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Medicine Meets Business: Greg Sawchyn's Unique Approach to Healthcare Innovation | Nursing Home Series | Senior Care · The Inspired Stories Podcast

• 0:04
  Welcome to another edition of the Inspired Stories podcast,
• 0:08
  where leaders share their experiences so we can learn from
• 0:12
  their successes and be inspired by how they've overcome
• 0:15
  adversity. My name is Anthony Kotaspodi and
• 0:18
  today's guest is Doctor Greg Sachin, Regional President at
• 0:22
  Welby Senior Medical Now. Wellby specializes in caring for
• 0:27
  older adults facing complex or chronic conditions.
• 0:30
  Their mission is to help patients lead healthier, more
• 0:34
  meaningful lives through compassionate personal care
• 0:37
  while promoting physical, social and emotional well-being.
• 0:41
  Greg joined Wellby in December 2022 and has a strong background
• 0:46
  in Value Based care. He previously served as vice
• 0:50
  president of Value Based Care at Sound Physicians and senior
• 0:54
  director of product strategy and innovations at Ohio Health.
• 0:58
  Greg is also a physician with an MBA in corporate finance from
• 1:03
  The Ohio State University, which gives him a unique perspective
• 1:06
  on both clinical and business strategy.
• 1:09
  Through his work, he has helped design programs that improve
• 1:12
  patient outcomes while reducing unnecessary costs.
• 1:16
  Today, we'll learn how Greg's leadership and medical expertise
• 1:20
  guide his team at Well be to deliver top notch care to
• 1:24
  seniors in Ohio. Now before we get into all that
• 1:27
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• 1:30
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  To find out if your company qualifies, contact us today at
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  AD back benefitsagency.com. All right, back to our guest
• 2:00
  today, the regional market President of Welby Senior
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  Medical, Greg Sachin. I appreciate you making the time
• 2:05
  to Share your story today. Yeah.
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  Thanks Anthony for inviting me. OK, so Greg, before you started
• 2:12
  your professional career, you obtained a lot of formal
• 2:16
  education. You have an undergrad degree, an
• 2:20
  MD medical degree, and an MBA, all from The Ohio State
• 2:23
  University and all back-to-back to back.
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  Sometimes people will get a degree, go work for a while,
• 2:31
  figure out that they need some additional schooling, but you
• 2:34
  got it done all in one fell full swoop.
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  Did did you have kind of a vision of where you wanted to go
• 2:41
  in your life right from the start?
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  Yeah, I mean, I think that from my history, I don't necessarily
• 2:48
  recommend it for everybody. I mean, it's, it's one thing
• 2:51
  where, you know, things kind of progressed and fell into place
• 2:55
  and I, I just kind of went with the momentum, to be honest with
• 2:58
  you, you know, even throughout undergrad and you know, it
• 3:01
  doesn't really show necessarily just by the end result, but I, I
• 3:04
  kind of went between science and business the entire time.
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  Actually, sorry the, the stream said it paused, but I guess not.
• 3:19
  So what, you know, I actually switched my major like four or
• 3:22
  five times in undergraduate between science and business and
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  I still managed to get out in four years.
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  So, you know, like that, that was, that was definitely an
• 3:29
  accomplishment. And then, you know, state at
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  Ohio State at the time, he's the current chief medical officer
• 3:37
  over at Ohio State, Doctor Thomas had started this like
• 3:41
  combined MD and MBA program. So you could actually go in and
• 3:44
  do a combined degree between getting a medical doctorate and
• 3:47
  an MBA and decided to, to, to join on with that and pursue it
• 3:53
  until the end. And, you know, there are a
• 3:55
  couple other folks in, in, in my class.
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  I, I actually keep really good touch with all of them.
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  And so, you know, it just ended up working out that I wanted to
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  be in this space between the science, the medicine and the
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  business side throughout. And, and I've kind of charted
• 4:11
  that path through my career in a, in a kind of back and forth
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  kind of way. And so, yeah, you mentioned that
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  in undergrad you kind of went back and forth.
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  So you had an interest in both areas from an early age.
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  Where did that come from? Did you grow up in a household
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  of doctors or business people? No, I'm actually the, the first
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  person in my immediate family to go to any college.
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  You know, my, my mom is a registered nurse retired.
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  But you know, back then you didn't really have to go to
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  college to be a nurse. You kind of went from like a
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  high school to just go get an RN in nurses training.
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  And my dad just really had a, a high school education.
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  So I kind of grew up a little bit around nursing, but you
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  know, really it was kind of high school where I, I, I just really
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  enjoyed science and learning more about it.
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  And, but at the same time, I, I enjoyed numbers and business and
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  numbers seem to go together for me.
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  And, you know, I've just kind of tried to push those two things
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  together throughout my career. So let's maybe talk about some
• 5:16
  of the stops along the way. I'm looking at your LinkedIn
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  page here. Right out of school.
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  Looks like Lancaster Pollard. Yeah, Associate and then AVP
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  there. What?
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  What kind of what? What did you learn here?
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  Yeah. So Lancaster Pollard Middle
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  Market Investment Bank focused on hospitals and senior living.
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  You know, I actually had the opportunity during my MBA to
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  meet somebody who was already working there.
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  And, you know, really, he told me about the firm.
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  So he was going to get his MBA plan to go back to the firm and
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  and it just seemed like a good fit.
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  Got to know them a little bit over the course of probably
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  about a year and then ultimately decided to join the firm right
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  after I finished my MD and MBA, had the opportunity to, to
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  really Start learning about how the healthcare system works from
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  the business side. So you go to Med school, it's
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  all science, it's all, you know, Physiology and, and you know how
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  to take care of patients, which is great.
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  I mean, that's, that's what it should be.
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  But your typical MD gets out and they, they really don't know
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  anything about the sort of business of, of medicine, maybe
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  maybe to the detriment. And I think that if you talk to
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  most doctors, they would say that, that they wish they had
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  more of that training during their, their medical career.
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  And then similar with MBA like it, it's, it's very sort of
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  generalized business kind of education, not a lot about
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  healthcare specifically, but just generalized business
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  things. So by going to, to Lancaster
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  pilot, it really gave me the opportunity to kind of get some
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  of the drivers of, of healthcare business.
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  You know what, what I really focused on there was critical
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  access hospitals. So there's a program that exists
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  in the federal government where a hospital can get what's called
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  a critical access designation. So if you have 25 beds or less,
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  you can be a critical access hospital and there's some
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  special reimbursement rules with Medicare.
