Latest / I Am Wiser Podcast with Dr. Laura Purdy / What Is Worth Fighting For?

Transcript

What Is Worth Fighting For? · I Am Wiser Podcast with Dr. Laura Purdy

• 0:00
  SPEAKER_01: We may not see eye to eye with, but at least we could learn to respect each other.
• 0:03
  SPEAKER_01: The fights that you see on TV and the cats that are not replicated within teams where people from vastly different backgrounds and beliefs put those beliefs on the side to serve something bigger than themselves.
• 0:13
  SPEAKER_01: And I feel very grateful and honored that I got to be part of that and to serve alongside people that I consider heroes who under fire put tourniquets on their friends and put themselves second to the people next to them.
• 0:25
  SPEAKER_01: It's um it's sad that it's required, but it's an honor to get to be part of that.
• 0:29
  SPEAKER_00: Welcome to the I Am Wiser Podcast, where the biggest questions in health care and wellness meet the collective wisdom of industry leaders and innovators.
• 0:38
  SPEAKER_00: I'm Dr.
• 0:39
  SPEAKER_00: Laura Purdy, and here we explore the intersections of AI, care delivery, telehealth policy, and more.
• 0:47
  SPEAKER_00: Through the lens of those who are reshaping healthcare.
• 0:51
  SPEAKER_00: This is not just about theory, it's about lived experience and real industry insights.
• 0:57
  SPEAKER_00: Let's dive in and get wiser together.
• 1:00
  SPEAKER_00: Welcome to today's episode of the I Am Wiser Podcast with Dr.
• 1:03
  SPEAKER_00: Laura Purdy, where I explore the real stories behind groundbreaking healthcare innovations and the human impact they have on patients and providers.
• 1:12
  SPEAKER_00: On that note, I am very delighted to welcome today Corey Feldman, co-founder and CEO of Protego?
• 1:21
  SPEAKER_00: Protego?
• 1:22
  SPEAKER_00: You didn't tell me how to say it, actually.
• 1:23
  SPEAKER_00: Protego.
• 1:24
  SPEAKER_00: A company focused Protego, a company focused on streamlining healthcare revenue cycles through cutting-edge AI tools.
• 1:31
  SPEAKER_00: Corey's passion for efficiency and simplicity has led him to focus on the critical metric of speed to value, helping healthcare providers implement AI seamlessly, reducing operational burdens, and ultimately improving patient outcomes.
• 1:46
  SPEAKER_00: In a world where AI promises much, but often takes months or even years to show any value, Corey and his team are committed to delivering results in a fraction of the time, enabling providers to spend more time focusing on what truly matters, patient care.
• 2:02
  SPEAKER_00: Welcome, Corey.
• 2:04
  SPEAKER_00: It's nice to have you.
• 2:05
  SPEAKER_01: Thank you for having me.
• 2:07
  SPEAKER_01: Great to be here.
• 2:08
  SPEAKER_00: So we were walking down memory lane before we got started.
• 2:11
  SPEAKER_00: And the reason why I asked you to come here, we've known each other for many years.
• 2:15
  SPEAKER_00: And I would say we're colleagues, we're friends, and we certainly, you know, will never be a stranger to you, no matter what.
• 2:21
  SPEAKER_00: And we actually recorded a podcast together about three and a half years ago.
• 2:26
  SPEAKER_00: If you can even believe May of 2022, we recorded.
• 2:30
  SPEAKER_00: I don't remember when it aired, but that was when my recording on the calendar was.
• 2:34
  SPEAKER_00: And we're here today to talk about how we have become wiser as humans, as people, as citizens, as soldiers, maybe.
• 2:43
  SPEAKER_00: I mean, wherever you, whatever direction you want to take, but we're here to talk about how we've gotten wiser.
• 2:48
  SPEAKER_00: So thanks for coming to talk to me today.
• 2:50
  SPEAKER_01: Sure.
• 2:50
  SPEAKER_01: Well, thank you for having me, and thank you for informing me of the sparkly dress code, which I uh was all too happy to abide by.
• 2:57
  SPEAKER_01: I don't get to do a lot of calls with this uh sparkly jacket on, so thank you for giving me the opportunity.
• 3:02
  SPEAKER_00: Um if we're not having a disco party, what are we even doing?
• 3:06
  SPEAKER_01: Exactly, right?
• 3:07
  SPEAKER_01: Like what's the point?
• 3:08
  SPEAKER_01: So I think at the point at which we met, I was probably still working for like selling into the provider side.
• 3:16
  SPEAKER_01: And I think the big thing for me in healthcare is it's it's a circle, right?
• 3:20
  SPEAKER_01: And you can understand how care is provisioned and and what that experience is like from the patient perspective, but then how does it get paid for?
• 3:27
  SPEAKER_01: And so there were two portions of that puzzle that I didn't know when we met.
• 3:32
  SPEAKER_01: Uh, I worked for Leverage Health after you and I met, where I represented a series of portfolio companies selling them into payers.
• 3:39
  SPEAKER_01: And so I came to be familiar with how healthcare gets compensated or not compensated, as is the purpose of our company.
• 3:47
  SPEAKER_01: And I also became a volunteer EMT.
• 3:49
  SPEAKER_01: Um so I I worked for Central Park Medical Unit for a couple of years during COVID and um helped patients and and actually delivering frontline care also gave me a new perspective.
• 3:59
  SPEAKER_01: And then the third thing that you touched on is that as an IDF reservist, I was called back to the reserves uh in the wake of October 7th and uh fought for about eight weeks in in Gaza.
• 4:09
  SPEAKER_01: So that also changed uh my perspective pretty dramatically on life in the world.
• 4:14
  SPEAKER_01: So we can double-click on any of those categories that you find interesting, but definitely feels like a lot more than three, three and a half years have passed.
• 4:22
  SPEAKER_00: It really does.
• 4:24
  SPEAKER_00: So, first things first, I would be remiss if it if I did not say thank you for your service, right?
• 4:28
  SPEAKER_00: And as we talked about, I'm a veteran.
