Latest / Zero Friction / Building the Future of Healthcare at Home with Josh Garrison || Zero Friction Podcast
Transcript
- Terry Coutsolioutsos: Welcome to the Zero Friction Podcast. This is Terry Coutsolioutsos and I have another exciting guest today, Josh Garrison, who is the co-founder of Health. And Village Health in its current state is an EMR platform that's doing its own purpose of changing healthcare, but more importantly, it's setting up for a bigger transformation on how urgent care may be delivered in the future. So Josh, if you could, just give us a little background on yourself and then take us up to speed where Village Health is today. Josh Garrison: Yeah, hey Terry. It's a pleasure to be here. So my name is Josh Garrison and I've spent kind of the last ten years ⁓ working in big tech kind of at the intersection between tech ⁓ operations and really up with a lot of family, parents and aunts and uncles in the healthcare space and also as a consumer myself I kind of started to view healthcare as an area where there's a lot of addressable and ⁓ And you know, we could start to rethink how to improve the patient experience. And so this was kind of an interest mine personally. and then when COVID came about, I think ⁓ that was a good at scale ⁓ stress saying, hey, know, this system doesn't work. you know, we had SLAs a wait time perspective. going going in the wrong direction. had basically going in the wrong direction. And there a couple of mindset shifts ⁓ that I started to get ⁓ in and reading about and ⁓ observing that I felt was kind of lacking in healthcare kind of that first mindset shift was overall ⁓ you know is kind of lacking ⁓ a bit in consumerism. think Walt Disney said best, you know, and said, hey when you look at ⁓ you know healthcare today you know you just don't see a lot of consumerism and really just kind of another mindset you know is patients is ⁓ is customers. with these mindsets place we initially started building our ⁓ which is a boutique EMR that looks to put a language model where we think it makes sense for providers really help ⁓ claw back the provider ⁓ to administration or administration ratio. if we take look at the provider to ⁓ administration ratio you've seen provider growth from the seventies know really stay flat ⁓ you you've seen administration growth ⁓ grow ⁓ thirty hundred percent right so there's a of money being spent there. I think some that is structural, some of that is being driven by poor EMR experiences. we built an EMR that know really just allows users you know really for kind of all ⁓ to the patients through a traditional patient journey whether it's a appointment ⁓ or more recurring rehabilitative care where smart goals and soap notes need to be administered providers can do all that in platform at a very low cost and kind of have all their insurance bills Prepped, but also have ⁓ good visibility of what are looking like across their ⁓ And really, is kind of our first step in building something larger where ultimately kind of going into that, you know, ⁓ lack of consumerism, we that kind of the patient experiences. For a lot of illnesses, why just have the doctor kind of show up in your home? ⁓ as we kind of scale ⁓ launch the EMR, we're we're pivoting into kind of building out ⁓ a provider network that ⁓ from comfort of your own home really allows patients to say, Hey, ⁓ I'm feeling good. I would like to have someone ⁓ come and take a look. And ⁓ we that we need to do some treatment ⁓ that we traditionally execute kind of in ER or through admission, ⁓ we're actually going to try and administer at home ⁓ try and circumvent that whole admission process. Terry Coutsolioutsos: That's a really interesting concept and you know in today's society, you know, with and DoorDash ⁓ Amazon, you know, who you work for as well, right? Like we live in a ⁓ button society where no matter what we need, th there's it's never further than our phone, right? Or our laptop or our desktop or whatever that might be. And so why should healthcare be any different? Like so if Especially if we can do it more affordably, more efficiently, create great experiences and provide good care. And along the way, find a way to reduce the cost of health care. ⁓ instead of going to an urgent care center and spending three or four or five hundred dollars out of pocket for you know one ailment or another in a shot or something, like, you know, you can have a a virtual visit, you can have it triaged. Josh Garrison: Absolutely. Terry Coutsolioutsos: at a lower cost, faster efficiency, and then find a way if you do need a higher level of care, right? And we can talk about what that level of care looks like and how Village Health has identified that nice sweet spot category where you feel like you can make a real impact. To me that's phenomenal. Like in in you know, you have virtual telehealth for primary care. You know, the urgent care business across America is exploding and now you're bringing something that can totally continue that transformation, not only further away from the hospital to urgent care, but now you can get urgent care delivered at home, which is what a what a remarkable concept. Josh Garrison: Yeah, yeah, absolutely. And you you really kinda, you know, hit it on the head, with you know, just kind of some of ⁓ some of cost allocations not really kind of, you know, working out for ⁓ for patients, know, and there just being an opportunity to, ⁓ you know, we reset the table and rethought about kind of how we treated the patient without any kind advances ⁓ in, ⁓ you ⁓ studies, you or or medical treatments. ⁓ You know, we think we can we can deliver a lot of savings for for customers because when look at you know ER admission, you know, 25% of your bill, you know, out the door ⁓ is administrative spend. 15% for primary care. and then you know when you're in inpatient, you get a little bit of you know cost spreading that's down to 8%, but we really think that you know going to the patient will actually you know be able to help deliver a ⁓ cheaper and at the same time there's a lot hospital at home studies out there through PubMed ⁓ and what they is kinda had two treatment groups or they had a treatment group and a control group where you know one group was was at home and the other group was treated in the traditional system and we that in the that was treated at home they were able to reduce average cost by about 38% so you know if your ⁓ you know showed up at house you're able to ⁓ circumvent kind of the traditional ER and overall kind of process and your bill was thirty-eight percent cheaper, you have kind of the experience of doing it at your house, ⁓ kind of the overall service model that that we're leaning into. ⁓ Terry Coutsolioutsos: And you know, there's other evolutionary demographics that are changing too. So insurance becomes more expensive. Families are opting for lower premium, higher deductible policies, right? You go to an urgent care center with an insurance plan and it's three, four, or five hundred dollars. Like it's not like it's not a small amount of money. You know, I have my own personal family experiences with my kids and they think they're young and they don't need to have a robust health plan so they go for the cheap one you know you gotta go to urgent care and it was like five hundred bucks like walk in and walk out of there. And so like there has to be better options for us because you know paying out of pocket basically when you have a seven thousand dollar deductible you're gonna be paying out of pocket Josh Garrison: Yeah. Terry Coutsolioutsos: all year long if you're relatively healthy. And every time you go for a cold or you know, sinuses or whatever it might be, you drop in three, four, five hundred bucks. That's that's like real money. you know, it's beyond real money. It's big money. And so doing what you're doing, you know, quickly, efficiently, cost effectively, triaging the care. You can always go get higher levels of care if you need it, but being able to manage that you know, a remarkable opportunity. Josh Garrison: Yeah, yeah, absolutely. And you mentioned you know, there there has to be better options and I think kind of a an interesting gauge of kind of where we're at, you know, a healthcare system is, ⁓ know, if you look at net promoter scores, right? So hey, how often are, ⁓ know, the customers I interact with, you know, promoting ⁓ experiences I deliver? Like healthcare in aggregate is ⁓ in low teens and, you more consumer centric companies like ⁓ Apple, you they in the 80s right so that's kind of you know I I think the customers ⁓ know in the aggregate in the NPS scores are us that ⁓ and if you look at life expectancy versus health spending, ⁓ I this also kind of aligns ⁓ with NPS, right? We've we've been a clear laggard in the United States, ⁓ for quite some time. Like to me this is ⁓ you just unfortunately I think failure at scale. ⁓ the news is is, ⁓ you we're we're starting to go ⁓ high to the right on life expectancy, right? But it it