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  The way that works this, this critical access hospital
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  designation really came into popularity kind of when I was
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  kind of starting with that in the mid 2000s where a lot of
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  Hill Burton hospitals. So Hill Burton was an act of
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  Congress back in I think it's like 1950s that allowed a lot of
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  these rural areas to build hospitals.
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  But they, they'd always struggled, you know, to retain
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  medical staff to be profitable. And so a lot of these facilities
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  were in somewhat disrepair and then some, you know, more
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  favorable reimbursement came online and in 2000 and that gave
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  them the opportunity to replace their facilities, renovate them
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  and things like that. And so we did a lot of business
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  doing that. And I got to learn a lot about
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  hospitals, especially in kind of rural areas and the drivers.
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  And it was, it was, it was really great learning experience
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  for me. What?
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  What is this critical access hospital designation allow?
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  What's the advantage of having this?
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  Yeah. So typically under Medicare you,
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  you get like a ADRG reimbursement for an inpatient
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  admission. So basically like Medicare will
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  say, hey, this patient's in your hospital for heart failure and
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  then we're going to make some adjustments to it, but we're
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  going to give you a $6000 for that admission.
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  Doesn't really matter what your costs are, what the inputs are
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  or anything like that. It's just sort of a, a flat
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  payment. What critical access did was
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  kind of take the reimbursement system back to the way it was
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  before the DRG system came into place where there was like a
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  cost plus reimbursement. So basically they got 100 and 1%
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  of their costs. And there was, you know, very
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  formulaic how you actually came up with cost, but that included
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  like interest and appreciation on a building, a hospital
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  building. And so because of that, that
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  allowed them to go out and, and actually like, you know, issue
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  bonds and borrow money to, to replace or renovate their
• 8:54
  hospitals. Interestingly, you know, that
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  besides critical access, the, the other sort of DRG exemption
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  that exists out there are, are like National Cancer Institute
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  facilities. So you know, it's complete other
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  end of the spectrum from like a 25 bed.
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  And you know, I, I even worked with hospitals that had like 7
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  beds to like the James Cancer Institute where, you know, they
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  have an actual, a similar sort of reimbursement structure that
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  allows them to build very large and nice buildings.
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  And is this how has this critical access hospital
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  designation actually played out? Is it proved helpful?
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  Is it helping these hospitals and sort of these smaller towns
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  stay afloat? Yeah, I mean, it's, it's tough
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  right now for small hospitals in rural areas.
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  So and you know, I think this has helped.
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  It hasn't solved all the problems.
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  I mean, there's, there's a number of issues.
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  One, in order to operate a hospital, you have to have a
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  medical staff, you have to have physicians that are willing to
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  be there. The reality is, is it's, it's
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  harder to attract physicians to want to practice in rural areas.
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  You, you actually as a physician can make a lot more money going
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  in a rural area than you can even in, in an urban area.
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  It's somewhat sort of backwards of what you would expect.
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  But you know, that's one aspect. And, and the second one is just
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  by having a smaller facility, you still have to have resources
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  and things like that. So it is more expensive to
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  operate. And so, you know, it has been
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  very tough and continues to be so for for rural hospitals.
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  And then you see a couple strategies.
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  You know, one they, you know, they're trying to just hang on.
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  You have seen a lot of facilities close or they
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  affiliate with a big health system like like in Ohio Health
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  or Ascension or you know, somebody like that, that can
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  give them an umbrella to to help allow them to continue to
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  operate in a in a rural area. But it's I wouldn't say that
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  it's been solved by any stretch of the imagination.
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  So in 2009 you moved on and you founded your own company.
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  What was that? Yeah.
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  So, you know, in 2009, I ended up sort of breaking off from,
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  from Lancaster Pollard and started my own financial
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  advising company and started taking on sort of finance
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  consulting sort of gigs as well as operational consulting gigs,
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  really catalyzed by a necessary move in my personal life.
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  So my my wife's also a physician and she got a fellowship, a very
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  great fellowship in ophthalmology in, in
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  Philadelphia. And so we ended up having to go
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  out there and which, you know, kind of took me away from all
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  these critical access hospitals in Michigan that I was working
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  with. But you know, it ended up being
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  something that was a huge risk. I mean, like, you know, I, I
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  ended up, you know, walking away from a job steady paycheck and
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  now you're on your own where, you know, if you're, if you're
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  not bringing clients and things like that in the door, you just
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  don't get paid. Like there's no such thing as
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  vacation time. There's no such thing as sick
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  time. There's, there's none of that.
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  It's just, you know, whatever you you in, in medicine terms,
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  you use this term, you eat what you kill.
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  And when you're, yeah, when you're talking about bringing
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  the hospital in, bringing them in for what purpose?
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  The service of. So to consult with them on
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  similar sort of financing arrangements.
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  So like I would work with either hospitals on, you know, like a
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  renovation or you know, something like that they want to
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  do for their facility. But actually ended up kind of
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  migrating more towards working directly with physicians and
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  physician groups on joint ventures with health systems and
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  medical office buildings and, and things like that.
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  And end up being a, a really nice niche that with the MD and
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  working with other physicians, you sort of like, you get what
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  get what makes them tick. And but you kind of bring this
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  like a little bit more business experience to them.
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  So that as they're doing these negotiations with health systems
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  and things like that, then, you know, they've got somebody in
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  their corner who can really operate at the same level as
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  the, you know, specialized people at the health system when
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  they're talking about joint ventures and things like that.
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  What do you think the future of these small rural hospitals is?
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  My mother-in-law is affected by this up in Northeast Ohio.
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  They've had their hospital clothes and bankruptcy looming
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  and acquired. Is it going to be acquired?
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  Is it going to be shut down? And, and it seems like it's kind
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  of a a common story right now. It is unfortunately that that's
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  the case. I mean, I think when you look at
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  the, the spectrum of healthcare, what used to exist in rural
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  areas as well as urban areas is like you build a hospital and
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  then that hospital provides all services to all people.
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  And you know that from, you know, OBGYN services to, you
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  know, complex surgeries and, and things like that.
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  The reality is that's just not going to be practical.
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  I mean, like, you know, a, a rural hospital with 25 beds
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  isn't going to be able to hire and retain a cardiovascular
• 13:54
  surgeon for just that facility. It's just there, there aren't
• 13:57
  enough cardiovascular surgeons around and there probably
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  honestly wouldn't be enough volume at that hospital to
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  really justify the expense. And So what I think you're going
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  to see over time, and I think you already are seeing quite a
• 14:08
  bit of it, is, you know, clearly you need hospitals, you need
• 14:12
  facilities in rural areas or people can't live there.
• 14:15
  I mean, you need healthcare. It's not going to be all
• 14:17
  telemedicine, you know, it's just not practical.