• 4:30
  SPEAKER_00: I served for 14 years, I did not go to war because I couldn't stop having children.
• 4:35
  SPEAKER_00: Um, but I worked at Walter Reed in 2008.
• 4:38
  SPEAKER_00: I took care of patients that were imminently off the battlefield.
• 4:42
  SPEAKER_00: I received like CCAT, you know, traumas with their American quilts, and I took care of people at Walter Reed and Bethesda and Texas, um, whatever they called it at that time.
• 4:50
  SPEAKER_00: And I took care of soldiers, wounded soldiers, um, with every type of injury that you could imagine.
• 4:56
  SPEAKER_00: If they could make it back to the U.S., I took care of them.
• 4:58
  SPEAKER_00: And so I, you know, I would be remiss not to say thank you for your service.
• 5:01
  SPEAKER_00: It doesn't matter where you serve, it doesn't matter when you serve, it doesn't matter whose war you are fighting in.
• 5:06
  SPEAKER_00: To be a soldier on the front lines of a war is a position of honor and dignity.
• 5:12
  SPEAKER_00: And we honor that experience in your life.
• 5:14
  SPEAKER_00: We thank you for your time serving whatever cause it is that you serve.
• 5:18
  SPEAKER_00: And um, as a disclaimer, this is not meant to be political in any way, shape, or form.
• 5:22
  SPEAKER_00: It's not meant to represent pro or con any one particular side or um agenda, but it's meant to honor you in that sacrifice that you gave in your life.
• 5:35
  SPEAKER_01: Thank you.
• 5:36
  SPEAKER_01: Appreciate that.
• 5:37
  SPEAKER_00: So we'll come back to that.
• 5:38
  SPEAKER_00: So let's talk about work first and then we'll then we'll talk about war.
• 5:41
  SPEAKER_00: We'll we'll warm up to it.
• 5:43
  SPEAKER_00: So you started working as that's what I remember you as is a volunteer EMT, right in the, you know, COVID times, coming out of that crazy time, and also kind of getting into the startup world and looking at how to tackle some of these problems that a lot of people don't really care about tackling.
• 6:00
  SPEAKER_00: So, what what have you learned?
• 6:02
  SPEAKER_00: I mean, what was your biggest, you could say, like wake-up caller, disillusioning moment?
• 6:06
  SPEAKER_00: What what have you learned in your journey so far?
• 6:09
  SPEAKER_01: Well, uh, it it turns out even when you're a free ambulance service, you have to document.
• 6:13
  SPEAKER_01: So that was kind of crazy, right?
• 6:14
  SPEAKER_01: It's like you don't escape the documentation uh just because you're provisioning services for free.
• 6:19
  SPEAKER_01: But I think as you obviously experienced for much of your career, the uh almost divine experience of being able to treat someone on the worst day of their life is just an incredible gift.
• 6:32
  SPEAKER_01: And to see the professionalism, you know, when we would bring gunshot victims to the ED and to see the almost like symphony level choreography that was waiting for them in terms of the competence of the different physicians and nurses.
• 6:46
  SPEAKER_01: Everyone had their role, everyone knew what they were supposed to do.
• 6:49
  SPEAKER_01: And it was just like so brilliant to be part of that, and also to tell someone who's not only scared because they went over the front of their bicycle on their first trip to New York and knocked out their teeth, or they, you know, got hit by a car, or God forbid had some cardiac issue.
• 7:02
  SPEAKER_01: Not only, hey, we're here to help you, but also you're not going to be charged for it.
• 7:06
  SPEAKER_01: That was a pretty cool and remarkable thing to see people almost as relieved that they won't be financially responsible as they are that they're getting the help they need.
• 7:15
  SPEAKER_01: And I think that was somewhat eye-opening that people, you know, I think over half of Americans report foregoing care because of the fear of the cost.
• 7:23
  SPEAKER_01: And so to understand that, like, yeah, where they're providing them medical care, but that's actually not what they're most excited about.
• 7:28
  SPEAKER_01: They're excited that they're not gonna have to pay for the ride in the ambulance.
• 7:32
  SPEAKER_01: That was a real eye-opening moment about just some of the tremendous, deeply ingrained challenges of of U.S.
• 7:40
  SPEAKER_01: healthcare from the perspective of patients.
• 7:44
  SPEAKER_00: You're really thinking about making an impact, but not just a medical impact, but a life impact.
• 7:49
  SPEAKER_00: Because for most people, there is life after that ambulance ride.
• 7:52
  SPEAKER_00: And they still have to pay their bills, they still have to go to work, they still have to provide for their family.
• 7:55
  SPEAKER_00: And healthcare is really cost prohibitive for a lot of people.
• 7:59
  SPEAKER_00: So then you took that information, you took that experience and carried it forward.
• 8:03
  SPEAKER_00: What are what are you guys working on today?
• 8:05
  SPEAKER_00: Is it is it working what you're what you're doing?
• 8:07
  SPEAKER_00: Does it work?
• 8:08
  SPEAKER_01: Yeah, at long last, it is.
• 8:10
  SPEAKER_01: Uh so my my journey into this startup actually began even before we met.
• 8:15
  SPEAKER_01: My brother has colitis.
• 8:17
  SPEAKER_01: He had eight surgeries when he was 17, spent over 100 days in the hospital.
• 8:21
  SPEAKER_01: And really, it was a tough time for the family.
• 8:24
  SPEAKER_01: My parents would alternate sleeping in the chair next to his bed.
• 8:28
  SPEAKER_01: My mom would come home super early to put my two sisters on the bus to school who were much younger.
• 8:33
  SPEAKER_01: My dad would go from that chair right to the office where he managed a trading floor of a thousand people.
• 8:38
  SPEAKER_01: And and of course, the only thing that matters when you don't have your health is your health.
• 8:42
  SPEAKER_01: And so everyone was was quite concerned about Russell, who was quite thin at that stage.
• 8:49
  SPEAKER_01: And when we finally made it through that clinical nightmare and he came home after those hundred days, then we got hit with a million dollars in bills as a family.
