you could have the most complex cancer, the most complex cardiology issue, irrespective.
• 23:11
  SPEAKER_02: But you know, you could just access our platform from here and get the best level of specialty diagnosis and treatment protocol within minutes.
• 23:22
  SPEAKER_02: Okay?
• 23:23
  SPEAKER_02: And that in a decade or so would be free.
• 23:26
  SPEAKER_02: So it's you know, it's platformification of care, whey morphication, call it what you want.
• 23:30
  SPEAKER_02: I think that's going to be, and and and you can see the impact of that from a cost access and quality point of view as well.
• 23:37
  SPEAKER_02: I I think you're going to see uh a huge shift uh in terms of um a shift from sick care to welfare.
• 23:49
  SPEAKER_02: The current model, when you talk of healthcare today, you're in effect talking about a model built economically, operationally on illness.
• 24:01
  SPEAKER_02: Okay, and uh, you know, we now have this ability to collect data from individuals from the time they're born or even pre-birth to the time they die, which means that we can start now making that transition up the value chain in terms of life cycle to start identifying uh predispositions, uh, predictors of illness and ill health very early on and intervening really early on.
• 24:37
  SPEAKER_02: Yeah, so so we're gonna see that.
• 24:39
  SPEAKER_02: We're gonna see science-based wildcare longevity become a big thing.
• 24:44
  SPEAKER_02: Uh and you could see that's gonna result in the emergence of a whole new discipline that I'm, you know, interventional preventive medicine, where we're gonna start doing uh interventional surgeries to prevent uh, you know, in some shape is happening at a very small scale today.
• 25:06
  SPEAKER_02: You know, you have some females who had high risk of breast cancer doing preventive mastectomies.
• 25:11
  SPEAKER_02: I think when we start, when we're able to, you know, kind of start doing that from childhood and identifying high-risk individuals because they're genetically and environmentally predisposed, you know, what preventive uh surgery would we intervention would we have to take?
• 25:30
  SPEAKER_02: Now, this could go to pre-birth because gene editing, CRISPR, you know, which you've probably heard of, which is pretty mainstream now, gene editing is preventive surgery, but it's surgery at the level of the DNA.
• 25:45
  SPEAKER_02: Okay, so so you know you're you're gonna see that kind of emerge as a uh uh as a big uh uh change.
• 25:55
  SPEAKER_02: I I think on the provider side, the concept of a physician and a specialist will disappear.
• 26:01
  SPEAKER_02: Uh I think what you're going to find is I'm framing them now as omnispecialists or polymath physicians uh because you really don't need a cardiologist and a nephrologist and an endocrinologist.
• 26:19
  SPEAKER_02: You know, artificial intelligence can make a single physician a multi-specialist.
• 26:26
  SPEAKER_02: Okay.
• 26:27
  SPEAKER_02: And so so they won't just have breath, they'll have breath and depth in every specialty.
• 26:35
  SPEAKER_02: So essentially, you know, this notion of specialties, etc., I think will will disappear.
• 26:42
  SPEAKER_02: Uh I think uh if we look at the typology of hospitals for 2050, given everything I'm just talking about, and the fact that I think 70% of care is going to be delivered at home by patients.
• 26:56
  SPEAKER_02: So, what's the hospital system going to look like?
• 26:59
  SPEAKER_02: I think in 2050, it's just going to be reserved for very acute care and interventional stuff, you know, trauma surgery, surgical intervention, whether it's uh for treatment or prevention.
• 27:12
  SPEAKER_02: I think that's one typology.
• 27:15
  SPEAKER_02: I think uh hospitals of the future will be merely command centers.
• 27:20
  SPEAKER_02: There'll be air traffic control centers where you know uh folk located in there are managing this population that's out at home, you know, distributing diagnostic tests, uh, analyzing results, and working kind of as real air traffic controllers.
• 27:38
  SPEAKER_02: So that's gonna be a the second typology.
• 27:42
  SPEAKER_02: I think the third we're gonna start seeing is centers come up with complex diagnostics.
• 27:48
  SPEAKER_02: You know, uh today, I think in 2050, if you look at where material science is going, nanotechnology, artificial intelligence, quantum, all of those things, we're gonna have access to really, really, really sophisticated diagnostic technology that we uh we can't even envision today.
• 28:08
  SPEAKER_02: And they may be imaging, they may be biological.
• 28:10
  SPEAKER_02: So you're gonna have these very complex technologies located in the third typology, these uh diagnostic centers.