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  You know, you need to be able to lay hands on people to be able
• 14:21
  to take care of them, especially in an emergency.
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  So I think what you're going to see is, you know, these like
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  emergency rooms with, you know, call them emergency room plus
• 14:30
  where I can treat you in emergency.
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  I can do some observation, I can do some procedures, I can
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  stabilize you, but if you need something big, then I got to
• 14:40
  transfer you to a bigger facility.
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  And similarly, like even in cities like you have these sort
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  of mid tier hospitals with like a hundred 150 beds.
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  I you can make a strong argument that like those facilities
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  shouldn't really exist either. Like if you really want to get
• 14:56
  efficient, there should be a couple very large facilities
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  that have, you know, everything 24/7, you know, hundreds of O
• 15:04
  Rs, you know, that kind of thing to really take care of complex
• 15:10
  conditions because it's, it's one of those things where, you
• 15:14
  know, there are economies to scale.
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  And, and as you see in medicine, the technology, which is
• 15:19
  amazing, isn't cheap. You know, I, I think that even
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  in Columbus, OH here, the, a bunch of the, the health systems
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  kind of got together to buy one of these like protein beam
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  therapy things for cancer, because they just realized it
• 15:34
  like, Hey, we're not all going to buy one of these on our own.
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  So we just need really one for the city.
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  And so that's what they they built.
• 15:42
  So what is that protein beam therapy?
• 15:44
  You know, you're getting out of my you're getting out of my air
• 15:46
  of expertise. But it's it's a it's it's a
• 15:50
  radiation sort of treatment modality that has like a very
• 15:55
  focused beam to go after like a, a tumor and cancer.
• 16:00
  So like normally like radiation, you, you radiate everything.
• 16:03
  It's my understanding is like the protein beam's more like
• 16:07
  functions more like a laser where it's like a very direct
• 16:10
  hit of a certain type of radiation to, to a tumor.
• 16:14
  But you need to, they're very expensive.
• 16:18
  I want to say like they, they spent $50 million on this thing.
• 16:22
  And, you know, some, somebody could probably correct me on
• 16:25
  that. Like I'm, I'm, you know.
• 16:26
  Are there specific types of cancer that it can be used on?
• 16:29
  Yeah, yeah. I mean, yeah, yeah, you you
• 16:32
  really have to ask an oncologist for the details of that.
• 16:35
  We've really gone outside your realm.
• 16:36
  OK, let's. Let's let's bring I think
• 16:38
  probably most solid tumors and you know, things like that.
• 16:40
  You would probably, you know, be this, but whether that or
• 16:43
  traditional radiation, you'd you'd have to ask an oncologist
• 16:47
  for sure. You don't want my opinion and
• 16:49
  this is something else I'd. Shake you staying in your lane?
• 16:52
  Yeah, yeah, exactly. Like trust the experts and I'm
• 16:56
  not an oncologist. All right, so let's go back to
• 16:58
  the business that you started back in 2009.
• 17:00
  Looks like you ran through 2017. What was something you did there
• 17:04
  that you're most proud of? You know, there was a a
• 17:08
  physician group that was in a joint venture with, they'd
• 17:12
  already done this joint venture with a large health system and
• 17:19
  that health system for its own sort of financial, you know,
• 17:23
  difficulties was really trying to strong arm them into, you
• 17:27
  know, selling this asset. It was medical office building
• 17:31
  to a REIT, a real estate investment trust.
• 17:35
  And this was like back in like 2009.
• 17:41
  And so it was, you know, the middle of the great financial
• 17:44
  crisis. So, you know, everything was
• 17:47
  going for fire, fire sale prices.
• 17:48
  And this health system was just trying to unload this asset for
• 17:51
  its own cash reasons and everything else.
• 17:54
  And they were trying to bully this this physician group and
• 17:57
  kind of going along with it. The physician group brought me
• 18:00
  in and said, hey, you know, I'm not sure this is a good deal
• 18:04
  that they're trying to do. And, and, you know, I kind of,
• 18:07
  you know, helped them and went through the financials and
• 18:09
  everything else and, and it, it was not a good deal.
• 18:12
  It was a terrible deal. Basically, they're going to be
• 18:15
  selling it for just a little bit more than the debt they owed on
• 18:17
  it. They would have walked away with
• 18:18
  their investments, but not much else.
• 18:21
  And so we kind of put some strategies in place basically to
• 18:24
  assert their control over this joint venture and, you know,
• 18:29
  just kind of delay things. And sure enough, the market kind
• 18:32
  of settled itself out and things started coming back and we
• 18:35
  actually did end up selling it, I think it was two years later.
• 18:38
  And they all realized actually like a 10X return on their
• 18:41
  original investment because you know, like that's the way
• 18:43
  leverage works, right? So you have like a bunch of debt
• 18:45
  on something and then the equities based on sort of the,
• 18:47
  the gap to that debt. And so the assets, it's the
• 18:50
  asset itself was probably valued it, you know, call it 150% of
• 18:55
  what this health system was going to sell it for.
• 18:57
  But because of that, their, their equity went up something
• 19:00
  like 10X. That's what they got to go home
• 19:03
  with. So, you know, I was, I was just
• 19:04
  happy because I was proud of it. Because you know, you have
• 19:08
  physicians that again, they don't get a lot of business
• 19:10
  training, they don't get a lot of that.
• 19:13
  And then, you know, somebody was really trying to take advantage
• 19:16
  of them financially. And, you know, it was, it was
• 19:19
  kind of why I decided to do that during that part of my life was
• 19:23
  to kind of be in their corner and and kind of give them an
• 19:25
  equal seat at the table of, you know, how they could really
• 19:28
  operate. It had to feel very rewarding.
• 19:31
  So so you had this company till 2017, about almost eight years,
• 19:37
  then you decide to kind of wrap that up and move on.
• 19:40
  What was behind that decision? Yeah, so it's interesting.
• 19:43
  So I, I, you know, I started at Ohio Health and Ohio Health is
• 19:48
  effectively like a client of mine.
• 19:51
  You know, they, they were kind of getting into value based
• 19:54
  care. Got to know doctor Bruce
• 19:57
  Vanderhoff, the the chief medical officer there at the
• 19:59
  time. He's over at the, the Ohio
• 20:01
  Department of Health now. And just, you know, really had a
• 20:06
  good relationship with him. And he kind of told me about
• 20:09
  kind of what they were looking to do and whether I could be
• 20:12
  helpful with that. And so I said, yeah, like, let's
• 20:14
  let's do this. And then actually took them on
• 20:17
  and they were, you know, a large client I was spending half my
• 20:19
  time. There and eventually they said,
• 20:21
  hey, you know, we want to we want to do more of this.