• 8:57
  SPEAKER_01: And that is that's crazy, right?
• 9:00
  SPEAKER_01: And it was pre-no surprises act.
• 9:02
  SPEAKER_01: So I don't know that it would have happened that way today, but uh a different way it might have happened, arguably worse, is that after the first bill was denied, the hospital might have said, All right, you gotta pay for this, or we're not doing the second one because w we are on the hook for it.
• 9:17
  SPEAKER_01: Right.
• 9:17
  SPEAKER_01: And then my brother wouldn't be here.
• 9:19
  SPEAKER_01: So uh you could argue that uh getting a million dollars in bills is certainly better than the alternative, but but what's what it definitely revealed was was a broken system as it relates to the care that patients need.
• 9:31
  SPEAKER_01: The best physicians in the world were telling my brother that he needed X or Y done and and they did those things in order to save him.
• 9:38
  SPEAKER_01: And then you have an insurance company on the other side saying those are not medically necessary, as as if the you know pediatrician that the that the insurance company had hired to probably you know do the peer-to-peer had any idea what this world-class GI doc uh was doing.
• 9:52
  SPEAKER_01: So the the beginning of this was just an examination of that particular challenge in my life and zooming out and saying, well, what does that look like across America?
• 10:01
  SPEAKER_01: And it turns out that there's like$750 billion in denied medical claims a year.
• 10:06
  SPEAKER_01: I mean, it's speaking of like Israel and the idea that's larger than the GDP of Israel, just to give you a sense.
• 10:12
  SPEAKER_01: Uh it's by by like a factor of like 1.3 or something.
• 10:15
  SPEAKER_01: So that's a huge, huge problem.
• 10:17
  SPEAKER_01: And of course, um, if if provide if if providers can't get compensated for their care, then it leads to a lot of the things that cause challenges today.
• 10:27
  SPEAKER_01: Consolidation, right?
• 10:28
  SPEAKER_01: If you can't get the same rates as your larger hospital neighbor, you probably have to sell.
• 10:32
  SPEAKER_01: If you can't get paid because you don't have the negotiating power and the payer is bossing you around, you probably have to sell out to private equity.
• 10:38
  SPEAKER_01: Right?
• 10:38
  SPEAKER_01: And all these things that are meant to increase efficiency, it seem it the c it would seem to be the case that they are actually reducing the quality of care and increasing prices for patients.
• 10:48
  SPEAKER_01: And so to the extent that we can empower independent physicians to remain independent by ensuring they get paid for the things they're supposed to get paid for, we can empower higher quality care and we can prevent these denials from hitting the patient before the patient even knows that we've helped them.
• 11:01
  SPEAKER_01: And so that's why we intervene on the on the uh on the side of the provider to try to prevent those denials from happening and then to automate the appeals uh with AI when those denials do in fact occur.
• 11:13
  SPEAKER_00: That's great.
• 11:13
  SPEAKER_00: Do you have any data?
• 11:14
  SPEAKER_00: Like, can you say for the average number of physicians you've been able to like do you have any measures of effectiveness that you can brag on yourself with in this moment?
• 11:23
  SPEAKER_01: I would say there's there's two categories.
• 11:25
  SPEAKER_01: So um w for for one of our early GI clients, we had them kind of manually track the time it was taking them to file some of these complex appeals in terms of the research and then actually writing them out.
• 11:36
  SPEAKER_01: And and of course, when it involves buy and bill, you're talking about comprehensive drug guidelines.
• 11:41
  SPEAKER_01: And so they were recording 30, 45 minutes, 60 minutes, sometimes north of an hour to do the research and write the appeal.
• 11:47
  SPEAKER_01: And we are able to do, we're able to do those same appeal types in about two to three minutes.
• 11:52
  SPEAKER_01: So we found we could reduce, even without integration, uh the time required to research and write appeals by about 91%.
• 11:59
  SPEAKER_01: And then on the preventative end, you know, one of our early clients that where we were, you know, we started as a services company just fighting denials, and one of those companies asked us to do all of their billing, just kind of become a full services RCM provider, which was a great learning experience.
• 12:15
  SPEAKER_01: We still manage a team of about 12 employees who support that client.
• 12:19
  SPEAKER_01: And one of the beauty, one of the beautiful things that came out of that was access to data from our own team and starting to look at why are we getting denials?
• 12:28
  SPEAKER_01: Where are these things coming from?
• 12:30
  SPEAKER_01: And I'm gonna botch this quote, but right, it's something like we've seen the enemy and he is us, right?
• 12:35
  SPEAKER_01: And like we realize a lot of these denials are correctable.
• 12:40
  SPEAKER_01: Not because our team is not incredibly competent, but because there's so many disparate guidelines that govern payment, be they national NCCIs, MUEs, PTPs, FDA guidelines, individual payer policies, and you might have gotten the national coding guidelines correct, but United and ADNA might request slightly different ways that a claim is coded depending on the payer.
• 12:58
  SPEAKER_01: And so what we found was if we brought that same tech from the back end to the front end to prevent denials from happening, um, we could be that much more effective on behalf of our clients and prevent the patients from ever dealing with those denials to the level of being able to say, hey, for this particular insurance company, if you're trying to build that product or that drug and that's the diagnosis, you're gonna fail medical necessity because here are the qualifying diagnoses for medical necessity.
• 13:24
  SPEAKER_01: So pulling that in on an individual payer basis.
• 13:27
  SPEAKER_01: And for that client, we found, you know, looking into the granular level of why things were denied, what category they fell into, we could have prevented 42% of the denials that we'd gotten four months earlier with access to that tool.
• 13:40
  SPEAKER_01: So um it's it's pretty significant.
• 13:42
  SPEAKER_01: It's obviously not going to be that high for everyone, but um there's tremendous potential to prevent a lot of the things that cause denials and frankly to make your existing workforce more effective and efficient.
• 13:53
  SPEAKER_01: We know that a lot of groups are expanding and wanting to bring on more physicians, and it's hard to find good people.
