Latest / StartUp Health NOW Podcast / Reducing Licensing Friction to Unlock Clinician Capacity with Dr. Ian Madom, CEO & Co-founder of Mocingbird

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Reducing Licensing Friction to Unlock Clinician Capacity with Dr. Ian Madom, CEO & Co-founder of Mocingbird · StartUp Health NOW Podcast

• 0:00
  [chimes] Welcome. My name's Unity Stoakes from Startup Health. Today, we have a wide-ranging conversation with health transformer extraordinaire, Dr. Ian Madone, who's the co-founder and CEO of Mockingbird.
• 0:16
  We're gonna go deep in what's really going on in the world of health systems, administration, and how there's new platforms to help administrators and clinicians really manage the process of CMEs, compliance, licensing, all those details that really bog the system down.
• 0:35
  So stick around for a wide-ranging conversation with Dr. Ian Madone. [upbeat music] Ian. Hi, Unity. How are you? How are you, sir?
• 0:53
  I am pretty good. I'm s- just... I've just finished clinic, so- You, uh, the, the, the best part of my day is when I get to speak to a doctor-preneur who's- [laughs]... coming off the front lines.
• 1:04
  They actually know what's going on. You know, you're talking to patients. You're doing real work, so, uh- Oh, I appreciate that very much.
• 1:12
  It's a, it's a labor of love that I'm not sure my wife always appreciates, but she certainly understands it, so. You're, you're in Rhode Island, correct? I'm in Rhode Island, yes. Yeah. Okay. Yeah.
• 1:25
  Well, I'm really excited to catch up because, you know, one of my mantras is that a lot of the best innovation in the world is the simplest. It's the most elegant.
• 1:35
  And I think what you and Mockingbird have been bringing to life is one of those things because it's, like, one of the unsung, you know, things that really is improving people like your peers' lives, administrators' lives through the whole system.
• 1:52
  So I'm excited to catch up with you on all the great work that Mockingbird's doing and- Yeah. But I thought we'd start with you because as we were just saying, you're a practicing doctor. You're a physician- Yeah...
• 2:03
  clinician. Yeah. Tell us about your background. Tell us about you and, and kinda the beginning of your, your journey of, of
• 2:12
  getting into healthcare, and why you went into healthcare, and then what led you to launch Mockingbird. Yeah. My... So my father is a physician. He's a pediatrician. My mother was a pediatric nurse.
• 2:24
  They met back in Brooklyn [laughs] back when they were young. And I have always been around... I, I kinda like to say I've been in healthcare for 49 years [laughs] since I, you know, since I was a baby. We lived in...
• 2:40
  My father, after his residency at Long Island LIJ Hospital, now Northwell, we moved into Eastern Long Island, and he hung a shingle. We had a house.
• 2:50
  It was, like, this ranch house, and one side of the house was his office. The other side we lived in. And so we were over there.
• 2:57
  Like, I'd be playing in the, the waiting room, right, as a little kid, and my father was seeing patients. And so that's... it's always kind of been around in the house.
• 3:09
  And as I grew up, I realized that I did wanna go into healthcare. I spent,
• 3:15
  I think I spent a couple afternoons with my father, who quickly told me I wasn't cut out to be a pediatrician, [laughs] I should be a surgeon, 'cause I had a surgeon mentality, and I ended up choosing that.
• 3:27
  So I'm an orthopedic spine surgeon. And the one thing that, that doctors love to do is complain. [laughs] They love to complain about the problems in healthcare.
• 3:38
  The one thing I learned from my dad was don't complain unless you have a solution to it, and start to fix the problems that you see that are present.
• 3:49
  And so I always felt like I was, had that mindset early on in my career.
• 3:55
  I was lucky enough to go do a executive MBA at, uh, at Yale, where I met a lot of other both clinicians and other people in healthcare, and I met my co-founder for Mockingbird there.
• 4:07
  And we spent a lot of time outside of class talking about the problems, but the solutions that maybe we could bring to, to the ecosystem.
• 4:15
  And one of the things that we really spent a lot of time from our own pain points was all of these different certifications that we just have an impossible time tracking, and tracking all the compliance that goes along with it, that's mostly education-based, can't we do this in a simpler way with, with software and bring a real, as you said, a simple solution to clinicians' lives?
• 4:39
  Because at the end of the day, I just wanna take care of people. I wanna be in the office seeing people. I wanna be in the operating room taking care of people and fixing their problem with their neck or their back.