• 20:24
  Do you want to come on full time?
• 20:26
  And I said, yeah, I think so. I'm at a time my life where that
• 20:29
  makes a lot of sense for me to do.
• 20:31
  And I love the work that I was doing in this value based care
• 20:36
  space. So made that move and decided to
• 20:38
  kind of let the the other sort of consulting stuff run off and
• 20:43
  join Ohio Health full time at that point.
• 20:45
  Yeah, there's definitely there's security, especially as you're
• 20:48
  starting a a young family, there's security and you know,
• 20:51
  kind of having a a regular stable paycheck from a, you
• 20:54
  know, a well established employer like that.
• 20:56
  And so you started out director clinical guidance counsels, you
• 21:01
  moved up supply chain medical director, senior director
• 21:04
  product strategy and innovation. Kind of tell me about this
• 21:07
  ascension. Yeah.
• 21:09
  So it, it really paralleled what Ohio Health was doing in the
• 21:12
  space at the time was I'd say when I started there very early
• 21:18
  and sort of this value based care journey and it really is a
• 21:21
  a hospital system. They were going through a lot.
• 21:23
  What a lot of health systems were going through at the time
• 21:25
  is that, you know, you essentially had this, call it
• 21:28
  confederation of hospitals. You had a bunch of hospitals
• 21:31
  that it always just kind of operated independently, but were
• 21:33
  part of a system because there's some leverage there and reasons
• 21:36
  to do that. And under the leadership of the
• 21:39
  time, they said, hey, we really want to become a system.
• 21:41
  Like we want all the pieces to actually work together.
• 21:44
  We want the system to be before the sort of confederacy of, of
• 21:47
  hospitals. So moving from a confederacy to
• 21:49
  a federal system in in more ways than one.
• 21:53
  And so, you know, as they did that they, they started these
• 21:56
  things called clinical guidance councils to bring in the
• 22:00
  specialty areas from the different hospitals and kind of
• 22:02
  agree on standards of care and practice and best practices
• 22:07
  amongst all the hospitals. So that where you would go is at
• 22:11
  the end of the day, if I went to one hospital or another hospital
• 22:14
  or another hospital and you had the same condition, you'd be
• 22:17
  treated in the same way. That wasn't necessarily true
• 22:20
  prior to that work and then as. You know, so this is really
• 22:24
  about standardizing the care across all the different
• 22:26
  locations. Yeah, yeah, in an evidence based
• 22:29
  way. So like, you know, you kind of
• 22:30
  looking at what, what's the literature say that we should be
• 22:32
  doing and looking at sort of the best practices from a lot of
• 22:36
  like really smart experts in the room.
• 22:39
  And whatever the specialty was, it again, it was one of those
• 22:43
  learning experiences where, you know, you definitely trust the
• 22:46
  experts in the room. Like when you get a bunch of
• 22:48
  really smart, like critical care doctors around a table, you
• 22:52
  know, you're going to get a good result at the end if you just
• 22:54
  listen to them. And that that was sort of our
• 22:56
  approach there to look at the different specialties of of
• 22:59
  medicine and, and really come up with those best practices.
• 23:02
  You've used the term value based care a couple of times.
• 23:05
  I can kind of infer what it means by, you know, the, the
• 23:09
  words in the phrase, but the the fact that you keep packaging
• 23:12
  them together, I have a feeling it, it kind of has a bigger,
• 23:16
  bigger meaning here. Yeah.
• 23:19
  I mean, you know, like there's, there's a lot of definitions out
• 23:21
  there and people will say value based care is this or that.
• 23:23
  At the end of the day, it's it's doing what's most efficient to
• 23:26
  get you the best result, which, you know, for, for any business
• 23:29
  or practice or specialty or trade.
• 23:32
  I mean, that's ultimately what you're trying to do.
• 23:34
  How do I employ resources in an efficient way to get the best
• 23:37
  result at the end? And you know, it's taking
• 23:41
  different flavors throughout that, but it's really a shift in
• 23:45
  thinking from the way medicine has traditionally operated.
• 23:47
  Like traditionally, it's like you show up in the Ed and it
• 23:50
  doesn't matter what's wrong with you.
• 23:51
  I'm going to pay you the same amount and you're going to get
• 23:53
  the same sort of thing. Value based care says, OK, well,
• 23:56
  let's look at, do you have something that's serious?
• 23:59
  Do you have something that's not serious?
• 24:01
  And we're going to treat those and pay for those and, and, you
• 24:04
  know, apply resources to those in different ways depending on,
• 24:07
  you know, what we expect the ultimate outcome to be.
• 24:11
  So your time there at Ohio Health, what was the thing that
• 24:14
  you're most proud of? You know, we came up with a, a,
• 24:19
  a, a way to be innovative and, and the, you know, giant, you
• 24:28
  know, 30,000 employee organization always has, you
• 24:33
  know, some, some difficulties with innovation.
• 24:35
  I mean, but it, it operates as a bureaucracy almost by by
• 24:39
  necessity. And you know, the momentum and
• 24:42
  the flywheel kind of do their thing and, and kind of changing
• 24:46
  that is very, very difficult. One of the things we actually
• 24:49
  did was come up with a, a fund to effectively internally seed
• 24:57
  like in like a venture capital kind of model, innovative things
• 25:00
  coming from clinicians that were evidence based, that might have
• 25:04
  a major impact on, you know, efficiency or better care and,
• 25:10
  and things like that. That just didn't make sense
• 25:12
  necessarily in sort of this fee for service world.
• 25:14
  So I want something that's, you know, FDA approved and you know,
• 25:18
  evidence based and everything else, but the insurance
• 25:20
  companies don't pay enough for it to cover the cost of the
• 25:23
  intervention. But it's still the right thing
• 25:26
  to do for patients and we're. Talking about, like, I don't
• 25:28
  know, different pieces of hardware or different
• 25:31
  medications or. There was some of that, yeah.
• 25:33
  Hardware, medications. We, we actually, one of the
• 25:37
  things was like an analytical tool that we could build into
• 25:40
  the EMR to like kind of push out evidence based medicine of, you
• 25:45
  know, what's appropriate to order an MRI on and what's not.
• 25:48
  And, and, you know, that kind of thing.
• 25:50
  And, but yeah, exactly that of, of kind of looking at some of
• 25:54
  these things that, you know, don't necessarily get directly
• 25:57
  reimbursed, cost more than what we're currently doing, but might
• 25:59
  result in a better outcome at the end.
• 26:01
  And then we, we measured all of that as we did these sort of
• 26:07
  fundings or, and, you know, looked at the end and said like,
• 26:10
  hey, this worked, this didn't work.