• 13:58
  SPEAKER_01: So what if we could empower you to keep that same team in place and just make them more effective so you could you can grow with them without having to hire additional additional folks?
• 14:08
  SPEAKER_00: Unbelievable.
• 14:09
  SPEAKER_00: So is the solution that you guys are primarily, I'm gonna use the term selling today, is it a SaaS platform or is it you doing the work for them?
• 14:18
  SPEAKER_00: Or how how do what's the model like today?
• 14:22
  SPEAKER_01: Yeah, it's it's it's purely a SaaS play, right?
• 14:24
  SPEAKER_01: And so we have a tool that sits alongside any web-based EHR without integration.
• 14:29
  SPEAKER_01: Um it's basically 1T3.
• 14:32
  SPEAKER_01: And um it looks at the screen and reads the inputs that determine coverage and can tell you where you're gonna go wrong so that the folks who are doing this work don't have to leave their native environment.
• 14:44
  SPEAKER_01: They don't have to go through, as you noted at the start of the show, kind of a costly integration process.
• 14:48
  SPEAKER_01: Now, by the time this episode airs, we will likely be um I don't I don't know where to guess, X percent of the way done with what we're ultimately building, which is a full uh platform that that integrates directly into the EHR, can detect denials, uh first of all, can tell you what to do to prevent denials, can detect zero dollar payments, do the research, generate the appeals, and then actually follow that adjudication process on behalf of the practice.
• 15:14
  SPEAKER_01: So that's that's the vision, and we will get there, but along the way, we wanted to offer a solution that could be useful right out of the gates and wouldn't require that costly integration.
• 15:24
  SPEAKER_01: And we don't intend to do away with that solution.
• 15:25
  SPEAKER_01: We we always intend to offer that for anyone who wants to get familiar with what we can do for them.
• 15:30
  SPEAKER_01: We want them to be able to see that with low upfront costs, to begin to trust us and see what we're capable of, and then perhaps make the leap to that larger, more integrated, comprehensive solution.
• 15:41
  SPEAKER_00: Unbelievable.
• 15:42
  SPEAKER_00: I this honestly, that's a great solution, and I'm happy that it's working.
• 15:46
  SPEAKER_00: It I've always been afraid of everything that has anything to do with insurance.
• 15:49
  SPEAKER_00: I'm kind of fully allergic to health insurance because there's one of the ways I've become more wise is because there's a lot of fraud out there.
• 15:57
  SPEAKER_00: And I've I've been a victim of a lot of fraud.
• 15:59
  SPEAKER_00: Actually, I just found out about more fraud yesterday because it's a real popular thing to do.
• 16:03
  SPEAKER_00: So, my question for you is how do you safely, if I can say, play in the sandbox of insurance, denials, appeals, claims, using people, using software, using AI.
• 16:18
  SPEAKER_00: How do you do all of that and not commit accidental fraud?
• 16:21
  SPEAKER_00: Because it's really easy to commit accidental fraud, I've learned.
• 16:25
  SPEAKER_01: Yeah, well, I would say this.
• 16:31
  SPEAKER_01: Our vision is the truth, the whole truth, and nothing but the truth.
• 16:34
  SPEAKER_01: And so what we're really just doing is calling to bear all of the different guidelines that already exist scattered across the internet.
• 16:40
  SPEAKER_01: Some are behind firewalls, you know, some are difficult to get to, but we find ways to get to them and basically just making them visible to the person at the point of claim creation.
• 16:51
  SPEAKER_01: And by the time this podcast drops, we may also be within the physician workflow, which is currently on our roadmap, which means as the clinician is writing that clinical note saying, wait, Dr.
• 17:02
  SPEAKER_01: Purdy, you're about to prescribe a patient with Stellara and you just listed IBS as the qualifying diagnosis.
• 17:08
  SPEAKER_01: And while you'd be correct if that was a united patient, for an aetna patient, the only qualifying diagnoses are Crohn's colitis and psoriasis.
• 17:14
  SPEAKER_01: So either you need to examine the patient for signs of one of those three conditions, or you need to prescribe a different drug because otherwise you're setting yourself up for a denial.
• 17:22
  SPEAKER_01: So it's not about telling you what to do or how to practice medicine.
• 17:26
  SPEAKER_01: It's about making available to you in real time the information that will allow you to make the best clinical and financial decision possible for the patient.
• 17:33
  SPEAKER_01: And we see those two things as related.
• 17:35
  SPEAKER_01: Clinical toxicity or financial toxicity is clinical toxicity and vice versa.
• 17:40
  SPEAKER_00: Yeah.
• 17:40
  SPEAKER_00: So you're really not making the decision, you're not telling the doctor what to do.
• 17:43
  SPEAKER_00: You're definitely not prescribing anything.
• 17:45
  SPEAKER_00: You're not even really submitting the claim necessarily, but what you're doing is, I don't know, providing an added layer of maybe protection or information.
• 17:54
  SPEAKER_00: You're educating the doctor because you're right, how are we gonna know this is what the guidelines say you have to have or do right now?
• 18:01
  SPEAKER_00: So you're empowering them and you're equipping them with information, but you're really not crossing the line and the line is there and you're on this side of it, and then it's up to the doctor and the person on the other side of the tool to make the decision of what to do with that information you're giving them.
• 18:15
  SPEAKER_01: Yeah.
• 18:15
  SPEAKER_01: And you know, you they have places to go.
• 18:18
  SPEAKER_01: They got they can go to Encoder Pro and they can type in the details of the claim.
• 18:22
  SPEAKER_01: They can a lot of my coders buy books like physical books or PDFs where they're looking through the guidelines, the change every year.
• 18:30
  SPEAKER_01: So we're basically just digitizing all this information and and and bringing to bear the relevant portion of it within the workflow.
• 18:37
  SPEAKER_01: I would say that's kind of the the long and short of it, is they are doing this work today, but they're doing it manually to find these sources of truth.
• 18:46
  SPEAKER_01: And we bring that source of truth to bear in real time where it's needed, and then allow them to make the decision, right?