• 28:19
  SPEAKER_02: And the fourth typology, I think, uh builds on the advances in biotechnology.
• 28:25
  SPEAKER_02: And I think that's going to be regenerative medicine and longevity centers, where people are coming in for stem cell transplants, they're coming in for you know uh genetic treatment, gene therapies, uh longevity kind of treatments, et cetera, which which would be mainstream by then.
• 28:46
  SPEAKER_02: So yeah, that's that's to me is uh is what it's gonna look like.
• 28:51
  SPEAKER_01: Well that's pretty optimistic.
• 28:52
  SPEAKER_01: I mean, uh the the one central thing though that you know you started off with that I've always been a big uh um proponent of is you know welfare versus sick care.
• 29:04
  SPEAKER_01: Uh our whole system is based on waiting until you have symptoms and then going to a hospital as opposed to uh leading uh leading uh a life that uh uh avoids disease as much as possible.
• 29:19
  SPEAKER_01: Um so that being said, um my my next question is uh you at least.
• 29:28
  SPEAKER_02: Let's just kind of flesh that out a bit.
• 29:30
  SPEAKER_02: I mean, I think so.
• 29:32
  SPEAKER_02: Well why have we not been able to pivot?
• 29:36
  SPEAKER_02: And one of the reasons is we we we couldn't understand the economic model for welfare.
• 29:42
  SPEAKER_02: We have a pretty good sense of the economic model for sick care, you know, how to bill, what to bill for, and how to do that.
• 29:49
  SPEAKER_02: We've got that fleshed out.
• 29:52
  SPEAKER_02: How do you bill for somebody who comes for you know to stay healthy?
• 29:57
  SPEAKER_02: So so the the the the when I say business model uh needs to be disrupted, that that's something I'm talking about as well.
• 30:05
  SPEAKER_02: It is, you know, what is the financial model that you're gonna build to be able to remunerate folk who operate in the welfare space?
• 30:16
  SPEAKER_02: I think it's starting to evolve.
• 30:18
  SPEAKER_02: And I think, you know, uh we're certainly looking at uh at some models here around.
• 30:26
  SPEAKER_02: So once we really uh get a grasp on on the financial models, because the current hospital system and healthcare, sick care systems, their only survival strategy is going to pivot to become welfare.
• 30:41
  SPEAKER_02: So they're gonna have to understand how to monetize welfare.
• 30:46
  SPEAKER_02: And so you know, so a lot of work has to be done in understanding that.
• 30:50
  SPEAKER_01: Yeah, and I would counter with that with the fact that this has societal impacts too.
• 30:57
  SPEAKER_01: Wellcare means you're selling healthy lifestyle.
• 31:00
  SPEAKER_01: So you're gonna impact McDonald's, you're gonna impact uh you're gonna impact all the extremely profitable industries that create the problem, that contribute to creating the problem.
• 31:12
  SPEAKER_01: And and they're gonna fight you at every uh at every step of the way, I would imagine, because they want to keep making the big bucks.
• 31:19
  SPEAKER_01: So uh I think that's gonna be the daunting part of the challenge is to for people to understand that and will willingly move toward that.
• 31:27
  SPEAKER_02: Yeah, but I think one p the one thing folk discount is the fact that the leaders of these corporates in two decades from now are the Gen Z folk today.
• 31:42
  SPEAKER_01: Okay.
• 31:43
  SPEAKER_01: There you go.
• 31:44
  SPEAKER_02: So this generational shift in leadership is essentially part of this the this this this kind of collision of fortune that I think we're we're we're setting ourselves up to.
• 31:58
  SPEAKER_02: I think when you look at future patient bases, they're gonna be uh generation beta, generation alpha.
• 32:06
  SPEAKER_02: You know, they're tech savvy.
• 32:09
  SPEAKER_02: They're really, you know, they're gonna hold our feet to the fire.
• 32:15
  SPEAKER_02: But the great thing is they're gonna be in leadership positions, they're gonna be the dominant market.
• 32:20
  SPEAKER_02: And if you're at McDonald's and you think you're gonna survive with a big Mac without lettuce and tomorrow options, you're gonna be out of business.
• 32:27
  SPEAKER_02: I can assure you about that.
• 32:29
  SPEAKER_02: And I I think that's what's going to help reshape healthcare as well.
• 32:33
  SPEAKER_02: I make this a big deal.
• 32:34
  SPEAKER_02: It it is the generations in leadership in 2050 and your patient base in 2050 is is as different as you can imagine from where we are today.