• 26:13
  You know, this is one of the things that made a lot of sense.
• 26:16
  You know, one of the, to give you an example, one of the
• 26:18
  things that, you know, we did that I, I, I really enjoyed
• 26:22
  doing it was because it was novel and it was one of those
• 26:24
  things that like this, this makes a lot of sense was like a,
• 26:30
  a special nutritional shake for people going into complex
• 26:35
  oncology surgeries. All right, So like, I'm going to
• 26:38
  give you a bunch of these like milkshakes.
• 26:39
  There was no dairy in them, but I'm going to call them
• 26:41
  milkshakes. Anyways, I'm going to give you a
• 26:43
  bunch of these milkshakes and I want you to take like, I don't
• 26:45
  remember, it's like 2 a day for a week before your surgery
• 26:49
  'cause there was some evidence out there that these things made
• 26:52
  a difference in post surgical complications, faster recovery,
• 26:57
  you know, things like that. And so these shakes.
• 27:00
  Just vitamins or yeah, it was, you know, they're kind of like
• 27:04
  an insure shake, but they had some extra stuff in them.
• 27:06
  There was called like Immuno nutrition Pixie.
• 27:10
  Test. Yeah, exactly.
• 27:11
  I, I think, I mean they were like made by Nestle and you
• 27:14
  know, it was, it wasn't much of chocolate or you know, it wasn't
• 27:17
  like nest, Nest quick or anything, but.
• 27:19
  So it wasn't a product that you guys developed, but you wanted
• 27:22
  to include this in the course of the?
• 27:25
  Yeah. We did not develop it, but it
• 27:27
  was something that was on the market but not very widely used,
• 27:30
  partly because like there was no reimbursement for it.
• 27:32
  So like your hospital system and I'm going to go do a surgery and
• 27:36
  my surgery cost this amount and I can do that surgery and get my
• 27:39
  reimbursement by just doing these things.
• 27:41
  Why would I go out there and spend an extra $100 for a bunch
• 27:45
  of milkshakes for the week before surgery if I'm going to
• 27:48
  get paid exactly the same amount whether I give you the
• 27:51
  milkshakes or not? And so, you know, this was one
• 27:55
  of those things that like there, there's no way they, they had no
• 27:58
  reason to approve that in sort of like this fee for service,
• 28:01
  like maximize profit kind of environment.
• 28:03
  And so we used it, like I said, they don't, they didn't cost
• 28:06
  much. I mean, it was like $100 for a
• 28:07
  course and these people are going in for ten $20,000
• 28:10
  surgeries. It wasn't a, you know,
• 28:12
  overwhelming amount, but the thought is, is that you have
• 28:15
  faster recovery, less complications, and, you know,
• 28:18
  it's a small sample size. I don't remember David Erisi,
• 28:21
  doctor David Erisi is the one who kind of pushed this along.
• 28:24
  I don't remember if he published anything on it or not.
• 28:26
  But anecdotally and, and you know, in the data that we saw,
• 28:29
  the, the complication rate for the patients that had the
• 28:31
  milkshakes was actually a little bit lower than the folks that
• 28:35
  that didn't have the milkshakes. Now, there could be lots of
• 28:37
  confounders and things like that in there, but it was, it was
• 28:40
  something that was like, like there's, there's something here.
• 28:44
  It was just really interesting to kind of look at the scenario
• 28:47
  and and see how it played out. Did that program get continued?
• 28:53
  We we continued them for a little while.
• 28:54
  I actually have no idea if they're still doing them or not,
• 28:57
  but yeah. So I mean that, that's a
• 29:00
  fascinating idea and, and it, and I love it.
• 29:03
  Like I, I, I love innovation and I love that it's sort of like,
• 29:07
  hey, you know, this, this isn't something that we're going to
• 29:09
  get reimbursed for, but this could produce a better outcome
• 29:13
  for the patient, which in the end is better for everybody,
• 29:16
  right? They don't have to come back,
• 29:19
  You know, that saves money that, you know, it's, it's less money
• 29:22
  out of everybody's pocket, it's less time, it's better health
• 29:24
  result for the, the consumer. Before we move on and and talk
• 29:28
  about kind of your your next couple of stops, is there one
• 29:31
  more of these innovation products that might be projects
• 29:33
  that might be interesting to hear about so.
• 29:40
  Let me tell you about one that actually like did not give us
• 29:43
  the result that we wanted because you know, like that that
• 29:45
  one I thought. We learned from those things,
• 29:46
  too. Yeah.
• 29:47
  So, so one of the things that we did there was a a software suite
• 29:51
  that we could alluded to it earlier embed in the electronic
• 29:54
  medical record, the system Epic system that would you know,
• 29:59
  produce alerts for like evidence based practices.
• 30:02
  And you know, it was one of those things where there was an
• 30:07
  analytic on the back end. So we kind of knew things that
• 30:10
  were evidence based, things that were not evidence based and, and
• 30:13
  kind of how all that worked and who was doing certain things.
• 30:16
  And you know, ultimately, you know, it, it ended up not
• 30:22
  working out. We ended up not actually turning
• 30:23
  on the alerts. There is a lot of concern both
• 30:27
  amongst the physician and the administration that it wasn't,
• 30:30
  it wasn't firing, you know, it might lead people astray.
• 30:35
  Now, at the end of the day, the physician could say like you OK,
• 30:37
  well, thanks for the reminder. Or I'm just going to ignore it
• 30:39
  and do whatever I want. But ultimately, we ended up not
• 30:44
  turning on those alerts for, for a variety of reasons, you know,
• 30:48
  like one, an example of one of those alerts, you know, like
• 30:51
  vitamin D testing. People do this all the time
• 30:54
  today. And it's it's sort of the bane
• 30:55
  of my existence. You know, I, I live in Columbus,
• 30:58
  OH, you know, Columbus, OH in February is very cloudy.
• 31:03
  You can make a bet that virtually everybody in Columbus,
• 31:06
  OH in February is vitamin D deficiency if you were to do a
• 31:10
  test on them, unless they just had a trip to Florida or
• 31:12
  something. So, you know, I can do one of
• 31:16
  two things. I can say, hey, take a vitamin D
• 31:19
  supplement or take a multi vitamin or, you know, something
• 31:22
  like that, you know, a couple times a week and that that'll
• 31:25
  make sure your, your vitamin D is where you need it to be.
• 31:28
  Or I can go, go get a, you know, 50 to $100 test that tells me
• 31:33
  what I already know. And then my treatments can be
• 31:35
  the same. Anyways, I'm going to tell you
• 31:37
  to take a vitamin D supplement. Maybe I'll give you a shot of
• 31:39
  vitamin D, which, you know, doesn't.