• 4:49
  I don't wanna be figuring out what I need to do to just be able to do that. I have no problem with doing the education. I believe in education, spent my ti- my years learning stuff.
• 5:00
  But to spend time looking up what I need to do, and then going out and trying to find it in a way that's very labor-intensive, w- we just felt like there had to be a better way, so we brought one to the market.
• 5:14
  So, so you and your, your co-founder, also a doctor, right? Yeah. That's George Fermain. So you came up with this solution, Mockingbird. How do you describe Mockingbird today to the world?
• 5:28
  Mockingbird is a SaaS product, you know, piece of software that takes all of your different credentials, your license, your certifications for narcotics, maybe even your board certification, soon to, soon to be coming out, and manages all of the compliance needs to be able to renew that certification in a way that is timely, gives you the information that you need, points you in the direction of the education that you need to complete, so that when it's time to renew that, that certification, you're ready to go.
• 6:07
  And I don't think a lot of people realize, but this gets to be like a game of 3D chess when it's state by state in some cases, and it's- Yeah... there's, it's, it's, there's just so many things.
• 6:18
  It-Tell us a little bit about the administrative reality of, of healthcare today. Like, what's really going on? And then within the context of
• 6:28
  I think the solution, the SAS solution, it automates things not just for individual clinicians and, and, and physicians, but also for the administrators as well. Sure. What, what's going on?
• 6:39
  What's the administrative reality today? Yeah, we learned that early on just by our own personal experience. I had, when we were starting, it was very time would prove that we were in the right space.
• 6:52
  One of my admins that supported my practice at the time said, "Hey, you have a renewal coming up for the state of..." I believe it was Rhode Island, my main state of practice.
• 7:03
  "You have eight hours of opioid training due. By the way, I know it's Friday of Memorial Day weekend, it's due on Tuesday.
• 7:09
  [laughs] And here's 40 different websites you could go look at to figure out what you need to do." So at least she started the process for me.
• 7:18
  The, the issue in, uh, in our fragmented system is that every state, state has their own set of requirements that change on a yearly basis. Many of them overlap, but some of them don't in what the requirements are.
• 7:31
  But how to achieve compliance doesn't necessarily overlap. Some of them may require the same course, some of them may require a state-specific course.
• 7:42
  And then the timelines is where things really get tricky, that three-dimensional chess you're talking about. Because sometimes these, these credentials expire on your birthday.
• 7:53
  Sometimes they expire on June 30th or January 31st. Sometimes it's based on the date that it was issued. And no state is different in the way that they do it or has any consistency.
• 8:04
  So when, when you talk about a piece of software, how does it achieve compliance for you so that you're not spending an extra amount of time doing education that you don't need, right?
• 8:17
  You've already done that piece of education, and it applies it to the license as you, as you need. But then also from a cycle to cycle, how do you make sure that you've done the education at the right time?
• 8:30
  Based on when I did this piece of education, can it be applied to this state's cycle and not be applied to that state's cycle?
• 8:37
  That's an important piece where we find a lot of people are actually out of compliance, and then they're doing last-minute education. And to me, last-minute education is paying effectively just a toll or a tax.
• 8:50
  You're not... You're just trying to get it done as quickly as possible. There's no real opportunity to learn anything from that. And so the state's intent is not achieved in a [laughs] meaningful way because- Right...
• 9:02
  people are just trying to check the box.
• 9:04
  Yeah, and it seems like you've taken what often becomes a very reactive situation or solution where maybe an administrator's reminding you, like you said, right, th- two hours before something's due or four days over a holiday weekend.
• 9:19
  And, and taking that scramble and turning it into an automated system- Yeah... a, a, a system that can be done thoughtfully and manage a lot of, of the logistics for you as well as the administrator.
• 9:34
  Am I getting it right? It's, it's not just for individuals, it's also for a system- Yes... overall to help them with that administrative burden?
• 9:43
  Yeah, so we, we learned that our admins that are pr- that are supporting us are just as burdened by this, and they were tracking it on spreadsheets.
• 9:52
  We wanted a way that could connect them to their clinicians so that they're not just sending an email, a lot of which are going unanswered, and have a system that's notifying the clinician, but then they can also see where their whole organization sits.
• 10:08
  Because they're responsible for the overall compliance of their workforce.