• 18:52
  SPEAKER_01: Like add, you know, this this will only be paid with modifier 25 if if applicable.
• 18:56
  SPEAKER_01: We're not saying it's applicable, we're saying if you if you file the claim like this, it's not gonna get paid if that's not applicable and that's not added on.
• 19:03
  SPEAKER_01: So, you know, if someone's gonna commit fraud, what I've learned working in healthcare for 10 years is they're gonna do it with or without you, right?
• 19:09
  SPEAKER_01: Like it's not up to you.
• 19:10
  SPEAKER_01: So the best we can do is provide the facts and allow people to do what they're gonna do.
• 19:18
  SPEAKER_00: You're right.
• 19:18
  SPEAKER_00: If they're gonna do it, they're gonna do it.
• 19:20
  SPEAKER_00: So how do you then protect, how do you protect yourself?
• 19:23
  SPEAKER_00: How do you protect your team?
• 19:24
  SPEAKER_00: How do you put those protective layers in place to make sure that to the extent that you're aware, everything that's done inside of your house is done legally, compliantly, and in a way that will not end up on the morning news in a bad way.
• 19:37
  SPEAKER_01: Right.
• 19:37
  SPEAKER_01: Well, I mean, the first is is data security, right?
• 19:39
  SPEAKER_01: And so we're in the midst of our SOC 2 audit now.
• 19:41
  SPEAKER_01: By the time this airs, I assume we will have uh SOC2 clearance.
• 19:45
  SPEAKER_01: So the first is kind of how you protect confidential patient information.
• 19:48
  SPEAKER_01: We built that uh preventative tool, the Guardian, in the wake of the change healthcare fiasco to be something that can actually be used without confidential patient data.
• 19:59
  SPEAKER_01: So actually, if you want the copilot, you can download it as like a frontline RCM staff member.
• 20:06
  SPEAKER_01: And you tech you technically don't need a BAA because we're not pulling any confidential patient data.
• 20:10
  SPEAKER_01: We're pulling payer, procedure, diagnosis, right?
• 20:12
  SPEAKER_01: Like you don't need confidential patient data to make the determinations.
• 20:16
  SPEAKER_01: It's just a series of numbers and whether or not they correlate with the numbers published in this document or that.
• 20:21
  SPEAKER_01: We can go deeper, and we do when it comes to appeal generation and some of the more uh intricate tools, but we try to get we try to offer solutions that ask for as little information as possible.
• 20:31
  SPEAKER_01: Um in terms of compliance, of course, we have the disclaimers necessary, right?
• 20:35
  SPEAKER_01: Ultimately, we are not writing back into the EHR today.
• 20:38
  SPEAKER_01: We are simply providing them with a set of rules on the right side.
• 20:40
  SPEAKER_01: We source those rules, we show them where it comes from.
• 20:43
  SPEAKER_01: If they want, they can click into the clinical policy bulletins themselves and read it, but we show our work, and and all we're saying is hey, per Etna's policy, this is not going to meet the criteria for medical necessity.
• 20:54
  SPEAKER_01: We're not saying you should use this instead, right?
• 20:57
  SPEAKER_01: That would kind of enter the realm of clinical decision support, and we're not physicians, right?
• 21:01
  SPEAKER_01: We're a software company.
• 21:02
  SPEAKER_00: And that's not you.
• 21:04
  SPEAKER_00: Right.
• 21:04
  SPEAKER_00: You're a software company.
• 21:05
  SPEAKER_00: That's fantastic.
• 21:07
  SPEAKER_00: So as you've as you've embarked upon this journey, do you feel like your solution has been well received?
• 21:12
  SPEAKER_00: Like are people enjoying what you're doing?
• 21:14
  SPEAKER_00: Are you receiving a lot of opposition or friction in the opposite direction?
• 21:18
  SPEAKER_00: How's it going in the industry?
• 21:21
  SPEAKER_01: Yeah, I would say when I started, it was just with the appeal generation software.
• 21:25
  SPEAKER_01: And so I couldn't understand why people weren't buying it more.
• 21:29
  SPEAKER_01: And then then you start to dive into the deep the weeds of it, and you're like, okay, well, I have a solution that automates appeals that calls in clinical policy bulletins, but if I'm selling to 30 to 40 doctor groups, how many times are they really getting one of those in the course of a month?
• 21:43
  SPEAKER_01: And if it's even 50 or 70, they have a team of 10 to 20 people, like it's not necessarily the most time consuming thing for them.
• 21:51
  SPEAKER_01: And so the beginning was a bit of a struggle.
• 21:54
  SPEAKER_01: We kind of pushed the builder uphill and did get some early clients.
• 21:57
  SPEAKER_01: And they were fairly clear with us.
• 21:59
  SPEAKER_01: I was just the um thick skull and wasn't listening, but they all said from the start, like, what about prevention?
• 22:04
  SPEAKER_01: What about prevention?
• 22:05
  SPEAKER_01: And we say, don't be silly, it's impossible to prevent it.
• 22:08
  SPEAKER_01: Uh the payers are all, you know, yada yada.
• 22:10
  SPEAKER_01: And it's like, well, yeah, the payers do get it wrong.
• 22:13
  SPEAKER_01: And most denials appeal at the state level are ultimately overturned.
• 22:16
  SPEAKER_01: So like the data suggests that oftentimes they are incorrectly denying claims, but that doesn't mean that providers are always getting it right and not abiding by the coding guidelines and individual payer guidelines.
• 22:27
  SPEAKER_01: And so since developing this new tool, you know, basically early this summer, which we deployed to our internal team, we started selling it pretty quickly thereafter.
• 22:37
  SPEAKER_01: And since then the clients have been coming we went from you know 100K in revenue to or annual revenue to 300 in pretty short order to ultimately 500.
• 22:46
  SPEAKER_01: So it's like it's really uh moving quickly now.
• 22:49
  SPEAKER_01: And I think the reason is that it it fulfills a meaningful need in the market which is people don't have time and payers are using technology to adjudicate claims and providers are using people to file them.