• 31:42
  It might raise it a little bit faster, but doesn't really have
• 31:44
  a, a huge other effect. And and you know, there are
• 31:48
  conditions where you do want to do vitamin D testing, but like
• 31:51
  for the average person going into a primary care office,
• 31:54
  there's no evidence basis that, you know, everybody comes in
• 31:57
  should get a vitamin D test. And there's plenty of primary
• 31:59
  care docs out there that are doing vitamin D testing on all
• 32:01
  their patients, even though you already know the result.
• 32:03
  I'm in Columbus, OH, like you're in February, you're March,
• 32:07
  you're vitamin D deficient. Just take a supplement.
• 32:10
  They cost you, know you. Avoid the cost of the test and
• 32:13
  you just take the supplement, which is relatively inexpensive
• 32:15
  and unlikely to cause you any harm if you didn't actually need
• 32:20
  it in the first place. Am I?
• 32:21
  Right. Yeah, Yeah.
• 32:22
  So ultimately, again, you don't win them all.
• 32:28
  And that continues to be any time I hear vitamin D testing,
• 32:32
  I'm just like, what are you doing?
• 32:33
  What's the indication? Why are you doing it?
• 32:36
  Because, you know, in 95% of cases, the vitamin D testing
• 32:40
  that's being done in this country is completely
• 32:41
  unnecessary. Unnecessary.
• 32:43
  An unnecessary expense. OK, I I really want to get to
• 32:45
  Wellby, but you had one more stop before that.
• 32:48
  Tell us about that. Yeah.
• 32:50
  So after Ohio Health, I went to Sound Physicians, Sound
• 32:54
  Physicians, National Hospital Medicine, mostly organization,
• 32:59
  but also emergency medicine, critical care, anaesthesia at
• 33:03
  the time biggest participant in the Medicare BPCIA program, the
• 33:09
  Medicare bundle payment for care improvement advanced I think for
• 33:15
  the the acronym for that. So basically taking what I
• 33:18
  alluded to earlier, hospitals are reimbursed on a DRG basis
• 33:22
  for a hospital admission. Well, now I'm going to give you
• 33:25
  essentially a payment for not only the hospital admission, but
• 33:29
  for the 90 days thereafter. And so if you have a
• 33:32
  complication, if you have a readmission, if you go to a
• 33:35
  skilled nursing facility or an inpatient rehab, you know,
• 33:37
  that's all sort of coming out of it.
• 33:39
  And so, you know, the ideal scenario is you're going to the
• 33:42
  hospital, we're going to fix you up, and then you're going to go
• 33:44
  home and you're going to get better and you don't come back
• 33:46
  to the hospital. You should be rewarded more than
• 33:49
  somebody who goes to the hospital, then, you know, goes
• 33:53
  to a skilled nursing facility, then goes home for a week and
• 33:56
  then, you know, decompensates, gets readmitted to the hospital,
• 34:00
  goes back to a skilled nursing facility, gets.
• 34:02
  And, you know, you can do this several times over 90 days.
• 34:05
  And many patients do, But the hospital systems never really
• 34:07
  had any incentive to, to change that because they got paid every
• 34:10
  time that patient comes back to the hospital.
• 34:13
  Skilled nursing facility gets paid for every day that
• 34:14
  patient's in the skilled nursing facility.
• 34:16
  And so everybody's just sitting there like, hey, well, I don't
• 34:19
  really care that much about the, the complications because I, I
• 34:22
  get paid every time something bad happens.
• 34:24
  Well, under this program, you, you kind of got paid more for
• 34:29
  having a good outcome, which, you know, aligns with really the
• 34:32
  way things should work. You know, you, you, I guess
• 34:35
  you'd call it kind of like a warranty.
• 34:38
  And, you know, because of that they, they, we did this hundreds
• 34:42
  of hospitals across the country and, you know, really had the
• 34:48
  opportunity to learn a lot about the way different health systems
• 34:50
  work. So, you know, before I went very
• 34:52
  deep at a place like Ohio Health and now I'm working more
• 34:56
  superficially, probably with virtually every like big name
• 35:01
  hospital system in the country in some way shape or form
• 35:03
  because of sounds overall reach. I think at the time we were in
• 35:08
  400 or plus hospitals across the country.
• 35:12
  And so really learned a lot about, you know, people will say
• 35:15
  health like when you see one health system, you've seen one
• 35:17
  health system. I, I completely disagree with
• 35:20
  that notion. The, the health systems that
• 35:22
  exist in this country all operate on it almost exactly the
• 35:25
  same way. They, they all have the same
• 35:27
  motivations. They all have the same goals.
• 35:29
  Many of them have sort of developed in exactly the same
• 35:32
  way. They, they've taken a, a strong
• 35:35
  hospital or maybe 2 hospitals they had in the city.
• 35:38
  And then they start adding hospitals and they grow, grow,
• 35:40
  grow. And you know, they're all,
• 35:42
  they're all essentially doing the same things maybe at
• 35:44
  different paces. And maybe the, the political
• 35:47
  power within that system's a little bit different.
• 35:49
  Maybe the financial health is a little bit different just based
• 35:51
  on where they're operating. But, you know, all the big
• 35:54
  health systems in this country actually all operate almost
• 35:57
  identically, no matter what sort of the headlines tell you about
• 36:01
  that not being the case. So Greg, this is a fascinating
• 36:04
  model that you're describing here, and it makes a ton of
• 36:06
  sense, right? It aligns everybody's goals.
• 36:09
  I'm curious, how did the data actually play out?
• 36:13
  So it, it, it really depends. And you know, effectively the
• 36:17
  federal government, it might still be going, but they, they
• 36:20
  sort of, they rug pulled it for, for lack of a better way of
• 36:23
  putting it because, you know, there were, there were certain
• 36:26
  aspects of it that didn't necessarily align with the way
• 36:32
  that they intended to. So like in, in, in certain
• 36:36
  scenarios, like if, if I'm going in for a, if I'm a relatively
• 36:39
  healthy person, I go in for a total joint replacement.
• 36:43
  It's a great program, right? So I go in for a total joint
• 36:45
  replacement. I'm in the hospital for a day.
• 36:47
  Actually, most total joint replacements are being done
• 36:49
  outpatient now, But let's say, you know, I'm, I have to be in
• 36:53
  the hospital for a couple days and then I'm going to go home
• 36:55
  and then like, you know, I just had my total joint because I had
• 36:58
  arthritis or something like that.
• 37:00
  The idea is I'm going to get better.