it's coming at the cost of of expenditure, so we've gotta solve that Terry Coutsolioutsos: so tell me what's next then. So you know, where do you go next with this platform? It's so interesting, it's so compelling by the way, like Like where do you and your your co-founder it's Raj, right? Raj is the technical guy. Where do you guys see this going next? Josh Garrison: Yeah. Yeah, absolutely. so ⁓ are definitely from a next steps perspective, you know, now that we have kind of the EMR in place, and a a solution where, you know, providers can go ⁓ in you really just execute the care and have a virtual experience that supports them. We really want to lean into growing the health at admis we really want to start looking at growing the health at home infrastructure and kind of taking a metro by metro approach. So we're very interested any where ⁓ you there's kind of strong Medicare, Medicaid, managed care programs. We're very interested in Arizona, Texas, and Georgia. And believe you know this will work anywhere where those programs are in place. And there's kind of been a lot of debate about, you know, if these changes, to Medicare and and Medicaid know are gonna be a positive thing ⁓ the healthcare industry. I view it as kind of our proving ground. because you look at you know ⁓ the legislation, they're getting strict ⁓ on ⁓ what reimbursed ⁓ you know, ⁓ at kind the data, you know, we just looked at with growth in physicians and administrators, you know, a lot of the cost that is being you passed on to patients ⁓ isn't right? It's we're just passing ⁓ indirect ⁓ to the patient. ⁓ So actually about a more Medicaid or a strict reimbursement regime. and so our thought process over the next six months ⁓ really want to find a CMO Chief Medical Officer Co-Founder, who's really mission aligned and can kind of help us start scaling metro by metro. and really kind what ⁓ alignment looks like for me in a CMO is ⁓ is you know, someone ⁓ not only a clinician is an operator at ⁓ and you know who's really in ⁓ kind of you know the ⁓ so to speak and and how we deliver you know healthcare to to customers. Terry Coutsolioutsos: That's awesome and you know, not only being a you know, being a great operator is a big part of it, having a great network ⁓ that's a big role for you guys. That's a will be a big strategic component of you know, how you deliver care, where you deliver care. I'm looking forward you, you know, going through that process. That's exciting. So what do you need to do in order to get this thing moving and off like where's your friction points right now, Josh, when you when you think about like n what's next for village? Josh Garrison: Yeah, so from a friction point perspective I would would again say circling to getting that CMO in place, And then also, you know, still kind of debating from an operational perspective if if we want to be more of a monolith, where, you know, we, know, hire all of the doctors, you know, they they work on kind of our payroll, you know, along with ⁓ you know, PAs, nurses, lab technicians, or if we kind of to ⁓ go a more contractor think there's there's pros and cons to both. with the approach you get a lot more control kind on on standards. right, but but scaling can be slower. you know, whereas if we start prov ⁓ partnering ⁓ with other providers who a little bit more capacity ⁓ than we have today, they might meet our standards, there may be some benefits in in partnering them ⁓ today. kind of before we have all of our infrastructure built out. So ⁓ are kind of the friction points that that are keeping me up at night. ⁓ Terry Coutsolioutsos: Gotcha. And so do you how do you view the different levels of care? Is it gonna be like three levels of care theoretically? Like you know, is there is there a virtual telehealth option in your model or is it just a go to home model and then triage to the facility? Josh Garrison: Yeah, yeah, absolutely. So You know, from a customer journey perspective, you know, we really want to start with, you know, the customer says they're sick ⁓ the app ⁓ you know, we can do ⁓ telehealth, ⁓ know, evaluation right there, but you know, we really wanna kind of target ⁓ niche is really kind of folks that are, you know, what's called a step three, you know, through five admission. These are kind of things like, ⁓ you know, ⁓ pneumonia, certain certain diabetic care regimens, things that today need to go to the hospital for, but you know, you're not ⁓ you're you're not a mortality risk, right? ⁓ only have to go