• 23:00
  SPEAKER_01: And so you need to bring they're bringing swords to a gunfight use the military analogy.
• 23:05
  SPEAKER_01: And so we are empowering them to to make quicker and better decisions.
• 23:10
  SPEAKER_01: And I think a a great example is this big group we just signed with it's a 250 doctor group.
• 23:15
  SPEAKER_01: They not only are a customer but actually an investor.
• 23:19
  SPEAKER_01: And you know they obviously have access to a ton of different potential solutions.
• 23:23
  SPEAKER_01: They have a big team uh dozens of certified coders on staff and we were meeting a need that I guess was not being met by the other players in the space that to meaningfully help them with their efficiency and effectiveness.
• 23:36
  SPEAKER_01: And so hopefully we'll have some meaningful results to share by the time this podcast drops that you can put into the show notes because right now we literally kicked off with them like last week but um the the timing should be should work out nicely for us to share results when when this goes live congratulations that sounds like a big win so I'm glad you guys are getting your big wins because you've worked hard you're doing a good thing for a good reason at the right time for the right people and I'm glad it's working out for you.
• 24:04
  SPEAKER_00: So speaking of military analogies let's shift we talked about work.
• 24:08
  SPEAKER_00: Now let's talk about war for the last few minutes if you feel like it.
• 24:12
  SPEAKER_00: You know when I was in medical school that was actually during the early years of the Iraq war and that's one of the things that I know people who go to combat eventually like to do is they like to kind of share their stories and let the world learn from their experiences, right?
• 24:25
  SPEAKER_00: So you were three years active if I heard you say that correctly did you serve in combat during that time or was this your first time in combat?
• 24:32
  SPEAKER_01: Yeah I mean unfortunately there's been you know flare-ups from the Gaza Strip for ever since Israel pulled out in 2005.
• 24:40
  SPEAKER_01: So when I was on the border in 2012 uh for six months we basically were at one point we're going back and forth from the roof to the bomb shelter so much that we moved our mattresses into the bomb shelter and just stayed there.
• 24:51
  SPEAKER_01: Um and what's crazy is like we were living in a our base was in a kibbutz or like next to a kibbutz and so they're shelling the kibbutz right but basically like it was not a to be clear it wasn't a standard military base.
• 25:04
  SPEAKER_01: We moved in there because of the threat to the kibbutz and they were shelling the kibbutz so so like the fact that we were sleeping in a shelter like fine but the fact that they were shelling us at all meant they were actually not shelling us.
• 25:16
  SPEAKER_01: They were shelling civilians.
• 25:18
  SPEAKER_01: So that was um yeah that was 2012 and having rockets explode near you is one thing and you know I was involved in you know some arrests where we had rocks thrown at us and I also think maybe your listeners don't know people think about like the picture of like a guy facing down a tank with a rock in his hand that's actually not how they throw rocks.
• 25:38
  SPEAKER_01: They have slingshots and those rocks come in about six feet to eighty miles an hour.
• 25:42
  SPEAKER_01: I'm just like it actually one of them hit me in the helmet and knocked me I'm six foot two it knocked me to the ground.
• 25:48
  SPEAKER_00: So like just to understand these are not like it's not a kid throwing a rock throwing a rock in shoe.
• 25:55
  SPEAKER_01: It's like a rock launch it's a ballistic projectile yeah yes exactly a rocket launcher a rock launcher okay and so this time you went back what's your moos are you medical moos or I don't know what they call it in the IDF but what's your you know military descriptor what's your job yeah well um I was a heavy machine gunner within a special operations uh infantry unit kind of loosely based off the recon marines um it's called uh Givaten and you know the strength of the IDF is in its reserves right we're surrounded by people unfortunately that don't like us very much and every 10 years since the country became a state someone tries to kill everyone.
• 26:33
  SPEAKER_01: So you know if you're a reservist that eventually you're gonna get called up because the standing army while the numbers are not published is not a terribly high number of people and so if there's something significant that happens the strength of the military and its ability to successfully defend its various different borders comes from the reserves.
• 26:49
  SPEAKER_01: So I knew in volunteering over the last 10 years to be a reservist that there might come a day when when that time came.
• 26:55
  SPEAKER_01: And so I was fundraising at HLTH uh uh on October 5th or 6th I think of 2023.
• 27:01
  SPEAKER_01: We just kicked off our fundraiser on October 2nd when uh when everything occurred my brother's wedding was on October 14th in New York and so I I went from the wedding to the airport.
• 27:11
  SPEAKER_01: Um it was as you could imagine it's like a scene of mayhem you know the NYPD counterterror squad was guarding the terminal of the airport that you couldn't drive up to it.
• 27:20
  SPEAKER_01: Uh it was basically just um soldiers and and Israelis that have been stuck abroad that were going home.
• 27:25
  SPEAKER_01: And it was um it was a crazy experience.
• 27:28
  SPEAKER_01: You know we we trained for a week or two we went into the northern Gaza Strip on October 31st we were the first boots on the ground and if you think about it like when you're a trained soldier like it's all you think about.
• 27:39
  SPEAKER_01: It's all you prepare for.
• 27:40
  SPEAKER_01: But I was an entrepreneur at that point.
• 27:43
  SPEAKER_01: Like I've been living my life for the last 12 or 13 years.
• 27:46
  SPEAKER_00: It had been a minute right it had been a minute.
• 27:49
  SPEAKER_01: And you're forced to like I think probably Ukraine is the only ex uh other example in in kind of the modern democratic world where like people experience this but it's like one day you're doing X and now all of a sudden your country needs you to flip on a dime and become this this agent of of of the state and you don't matter machine gunner I guess.
• 28:09
  SPEAKER_00: Yeah.
• 28:10
  SPEAKER_01: And and you're like entering this this hellhole where like you know there was no we didn't see any civilians.
• 28:16
  SPEAKER_01: There was no I mean we didn't even see terrorists because they would come, they would shoot at us and then they would disappear but it definitely gives you perspective on what's important in life and um you know like what really matters and I think you know you have a bad investor meeting it's like okay well I didn't get shot at today like how bad was today really nothing exploded.