• 37:01
  You shouldn't have done the total joint if the person is not
• 37:03
  going to get better. But then if you have
• 37:04
  complications, if you have to do all that, then you end up, you
• 37:07
  know, not doing as well as if you do a total joint and the
• 37:10
  patient goes home. You know, for us, Medicare
• 37:14
  actually changed some of the rules where because we were a
• 37:18
  hospital medicine group, we were disadvantaged in that kind of
• 37:21
  scenario. So like if you think about the
• 37:23
  way a hospital works, if I'm an orthopedic surgeon, I'm going to
• 37:27
  have somebody who comes into the hospital for a day or two days
• 37:31
  to have a total joint, no complications.
• 37:34
  I'm going to keep them on an orthopedic surgeon service
• 37:36
  service in the hospital. They'll probably never be seen
• 37:39
  by a hospital medicine physician because the orthopedic surgeons
• 37:41
  can come in around and say like, hey, wound looks good, how you
• 37:44
  doing? All right, time to go home.
• 37:46
  However, if you have complications, if there was some
• 37:50
  sort of trauma or something like that that was involved and
• 37:52
  that's why you had to have the total joint.
• 37:54
  Basically you're a more complicated patient.
• 37:55
  You might be there for a longer time, but you're also going to
• 37:57
  see a hospital medicine physician.
• 38:00
  Inherently the risk of that patient is higher.
• 38:03
  And because of where sound was positioned in this, you know, it
• 38:07
  made it very difficult because like for the instance of a total
• 38:10
  joint Medicare sort of changed the rules and said, Hey, it
• 38:14
  doesn't matter what kind of physician you are, you're going
• 38:16
  to get paid the same amount. Your target price for this
• 38:19
  episode, this this 90 day episode's going to be the same.
• 38:22
  And so we essentially had to figure out how to take very
• 38:26
  complicated patients that will naturally have a more
• 38:29
  complicated course, higher likelihood of readmission,
• 38:32
  higher likelihood of going to skilled nursing facility, not
• 38:34
  because of anything we're doing, but because of the risk
• 38:37
  associated with that patient, evidenced by the fact that they
• 38:39
  were even seeing a hospital medicine physician in the
• 38:42
  hospital. It it just made it impossible
• 38:45
  for us to do well. And so we ended up kind of
• 38:47
  pulling out of the program basically completely because of
• 38:52
  that. And the government shut it down.
• 38:55
  Yeah, I so I think it, it might even still be out there in some
• 38:58
  some form, but basically all the big participants that were doing
• 39:01
  it, the the amount of participants decreased like 90%
• 39:06
  and so. Yeah, I guess on the surface it
• 39:08
  sounded like, yeah, why haven't we been doing this all along?
• 39:11
  Right. Everybody's goals are aligned.
• 39:12
  Let's keep, you know, to do our best job to keep, you know,
• 39:16
  folks from those complications and from the readmissions.
• 39:19
  But right, there's the wrinkle that you just threw in there.
• 39:22
  It's like you've got some patients that are just naturally
• 39:25
  more complicated. They've got more, you know,
• 39:28
  comorbidity factors that are, are at play here.
• 39:31
  And so how how do you factor that all into the calculation?
• 39:35
  Yeah. And so this is so, you know,
• 39:38
  like that that sort of the clinical aspect of it there
• 39:42
  there's certainly a financial. So let me put it on my business
• 39:44
  hat for a second. There was definitely an
• 39:47
  arbitrage opportunity that existed in target prices because
• 39:51
  of the this. It was a very complicated
• 39:53
  methodology that CMS put in place.
• 39:54
  You could make an argument way too complicated.
• 39:57
  And you know, one of the things I've observed about healthcare,
• 40:00
  the more complicated A system is, the more easy it is to gain.
• 40:04
  And you know, you could shift things around and you could
• 40:07
  increase your target price. Deliver exactly the same amount
• 40:11
  of care, but do really well. And so you know, there was there
• 40:15
  was a lot of that going on as well.
• 40:17
  So that's essentially, you know, the the federal government will
• 40:19
  say that's why they rug pulled it.
• 40:21
  I don't think they'd use that term, but you know, I I see why
• 40:25
  they did it, but at the same time there was a lot of good
• 40:27
  stuff going on too. But like most things, you know,
• 40:30
  it's you, you know, I, I think it, it probably could have been
• 40:35
  tweaked more versus just saying like, Hey, we're just going to,
• 40:38
  we're going to shut this off all together because, because some
• 40:42
  players in the space were definitely gaming it.
• 40:44
  Yeah. OK.
• 40:46
  So December 2022, you joined Welby.
• 40:49
  This is what I really want to talk about, what you're doing
• 40:51
  now. What drew you to Welby?
• 40:53
  What did they, what did they got going on that was so exciting
• 40:55
  for you? Yeah, it was interesting.
• 40:57
  So as I mentioned, like, you know, sound was exiting this
• 41:00
  BPCIA program. So you kind of see the writing
• 41:02
  on the wall, right? I, I'm brought in to kind of
• 41:04
  help manage this, this giant program across the country.
• 41:07
  And like we're, we're going to decrease our participation by
• 41:10
  90%. It's like, you know, you got to
• 41:13
  find like my, my days here are probably numbered.
• 41:17
  So, you know, and so I sort of kind of putting feelers out
• 41:21
  there and that kind of thing. And one of the folks that
• 41:24
  reached out to me was a recruiter named independent
• 41:26
  recruiter named Steve Klopfer. And he's like, hey, I'm going to
• 41:30
  tell you about this, this company called Welby Senior
• 41:34
  Medical. Honestly, I'd never heard of
• 41:35
  them. They were operating in Ohio at
• 41:37
  the time. I never heard of them.
• 41:39
  And, you know, he tells me about this company and I'm just like
• 41:43
  you guys like the I, I, I really like this where, where you are
• 41:46
  with this. So Welby, overall, we're taking
• 41:50
  care of like the highest risk seniors in their homes.
• 41:54
  And so, as I mentioned, like, you know, value based care,
• 41:56
  applying resources to the people who need it the most and not
• 41:59
  necessarily applying resources to people that don't need it.
• 42:02
  The way that Welby works is that we'll, we'll take sort of a, a
• 42:05
  patient population and it's, it's all under Medicare
• 42:07
  Advantage for, for a variety of reasons.
• 42:10
  But basically like, we'll, we'll go to like an Aetna and say,
• 42:14
  like, Hey, give us your top 20% of sick patients and we'll take
• 42:20
  care of them. We'll take full risk on them and
• 42:22
  we're going to send somebody out to their home to take care of
• 42:23
  them. And so by targeting this like
• 42:26
  top 20% of patients in what is admittedly an expensive care
• 42:32
  model, I mean, it's, it's not cheap to put a physician or a
• 42:35
  nurse practitioner into somebody's house to take care of
• 42:38
  them. Because you know, like you go
• 42:39
  into a primary care office and they're seeing 30 plus patients
• 42:43
  a day and they're just, you know, I have got 10 minutes.