• 32:48
  SPEAKER_02: Uh and I can't wait for that.
• 32:50
  SPEAKER_01: The generation of that's the most optimistic thing you've said uh here is the change in the gener the change in the worldview of the generations that are forthcoming.
• 32:59
  SPEAKER_01: So just two more things before we go.
• 33:01
  SPEAKER_01: Number one, um, you had uh given a talk at 2022 at Strategic Marketplace Initiative uh uh conference about the next bet next big thing, and I wanted uh ask you what the immediate next big thing in healthcare is.
• 33:16
  SPEAKER_01: And finally, um you talk about the idea of a chief artificial intelligence officer.
• 33:23
  SPEAKER_01: Yeah, and and and tell us a little bit about that and what that role looks like.
• 33:27
  SPEAKER_01: Those are my my two last things to cover.
• 33:30
  SPEAKER_02: Yeah, I I I think the next big thing is is here already.
• 33:34
  SPEAKER_02: When I spoke about that in 2022, I was probably alluding to artificial intelligence.
• 33:39
  SPEAKER_02: I think it's here.
• 33:40
  SPEAKER_02: The next big thing for us is to uh deploy it at scale in a responsible way.
• 33:46
  SPEAKER_02: We're far from that.
• 33:48
  SPEAKER_02: So it's still kind of the next big thing because it's it's all hype at the moment.
• 33:53
  SPEAKER_02: Okay, we're we're trying to find our way.
• 33:55
  SPEAKER_02: Uh and so I think the ubiquitous deployment of AI at scale for clinical and non-clinical uses in health is something that I'm looking forward to.
• 34:07
  SPEAKER_02: I I still think we're about a decade away from that.
• 34:10
  SPEAKER_02: You know, that might uh you might be surprised at that, but I think that's where we are.
• 34:17
  SPEAKER_02: Uh it's just because of the nature of this profession.
• 34:20
  SPEAKER_02: But anyway, listen, you know, it took Waymo 17 years from conception to being accepted.
• 34:29
  SPEAKER_02: You know, it took us in healthcare 30 years to accept hand washing as an evidence-based approach to reduce infection rate.
• 34:39
  SPEAKER_02: Okay, so so so you know, when I say I think we're still about a decade away, uh, that's what I mean.
• 34:46
  SPEAKER_02: Uh, in terms of the chief AI officer, yeah, I I think it's a critical role uh that uh it's a it's a leadership role.
• 34:55
  SPEAKER_02: I mean, ultimately, you know, we're going to have to have leaders who have uh not just a conceptual and technical understanding, but understanding the economics, the business uh-related aspects of AI in healthcare and medicine.
• 35:12
  SPEAKER_02: And that's a unique phenotype, uh, you know, with multiple skill levels.
• 35:17
  SPEAKER_02: There are very few of these folk that are available, uh, but I think it's going to become the next biggest position, uh, and they would become an integral part of the C-suite of the future.
• 35:32
  SPEAKER_02: What we have done is we have already launched uh the a training program actually to develop this phenotype of CHAIOs.
• 35:43
  SPEAKER_02: And uh yeah, the phenomenon the response to that is phenomenal.
• 35:46
  SPEAKER_02: So, one, the training is available, but of course, there's a lead time before those guys become available.
• 35:53
  SPEAKER_02: And in the interim, we're actually offering uh fractional CHAIO positions as well.
• 36:00
  SPEAKER_02: So folk who have the phenotype and who have the skill set, you know, uh, you could use them for part of the time to help guide you.
• 36:09
  SPEAKER_02: So, so yeah, yeah, you know, everything starts and ends with leadership, uh Fred, as you know.
• 36:15
  SPEAKER_02: Uh so without having this transformational capacity and capability, we'll still be talking about uh, you know, does hand washing work or not?
• 36:25
  SPEAKER_02: I mean, that that's my biggest fear, is is we let this window pass without uh leadership and policy and uh uh you know thinking through business operating models, etc.
• 36:38
  SPEAKER_01: Well, Simil Weiss was ahead of the curve, we know that.
• 36:42
  SPEAKER_01: With a hand wave.
• 36:43
  SPEAKER_02: You know, ironically, if you if you listen to his story, he he was actually uh frowned upon by healthcare.
• 36:50
  SPEAKER_02: I know, I know, absolutely.
• 36:52
  SPEAKER_02: Yeah, he ended up in an asylum dying 30 years later off septicemia.
• 36:58
  SPEAKER_02: So it's a it's a poignant story of of how we operate in healthcare.