• 28:36
  SPEAKER_01: Nothing exploded.
• 28:37
  SPEAKER_01: It definitely mitigates your um your emotional kind of uh I don't know barometer for like what's gonna get you worked up and and what's not did you get to do any kind of reintegration program?
• 28:49
  SPEAKER_00: I know like in the US military when you go home you redeploy so the opposite of deploy is redeploy then they have a reintegration program where they put you through a few classes you can have access to mental health resources if you want it if you need some time to stay on post before you go back home I think not everybody does that or at least I mean this was several years ago but did you get to do any kind of reintegration program or did they just kind of plop you back and say go back to startup world?
• 29:16
  SPEAKER_01: No it's it's such a a great question and I think people neglect to think of you know people like to think about soldiers as like chess pieces and they don't think about the fact that they're real people that have families and if you look at the people who've done over 200 days of reserves they say 50% of wives report s significant marital trouble, 30% report considering divorce.
• 29:35
  SPEAKER_01: I mean Israel's in crisis from a mental and behavioral health perspective and the challenge is these people are not active duty.
• 29:40
  SPEAKER_01: So it's not like you're within a chain of command it's like no you're off on a Thursday Thursday night you're home with your family.
• 29:46
  SPEAKER_01: And then maybe you have the weekend off and you're back into Gaza on Monday.
• 29:50
  SPEAKER_01: So there really is no I mean you have access to therapy but there's not enough therapists in Israel to treat the tremendous BTSD that exists.
• 30:01
  SPEAKER_01: Terrorists fired an RPG into the house we were in and I lost half a tooth got some in my leg the next day um I was discharged from the hospital the same day the next day my co-founder met me at the hotel and we were working that morning um and then four days later I was back in Goblin.
• 30:16
  SPEAKER_00: Hold on wait hold on wait a minute so okay this is a wildly different experience than what it's like for U.S.
• 30:26
  SPEAKER_00: service members well first of all we don't have a war in our country right like as far as there's not a war right here.
• 30:31
  SPEAKER_00: So US service members when they get activated they're sent to the other side of the world and they don't see their family for six, 12 18 months and they can't leave you can't leave your barracks you don't leave the war zone there is nowhere to go unless you get injured or in trouble and a lot of people who get injured stay there and can continue.
• 30:49
  SPEAKER_00: You're telling me these people are going to work in the war zone essentially and coming back living in their civilian life for the most part and then going right back out there a couple days later.
• 31:06
  SPEAKER_01: One of our best friends is the uh captain of the Navy SEAL sniper team for Israel and on a I forgot you might remember that there was that host that successful hostage rescue um in the Gaza Strip so he uh infilled like took fire from the enemy returned fire carried one of the hostages to the extraction point while under fire and was carrying his child the next morning you know out of the combat zone.
• 31:33
  SPEAKER_01: Oh my god think about like the the mental genetics move back and forth between those worlds but like the sit there's a secret weapon which is we don't have a choice right like that's that's the nature of the beast in Israel is that yeah citizen soldiers are a necessity when people want to wipe you out and um people understand the stakes and while the country is certainly divided and has different you know some people hate the prime minister some people like him you know just like the same as in our country right but at the end of the day when the country's attacked like on 9-11 right like like we came together Israel came together and said you know regardless of what we think about um the democratic norms in this country there was a lot of stuff going on about the judicial reforms um we're gonna fight as one and my team is uh comprised of religious people that live in Judea and Samaria secular software developers in Tel Aviv foreigners like myself who weren't born in the country we have various different ideas about politics but we're we're brothers and we come together to serve a common cause and something that I wish maybe America could implement in some way because I think it would bring us closer to the people that we might not see eye to eye with but at least we could learn to respect each other as we have come to do in Israel.
• 32:44
  SPEAKER_01: The fights that you see on TV and the Knesset are not replicated within teams where people from vastly different backgrounds and beliefs put those beliefs on the side to serve something bigger than themselves.
• 32:54
  SPEAKER_01: And I feel very grateful and honored that I got to be part of that and to serve alongside people that I consider heroes who under under fire put tourniquets on their friends and put themselves second to the people next to them.
• 33:07
  SPEAKER_01: And it it's um it's sad that it's required, but it's an honor to get to be part of that.
• 33:12
  SPEAKER_00: Yeah I think that's the most beautiful piece of wisdom really for this whole episode is that there can be a reality in which people from different vantage points, beliefs and backgrounds can put aside those differences to just be humans supporting each other in the struggles or battles of human life for a greater cause.
• 33:31
  SPEAKER_00: So that's that's a beautiful piece of wisdom.
• 33:33
  SPEAKER_01: Yeah and one thing I'll share you can cut this out if you want I don't know if it frees into the realm I probably won't.
• 33:40
  SPEAKER_01: I probably won't so you know one thing I'll share as well and I think the the news in America often got it wrong during this war is that like when I think about why we went to war, we went to war for the people of Israel but also for the Palestinians because if you think about a country that has complete air superiority over the Gaza Strip it would have been all too easy to launch an air campaign and call it a day.
• 34:02
  SPEAKER_01: But the reason we went in and we went door to door was that we wanted to minimize civilian suffering because we weren't just doing it for Israel.
• 34:10
  SPEAKER_01: We were doing it for humanity and for and for good people on both sides who were caught up in a conflict.
• 34:15
  SPEAKER_01: And I think Israel might be the only country in the world during the second intifada there was a uh a refugee camp where soldiers went door to door and many were killed and the mothers of those children sued the Israeli government for excessive restraint.
• 34:28
  SPEAKER_01: They said find us any army on earth that would have gone to these lengths to protect the lives of civilians in the combat zone at the expense of its own military and so I think that that's often lost in translation is that like we were in there because like for for for for Israelis and for Palestinian civilians.