• 10:13
  And so as we have, as we have grown, we've spent more time on the administrative tools to the degree that we are about to, in the coming months, release a separate piece of software for the admins to use on their own where they can run the initial licensing for their clinicians, they can run the renewal for their clinicians, and see where the compliance is for their clinical staff all in one place for them to use, right?
• 10:45
  So now we can really focus on Mockingbird being primarily clinician based, right? That, that interface where the inputs are going in from the clinician, they're learning, they're tracking.
• 10:56
  And then the admin has their own piece of software that is looking at the overall organization and being able to execute on, "Well, maybe my, my clinician now needs these two state licenses," or, "These three renewals are coming up.
• 11:11
  I can get those all done in-house on my own." That's kind of where we're moving as an organization. So very focused on, on the admins that support us. Well, that, that's so helpful.
• 11:23
  And obviously in a post-COVID world, telehealth has taken off. You know, there's i- all this increased demand for, for care, and a lot of the demand is...
• 11:35
  or, or, or things have been changing to specialty care as well as across state lines. Have you noticed... So you guys, I think, launched, what? 2017, is that right? Yeah. I'm curious, like, what have you seen change?
• 11:52
  And then it seems like this solution's even more relevant today as clinicians are operating in multi-state, so there's even more licensing requirements, more CME requirements, more, more of these kind of logistical things [laughs] to, to manage.
• 12:08
  Is, am I getting that right? Yeah, 100%. I mean, so when we started, I think that, you know, we really started the, the work in 2018, and then we started to try to go out to, to market at the beginning of 2020.
• 12:22
  That didn't really work, right? Because there was a pandemic going on. We, so we effectively went out to market in 2021. Okay. And that was right around the time where telemedicine and virtual care was starting to grow.
• 12:37
  And I'd say that our biggestwedge in the market or the place we've been most effective up until about a year ago was virtual care.
• 12:47
  And even now, like virtual care, especially on behavioral health side of things, has been a big part of our growth story.
• 12:54
  But now we're starting to see health systems jump in and say, "Well, not only do we have virtual care, we have people practicing in multiple states because that's where our clinical operations function, and we need to..."
• 13:08
  The strategy to having people be multi-state licensed has become an effective reality for them.
• 13:15
  The growth of the Interstate Medical Licensure Compact that we work extremely closely with, we're developing their, their new portal for them that's being released over the, the, the coming months.
• 13:27
  They are a big part of this story as well, where people are becoming multi-state licensed. It's become easier to hold multiple states' licensure because of a system like Mockingbird.
• 13:39
  We don't, you know, in the past, you didn't-- you just had no idea where you stood. Now, you can have bigger outreach to larger amount of patients.
• 13:48
  It, it makes access a lot easier for patients, and it makes clinical operations for organizations a lot easier when people are mul- have multiple state licensure. Right.
• 13:58
  So they're-- because each different states have different board requirements is one- Okay... level. You, you got, there's different timelines. You mentioned some are on your birthday, some are by year-end.
• 14:10
  You know, there's all sorts of different timelines. There's ongoing renewals. There's all these different multi layers here. Does Mockingbird... Is this kind of an end-to-end licensing support? Now it is, yeah. Okay.
• 14:25
  Now, now, now we're...
• 14:27
  That this new piece of software really does the end-to-end for the admin staff that can go and get somebody their initial licensure, monitor their ongoing compliance, and then effectively renew their, their license or, or their controlled substance registration or their DEA.
• 14:47
  Whatever that requirement is that that organization has, they can, they can run that end to end. That's great. One, uh, and, you know, one of the topics that's a hot topic, it's been in the news even recently with, with
• 15:04
  basically where a lot of the job growth is, is in, in healthcare. But we still see kind of shortages within clinician shortages, obviously.
• 15:15
  I think one of the, the notions is, oh, there's just not enough clinicians out there.
• 15:19
  But it seems like one of the things I learned as I was doing more research is actually one of the re-- it, it's not just that there's not enough clinicians, it's also these, all these compliance issues, all these other delays that, that happen.
• 15:33
  So maybe talk a little bit about the kinda how this is helping just the, those issues, the workforce kinda scalability issues and, and some of those issues that maybe people don't think about. Yeah.
• 15:48
  Workforce management is, has been, I think, a focus of o-our industry for some time, but mostly focusing on how do I get the right clinician in front of the patient, or how do I schedule in a right way?
• 16:05
  The only in the past year to 18 months are people focusing on the access ma- basically like there are these huge swaths of geography where, where patients are underserved, right?