to the hospital because unfortunately that's the resources that's where ⁓ the resources are to to get that care. so kind from our our patient journey perspective is you know once kind of done that virtual triage or the patient you know, has said, you know, hey, I just would really like you to come out, you know, get eyes on. know, what we're gonna do is, ⁓ know, we're gonna evaluate the patient at home, kind start all the, you know, IV treatment labs, planned, you any nurse regimens, set up remote monitoring, ⁓ really just of the you know establishing what that regiment is, and bringing in equipment needed, and then kind of you know as the patient recovers you know we're checking in on them from a virtual perspective but we also have ⁓ physical scheduled ⁓ you know so we're always always getting that physical kind of in and touch point and then as patient is recovered ⁓ you know that's kind of our our teardown process ⁓ where we go kind of get all the equipment handle kind of discharge with the patient and then handle all the billing ⁓ on the side. Terry Coutsolioutsos: Well good. ⁓ and so from all your SAS lessons with the EMR and moving forward, like, you know, so getting the CMO in place, are you looking for funding? Are you funded? Are you bootstrapping? What it what what does the funding 'cause I'm guessing, you know, like scaling this thing is not, you know, inexpensive. Josh Garrison: Yeah, definitely, definitely. So we're we're definitely interested in ⁓ you know funding in and engaging venture you know for for kind of building out you know this ⁓ kind of health at home model. a lot of the lessons learned you know from from the SAS perspective you know would be I think the first big one is I I should have just of built the big thing first. I kind of took a hey let's ⁓ you know ⁓ use the EMR fund ⁓ know the bigger CapEx heavy And ⁓ did this I did this in the middle of ⁓ software re-rating where, you know, because of you agentic frameworks, ⁓ AI, ⁓ a of people in the market, you know, kind of think software eventually may be a commodity, right? And instead of a moat. so just going the thing is really important. other lessons learned in the space are Terry Coutsolioutsos: Right. Josh Garrison: very careful about where in your software architecture, ⁓ you invoke AI, I there is tons of over engineering within high designs where, you know, throughout workflow you're just calling the LLM a lot and you're going to blow out ⁓ your token budget. a lot of big players are ⁓ seeing this know with with with non-medical you challenges token ⁓ token is is really important. So if you're about using ⁓ AI in EMR rather than having ⁓ you know rather than in your customer workflow invoking the LLM, maybe just use the LLM to build really solid heuristic model, ⁓ that, know, can ⁓ can a a billing API, right? Or can write a report, you know, that can live you know on a server or in the cloud. Have the AI create ⁓ but don't invoke the Terry Coutsolioutsos: Right. Josh Garrison: every transaction ⁓ in your workflow. I think that that's really big. ⁓ lessons I would kinda ⁓ give to founders is, you as we continue to operate kind of in this agentic, ⁓ know, commodification of software is you know, don't afraid to put an ⁓ C P around your EMR and that way you can start integrating with other know, EMRs. MCP is you ⁓ know, context protocol. that's kind the standard language, you know, that, you know, Terry, I wanted my, ⁓ you know, EMR interact with your ⁓ revenue system, they kind of talk to each other that way. so having a plan kind of MCP your whole Terry Coutsolioutsos: Yeah, four. Josh Garrison: your whole software stack is I would also say is a a big lesson learned. Terry Coutsolioutsos: Yeah, something like probably how like Clay kinda works, how they do that aggregation model and you know how they you can have twelve or fifteen different platforms that operate within Clay pretty autonomously, which is nice too. So ⁓ Anyway I I agree with you the MCP is an important layer for any platform today. ⁓ for agents to work together and communicate and and engage. so any other last closing statements on the village health piece. I have one more question for you before we go, but I wanna make sure we you know, there's anything else left on village health, we can we can ⁓ we can kind of tackle it now. Josh Garrison: No, just you know, my my parting words, you know, for the viewers is, you know, for all of us that are working on, you know like cool innovations and projects, you know, just