• 37:05
  SPEAKER_01: Oh yeah, and we have at least one president, Garfield, who uh who died because of the fact that uh he was given prehistoric uh uh health care and no one washed their hands.
• 37:16
  SPEAKER_01: You know, the whole Civil War was uh you know, cut off one guy's leg and go to the next one, and uh we don't do anything in between.
• 37:23
  SPEAKER_01: So yeah.
• 37:24
  SPEAKER_01: So I was impressed with when you pointed that out.
• 37:26
  SPEAKER_02: That was but I mean so you think about it, you know, if it took us 30 years to learn how to wash our hands or to accept that, you know, we shouldn't we shouldn't have very high expectations in in terms of uh the the broad broad and wide-scale acceptance of AI.
• 37:43
  SPEAKER_02: That's my feeling.
• 37:44
  SPEAKER_01: Very good.
• 37:45
  SPEAKER_01: Well, Ruben, it's been great having you on the podcast.
• 37:49
  SPEAKER_01: And you've identified another topic that I'd like to get in with you on a future podcast, and that is when you talked about uh the uh the uh generations that are that are becoming present.
• 38:00
  SPEAKER_01: Uh we have any given place usually has about five generations in it, yeah each of has each of which has a different world view.
• 38:11
  SPEAKER_01: And and uh I'd I'd be interested to have a podcast where we discuss that in leadership and and how you integrate those things into uh a package that works for everybody.
• 38:21
  SPEAKER_02: Absolutely.
• 38:21
  SPEAKER_02: I mean, uh uh yeah, Fred, I that's a fantastic topic.
• 38:25
  SPEAKER_02: I actually wrote a blog on that a while ago, attributing a lot of the conflict uh within the healthcare space at the moment due to intergenerational rifts.
• 38:36
  SPEAKER_02: Uh you know, uh exactly what you're saying is when you have three or four different generations working in the same organization with different purposes and different missions and visions of of uh uh how things should be done, you're gonna get conflict.
• 38:52
  SPEAKER_02: And and uh and and it's not not always creative conflict, you know.
• 38:57
  SPEAKER_02: So yeah, yeah, but it's exciting, it's an exciting time.
• 39:00
  SPEAKER_02: So yeah.
• 39:01
  SPEAKER_01: Well, thanks so much.
• 39:02
  SPEAKER_01: You've elevated the level of uh conversation in our blog for this.
• 39:07
  SPEAKER_01: You're way over my head, but I've tried to keep up.
• 39:10
  SPEAKER_02: You know, yeah, you're great, Fred.
• 39:11
  SPEAKER_02: Thank you so much for having me.
• 39:13
  SPEAKER_02: I appreciate that.
• 39:14
  SPEAKER_01: Yep.
• 39:14
  SPEAKER_01: And we'll seriously, I wanna I want to get back again with uh with uh the different generations of uh folks in the workplace because I think that's uh I think that's a very valuable topic to be talking about.
• 39:26
  SPEAKER_02: And not just the workplace, it's also your customer base, your client base.
• 39:30
  SPEAKER_02: Okay, yep.
• 39:31
  SPEAKER_02: You know, the your client today is not going to be the same as your it's not this passive uh consumer in 2050.
• 39:41
  SPEAKER_02: So it's going to be fascinating because you you got to look at both the supply side and the demand side and and the generational impact of that.
• 39:49
  SPEAKER_01: Okay, Ruben.
• 39:50
  SPEAKER_01: Well, thank you so much.
• 39:51
  SPEAKER_01: It's been a pleasure having you here, and I hope to talk to you again soon.
• 39:54
  SPEAKER_02: Thank you, Fred.
• 39:55
  unknown: Thank you.
• 39:55
  SPEAKER_01: Take care.
• 39:56
  SPEAKER_01: See you.
• 39:56
  SPEAKER_02: Pleasure to have you again.
• 39:58
  SPEAKER_01: Bye.
• 40:01
  SPEAKER_00: Well, that's all for today.
• 40:03
  SPEAKER_00: Thanks so much for joining us, and don't forget to hit that subscribe button and connect with us online so you'll never miss an episode and can catch up on all the ones you might have missed.
• 40:11
  SPEAKER_00: Got a topic you're fired up about, or maybe you want to be a guest on the show?
• 40:15
  SPEAKER_00: Fred would love to hear from you.
• 40:17
  SPEAKER_00: Just reach out at F C R A N S at S T O N G E.com.
• 40:23
  SPEAKER_00: We'll see you next time.