• 16:20
  Because you don't have l- the physical access to a clinician. That's where virtual care has the opportunity to help patients in the United States, because we've really grown in how we can care for people virtually.
• 16:34
  We don't necessarily need to do an exam with them in the room. We can do an exam on camera.
• 16:39
  We can certainly take care of people's behavioral health issues virtually, and the comfort with virtual care will continue to grow.
• 16:49
  If you have, if you have patients getting access to care in a way that their clinician is not necessarily in their local geography, it just helps them.
• 17:01
  But from a clinical operations standpoint, there-there's also this understanding from larger health systems that there's certain things need, that need to happen where people will travel for that, and there's certain things that can happen closer to home.
• 17:16
  And so there's this interest that we're seeing amongst larger health systems and health organizations where they're saying, "Let's grow our footprint beyond our local geography, and if we need them to come in to get care for testing for, we can pull them in to do that on a periodic basis.
• 17:38
  But the more regular interactions that we're having with them is closer to home or in their home."
• 17:45
  And to, to really execute on that, you need to have licensure in the l- i-in that state, in that locality where the patient e-exists.
• 17:55
  It can't be I'm in Rhode Island, just 'cause I have a Rhode Island license, I can take care of anybody across the United States. It really depends on where the patient is.
• 18:05
  That's the whole point of state licensure came about to protect patients, to provide patient safety in the delivery of care, and every state has their own set of standards of what they think is acceptable as far as delivering that care, and they don't wanna give that up to a national organization.
• 18:28
  Even the Interstate Medical Licensure Compact is not intended to nationalize the state licensure. It's to give every state their own sovereignty over how that licensure is conducted.
• 18:42
  Now, they may agree across state lines, "Your standards are good. If you agree to these standards, then we're all gonna come together as a compact."
• 18:50
  These are complex interactions that exist in the ecosystem that are heavy liftsFor admins and for clinicians it makes people wanna throw their hands up.
• 19:02
  You need to create a simplified solution to just tell somebody, "What do I need to get done so that I can continue to care for people that are on my panel?"
• 19:12
  And earlier you mentioned, well, you're, you're a orthopedic surgeon. You mentioned behavioral health. Are, is this a solution ac- across clinician types and- Yeah... specialties? Give us a little color on that.
• 19:25
  Yeah, I mean, I think that physicians, I foc- we focused on physicians. That was my own personal pain point, but we see this, we support nurse practitioners, PAs.
• 19:36
  You know, the growth of those two professions has been e- we've seen incredible growth over the past five years. That's both a healthcare economics issue and also an access issue to education.
• 19:52
  There's only a small number of medical school spots, and we don't see that growing with our population. We do see the number of nurse practitioner spots in, in the education ecosystem and PA spots growing.
• 20:06
  But we support all behavioral health types as well, right?
• 20:09
  Whether it be a licensed clinical social worker to an LMFT, there's, you know, there's multiple behavioral health professions that we support, and we see this as a big component of solving our behavioral health clinician shortage in the United States, and access to adequate behavioral health in the United States, you first have to start with having folks who are licensed in all of these states to be able to deliver the care.
• 20:39
  So we cover nurses. We will continue to grow into other areas as, as we take on new customers that have a larger footprint of that, those type of professionals. Well, uh, it- it's just an amazing solution.
• 20:55
  It's great to see your growth. You know, we're, we're living in this new world of, of AI. I'm curious what you, your, your perspective on just the state of innovation today in, in your arena. What's surprising you most?
• 21:10
  What you're most excited about? What, what are some of the things you're seeing on the innovation side, and just coming from the,
• 21:17
  as a practicing surgeon, but also a doctor-preneur, you're, you're, you're really covering the spectrum of frontline innovation as well as the, the industry side and the business side. What's surprising you today?
• 21:33
  What are you excited about today? I think that, you know, AI obviously is a pretty, you know, a, a hot topic amongst both, you know, clinicians, people in different markets, investors.
• 21:48
  I think the thing that people are starting to figure out, laypeople, professional people, is that there's multiple types of tools within the artificial intelligence sphere, and that not all tools are meant to solve the same set of problems, right?
• 22:08
  You need to match up the right tool with the right problem.
• 22:11
  For us, with Mockingbird, we certainly have leveraged some AI models and tools and to, to help our, our system on the back end both scale and to achieve some of the things that we're doing.