really thinking keeping in mind that, you know, patients are ultimately, you know, customers, ⁓ and and thinking through, you know, how can we get that NPS, you know, those NPS scores in the right directions? How can we get you know, healthcare outcomes versus expenditures ⁓ in the right directions. I think if everybody just ⁓ those in the back of their minds and applies it to what they're working on, we'll be in a really cool spot. Future. Terry Coutsolioutsos: I totally agree. Couldn't be better said. You nailed it right on the head. at the end of the day, can you know, patients are our consumers of healthcare. ⁓ know, just like anything else that we're buying in today's society of, you know, five Google star ratings and customer experience and ⁓ all those things are important and I think The more that healthcare providers and platforms of healthcare realize that, that it is real money, it's not insurance money, it's people's like it's real people's money now. that we've got to put those things in front, like value for care, like it should be equivalent. And it sometimes it's not always there. So thank you for that. So Josh, I have one ⁓ final question for all my guests, or at least one I remember, that ⁓ I love asking this question where current day Josh had the opportunity to go back and meet twenty-two year old Josh. What would be the only one if you had one piece of advice to give, what advice would you provide? Josh Garrison: Okay. It would have been to lean into health care earlier. that time, that was around twenty sixteen. you know, so prior to COVID, and there was all this technology ⁓ out that you know could have enabled care at home. ⁓ I don't think need AI ⁓ to deliver care at home. ⁓ You could pause ⁓ AI and therapeutic and still ⁓ deliver all of this, you today. just with the innovations we have. So it would have ⁓ probably been to Terry Coutsolioutsos: Gotcha. Well that's great advice and you know, what a great purpose and what a great mission. So to Josh, it's been great having you today. Thank you so much for being here. We wish you and Raj and Village Health nothing but great success. Josh Garrison: Yeah, absolutely. Thanks so much, Terry. It was an honor to be here. Terry Coutsolioutsos: ⁓ I think you've got another chart for us which really kinda outlines maybe some the implications of our value based care system today. I I think we had talked a little bit about there's some really interesting data regarding physician and administrator growth. Josh Garrison: Yeah, absolutely. And so this is where we really believe is kind of the root cause of you know, what's driving our healthcare expenditures versus outcomes, ⁓ in the wrong direction. ⁓ you know, really this study is kinda going back and this is from ⁓ the Bureau of Labor Statistics, ⁓ but really going back from nineteen seventies is the baseline. You've seen thirty two hundred percent ⁓ in administrator headcount ⁓ only about, you know, ⁓ hundred percent, hundred and fifty percent ⁓ ⁓ physician headcount. ⁓ ⁓ And so we ⁓ Terry Coutsolioutsos: ⁓ what happened there in the middle? Like something like been some sort of dynamic change there in like nineteen ninety ish or so. Josh Garrison: Yeah, and so this was managed care and insurance reimbursement, you know, complexity going a lot higher. And I think the reason why NPS is going in the wrong direction is because the hospital system Terry Coutsolioutsos: No. Josh Garrison: ⁓ with having to have all these administrators, right? ⁓ you look at ⁓ the traditional, ⁓ know, kind of hospital system, ⁓ monthly ⁓ ⁓ their monthly expenditures about 35 to 40 percent ⁓ ⁓ even touching the patient. ⁓ Right. So when you have that amount of monthly misallocation and then you get slammed in backlog, right? Which, you know, is our COVID scenario, you're gonna, you know, have SLAs go in the wrong direction, you're not gonna be able to treat patients. So I think if we as a healthcare society kind of focused on bringing this down and bringing this up, we would be an much better spot ⁓ with those NPS scores. Terry Coutsolioutsos: For sure. And you know, the cost of care would be a lot more efficient, you know. I think our h healthcare system would run more efficiently too. Like, you know, you have that much cost associated with your deliverables. It'd be hard to believe any business could be viable at that kind of rate. Josh Garrison: Yeah, a absolutely. Terry Coutsolioutsos: That's a really compelling chart. Thank you for bringing that to our attention.