• 34:47
  SPEAKER_01: To protect all humans all humans like look look at the first you know first two weeks of the uh campaign in Iraq I think I think 5600 civilians per week or so don't quote me on the numbers look the fact checking week it was a lot it was a lot right it was shocking yes it was it was a lot there was no knocks on the door there was no warnings before it was just shock and awe so you're talking about like 2004 right you're talking about like August September two uh the invasion of Fallujah is what you're probably talking about.
• 35:15
  SPEAKER_01: Exactly and you know the U.S.
• 35:17
  SPEAKER_01: learned a lot from that right and I think did it better in in campaigns to come.
• 35:20
  SPEAKER_01: But um you know I I I I think despite all of the um things I've been called on the streets of New York, I actually am proud to have taken part in what I consider one of the more moral um military campaigns in history where despite the difficulty of fighting an enemy that intentionally embeds itself within civilian infrastructure, we did our best to avoid that.
• 35:40
  SPEAKER_01: And um and you know like come back to fighting um fighting I think the common thread for me is like fighting for people that I feel are are in need of defense, right?
• 35:50
  SPEAKER_01: And and like the Jewish people need an army to defend them and patience in America need defense against um some of the largest conglomerates that ever existed who can adjudicate claims of technology.
• 36:01
  SPEAKER_01: Most people don't know what their ERA or their EOB is and so I I'm but by no means comparing um insurance companies to to terrorism just to be clear I have friends that work for insurance companies but I think it's a broken people wouldn't argue with you if you did though so I know but but you know as as I said in the wake of the um in the wake of that the cheating of the UHG executive software not bullets right like that's not how you fuck fix problems.
• 36:24
  SPEAKER_01: If you have a choice you should use technology and your words and not uh systems which are maybe ironic coming from me maybe after what we just discussed but that's that's how I see it is that there's ways to fight within the system without burning it to the ground to try to make things more fair and more just and that comes down to all of us right like we, you know the public markets support these large insurance companies.
• 36:45
  SPEAKER_01: If we choose to invest in them, right, then we empower them, right?
• 36:48
  SPEAKER_01: Like it it's up to us as the American people to decide the future of our healthcare system.
• 36:52
  SPEAKER_01: And um we're just uh happy to be part of the the push to make it better.
• 36:57
  SPEAKER_00: That's beautiful.
• 36:58
  SPEAKER_00: And I you know what I think it's great.
• 37:00
  SPEAKER_00: I think we can have these conversations and we can talk about these sensitive subjects without being hateful, without being polarizing, without being militant, even though we served in militaries, we do not have to be militant even though we go to combat, we do not have to be combative, even though we are in um places with violence, we do not have to be violent and there is a distinction between the two.
• 37:23
  SPEAKER_00: So thank you for your vulnerability thank you for your service thank you for your honesty your transparency and your ability to come through that trial and still have it preserved within your heart to have the respect and the dignity and the honor for humans as humans not people as one particular demographic or another.
• 37:46
  SPEAKER_01: Thank you.
• 37:47
  SPEAKER_01: Well it's it's amazing to speak with a fellow veteran and to be able to share both the healthcare you know I don't often get to speak about both the military and the healthcare together and you obviously also straddle both both worlds.
• 37:58
  SPEAKER_01: So I really enjoyed the conversation with you.
• 38:01
  SPEAKER_00: Wonderful.
• 38:02
  SPEAKER_00: Okay well that was a great conversation thank you so much for for being here and for chatting with me.
• 38:07
  SPEAKER_00: Now real quick let's let you brag on yourself for just a couple minutes.
• 38:10
  SPEAKER_00: If there's anybody who's watching this listening to this especially doctors, practices, medical groups, people who are like wait a minute I need somebody to help me do that thing that he said in that name that she mispronounced at the beginning of the show because she didn't ask how to say it right up front.
• 38:24
  SPEAKER_00: Give us your plug where can we find you and how can people reach out to you to use your SaaS platform.
• 38:30
  SPEAKER_01: For sure.
• 38:30
  SPEAKER_01: So Protego Health, you said it correctly Protego Health.ai and I'm sure you'll put the link in the show notes.
• 38:37
  SPEAKER_01: And in a sentence we empower billing teams with AI driven tools to help prevent and appeal denied medical claims.
• 38:44
  SPEAKER_01: And so if I want to go one layer below that what I'd say is we act basically as an extension of the billing team kind of like your director sitting over your shoulder suggesting um potential edits to claims where valid in real time to improve the accuracy of those claim submissions and to ensure their adherence to coding and billing guidelines.
• 39:03
  SPEAKER_01: And so by cross-referencing uh claims against policies and coding initiatives we have a tool that can prevent those denied claims up front and also generate appeals on the back end while citing those individual payer policies and pertinent parts of the specific clinical record that justified that claim that can help ensure that denials that are meant to be overturned are overturned.
• 39:27
  SPEAKER_00: In a nutshell I love it do you have a website are you guys on LinkedIn?
• 39:33
  SPEAKER_00: Like where where are you?
• 39:34
  SPEAKER_00: Do you have social do you do social media?
• 39:36
  SPEAKER_00: Yeah we're everywhere you want to be um where Protego Health is uh is is on the gram um you can find Protego Health on LinkedIn you can find our website protegohealth.ai so um wherever people are we try to be there too I guess is how I'd put it I love it awesome thank you so much Corey hopefully it's not another three and a half years before we get to I really appreciate you being here today.
• 40:01
  SPEAKER_00: Best of luck thank you thank you for having me thank you for tuning in to the I Am Wiser podcast where each episode brings us closer to a wiser more human approach to healthcare.
• 40:13
  SPEAKER_00: If today's conversation inspired you or sparked new ideas share it with someone who's ready to rethink healthcare and if you have a story or innovation that could light the way for others reach out.
• 40:26
  SPEAKER_00: We'd love to hear from you.
• 40:28
  SPEAKER_00: This space is yours too.
• 40:30
  SPEAKER_00: Don't forget to follow rate and review us on your favorite platform.
• 40:34
  SPEAKER_00: Until next time stay curious stay courageous and stay wiser