• 22:28
  Large language models have been part of that, right? Some people say, "Well, can't I go to ChatGPT and just find out what my requirements are and then just use that?"
• 22:41
  There's some definitive risks in doing that, I've actually tried it out myself, because these large language models work really well when you point them at specifically what they need to be looking at, not just scouring the internet.
• 22:56
  It's gonna pull out a lot of bad or wrong information. So the role of AI is to have these tools in a structured environment to then achieve the things that you're asking them to achieve.
• 23:11
  The machines are really good at setting them to go do a task, achieve that task, and come back to a platform to then deliver that information in a meaningful way to the user.
• 23:23
  That, to me, is the, is where AI mo- like any t- any company that's out there us- utilizing AI, it's when they have a definitive use case. They've built a structure, a platform around that.
• 23:37
  They ask the AI to go out, retrieve this data, bring it back, and then me, as a company, I'm going to demonstrate it to my user in a meaningful and powerful way to get new insights and to be able to act on those insights.
• 23:53
  That's a combination of using AI and then using our human brains to make it meaningful [laughs] for the user. Totally. Totally. And how do you, how do you like being a doctor-preneur?
• 24:04
  What, what's the experience been like? What's your journey been like while you're practicing but also building? It's hard but rewarding. It's lonely yet engaging, right?
• 24:18
  It's, it's all of these things that are at opposite sides. It's a push/pull on a daily basis that some days make me say, "Why am I doing this?" And other days saying, "This is exactly why I'm doing this."
• 24:32
  So I, I think that it depends on the day that you grab me. Today is a day that I'm feeling really inspired and empowered. [laughs] Good. And other days that don't feel that way.
• 24:43
  But I think if you ask other docs that have jumped into this, if you, if you ask, you talk to entrepreneurs all the time.
• 24:49
  You know there are days that feel not so great and days that feel like you're gonna conquer the world, and that's what I think is really both humbling and exciting about building, building things that are going to help people.Well, I love, I love the work that Mockingbird does because it enables the clinician to do what they do best, which is spend time helping the patients- Yeah...
• 25:15
  rather than the administrative, all these licensing logistical burdens. So that's... it's really wonderful to see. What's, what's next for Mockingbird? What's, what's on the horizon? Anything you wanna share?
• 25:26
  Or you just, you're just heads down growing and scaling what's working?
• 25:30
  I mean, the real thing that we are excited to share in a more, I guess, organized [chuckles] way is in, in the coming months, this new licensing end-to-end platform that we're gonna bring, be bringing to market with two beta customers in April and then for general release in, in June.
• 25:47
  And we think this is really gonna help a lot of companies, a lot of organizations, a lot of health systems that are trying to do this on their own, but they're not able to scale their teams fast enough to be able to bring clinicians in and be able to put them in front of patients.
• 26:03
  We're gonna help them a lot. Incredible. Well, it, it's awesome to see how the amazing progress you, George, Stacy just keep making. It's just really fun to watch and be a part of in s- in, in, in a small way.
• 26:17
  Where should people go to connect with you, to reach out about business opportunities? It's Mockingbird, M- Yeah... M-O-C-I-N-G- Bird... bird.com? That is correct.
• 26:30
  MOC is maintenance of certification, so that's why we called it Mockingbird. Mockingbird doesn't have its own call. It ha- it echoes the voices around him, them, and we are echoing the voices of clinicians.
• 26:44
  And they can go to mockingbird.com and find out more.
• 26:47
  You can find us on, on LinkedIn and any of the other, you know, social media outlets that you have, and we really appreciate all of the support through the years that StartUp Health has given us.
• 26:58
  It's b- you guys have been an incredible partner from the, you know, our times at, at Vive and Health and doing podcasts, all this stuff.
• 27:08
  We really appreciate everything that you've built, Unity, in, in being able to support companies like us and, and changing the lifestyles of healthcare professionals and the patients that we take care of.
• 27:22
  Thank you so much. Appreciate that, and hope to see you very soon. Very good. Be well, Unity. Thank you so much. Thanks.
• 27:28
  [upbeat music] And finally, an invitation to all of the extraordinary health transformers, whether you are a startup, someone building the future of health, or whether you are an investor, funder, or buyer of the solutions out there in the marketplace, this is an invitation to you to join the StartUp Health member community.
• 27:52
  Learn more at startuphealth.com. Look forward to hopefully seeing you soon. [upbeat music]