• 42:46
  To spend. So how does this meet the
• 42:47
  definition of value based care? For for Welby, yeah, yeah.
• 42:53
  So you know, primary care, 30 patients a day, I've got 5-10
• 42:58
  minutes to spend with you. There's a subset of those
• 43:01
  patients called the top 20% of sick people that that need a lot
• 43:04
  more than 10 minutes at a time with their primary care
• 43:07
  physician. I mean, these are folks that one
• 43:09
  have a lot of different medical conditions.
• 43:12
  So they've got the heart failure on top of the COPD.
• 43:15
  On top of this, on top of that, they also have potentially like
• 43:18
  a lot of sort of like social issues, like social determinants
• 43:21
  of health issues, food insecurity, housing insecurity,
• 43:25
  families that may or may not be supportive and you know, a lot
• 43:30
  of kind of complications there. Potentially you have low health
• 43:32
  literacy. The patient and their family
• 43:34
  don't really understand what's going on with them, you know,
• 43:37
  because they they get it 10 minutes at a time in a primary
• 43:40
  care office where the person's, you know, typing on the EMR half
• 43:42
  the time. So it's not necessarily less
• 43:44
  expensive, it's just more appropriate level of care.
• 43:46
  Yeah, in a setting that's more comfortable for the patient.
• 43:51
  Yeah. But ultimately it ends up being
• 43:53
  less expensive. So while, while our physician
• 43:56
  services and our nurse practitioners, they cost money
• 44:00
  and, and everything else, it pales in comparison to the cost
• 44:04
  of an Ed visit or a hospital admission or unnecessary care
• 44:09
  that, that patient's going to get.
• 44:11
  And so even though our sort of physician services cost more and
• 44:16
  they don't cost anything, the patients don't pay anything for
• 44:18
  it. It's, it's all sort of covered.
• 44:19
  We're, we're at full risk. So we're actually, we, we sort
• 44:22
  of eat our own costs as part of the part of the model.
• 44:26
  You mean you eat? Your own costs.
• 44:28
  So being reimbursed by Medicare? No, we don't.
• 44:31
  Well, because of the billing rules, like we get a fee for
• 44:34
  service reimbursement for doing essentially like a primary care
• 44:37
  visit when we go in to the home. But that's not how like we we
• 44:40
  would be underwater. We would never make money if we
• 44:41
  did that. Effectively what we're doing is
• 44:44
  we're taking full risk on these patients.
• 44:46
  So what that means is that like an Aetna, Aetna gets $20,000
• 44:51
  from Medicare to take care of a patient today before Wellby gets
• 44:55
  involved, let's say that patient costs $25,000 a year.
• 45:00
  So Aetna is underwater, $5000 on these patients.
• 45:03
  And again, these are just all relative terms and they're
• 45:09
  losing money on these patients. Now Aetna makes a lot of money
• 45:11
  on the healthier people, but you know, for these patients,
• 45:15
  they're losing money because they're not being, you know,
• 45:17
  well managed because they're trying to be taken care of by 10
• 45:20
  different specialists, each seeing this patient for 5 or 10
• 45:22
  minutes at a time, getting different stories.
• 45:25
  And, you know, it's, it's kind of all over the place.
• 45:27
  And so the, the patient's not getting any better.
• 45:29
  They're, they're, they're back in and out of the hospital.
• 45:32
  We'll come in and we'll say, OK, we will take risk on that
• 45:35
  patient. So all right, now you give us
• 45:37
  the $20,000 that Medicare is giving you.
• 45:40
  And if the patient cost $25,000 and that's on us, we'll, we'll
• 45:44
  make up that different. But if we can get it done for
• 45:46
  $18,000 then you know well be make some money.
• 45:50
  Now our model you know might cost and again I'm giving you
• 45:54
  just relative $1000 to take care of that patient.
• 45:56
  So we've gone from you know we're getting $20,000 from CMS,
• 46:00
  $18,000 in care costs. Our costs are internally our
• 46:04
  internal costs are like $1000. So now we're at $19,000.
• 46:08
  Medicare gives us 20. There's like a $1000 profit
• 46:12
  there versus where Aetna was before.
• 46:15
  Were there like getting the same $20,000 from CMS, uncoordinated
• 46:20
  care, more hospital admissions, more EV visits, and they're
• 46:23
  coming out 25,000, so they're losing 5000.
• 46:25
  So it's like a win win. Patients get in the hospital
• 46:28
  less patient ideally is getting better.
• 46:32
  The insurance company isn't losing money.
• 46:35
  It's just more efficient, kind of better care.
• 46:37
  What's the single biggest factor in this being better care?
• 46:41
  Is it the fact that you've got one physician who is spending
• 46:44
  more time in being the quarterback?
• 46:47
  So the way that we operate, it's, it's a concept, we call it
• 46:50
  community. So we'll have a physician and
• 46:52
  like nurse practitioners or physician's assistants.
• 46:54
  And you know, some of this varies by state, depending on
• 46:56
  what the, the laws and regs are. A community will take care of,
• 47:01
  call it 2000 patients and that those 2000 patients belong to
• 47:06
  this community. And that's a physician, a bunch
• 47:08
  of nurse practitioners, pharmacy, social work,
• 47:11
  behavioral health, you know, it's, it's, it's, it's a care
• 47:15
  team, an individual and nurse practitioner will only take care
• 47:19
  of, call it 200 patients at a time on their panel.
• 47:22
  So they're responsible for the care of 200 people versus, you
• 47:25
  know, 10 times that if you're a primary care.
• 47:28
  Physician, is that right? Yeah, so imagine like you're
• 47:31
  you're only responsible for 200 people.
• 47:33
  I mean you you probably know 200 people.
• 47:35
  You know a lot about them like in and so like your job is just
• 47:38
  to like know these 200 people know their families know what's
• 47:41
  their their conditions are that patient has the Welby phone
• 47:46
  number that they can get a hold of a provider 24/7.
• 47:49
  Not necessarily their provider because we don't make our people
• 47:51
  like be on call 24/7 365. But you know, when you call in
• 47:57
  during business hours, you're going to get your own nurse
• 47:59
  practitioner on the phone. Like hey, John, how you doing?
• 48:02
  You know, I know you were in the hospital last week.
• 48:04
  Everything OK? You need me to come see you
• 48:06
  today? Because you know, we, we don't
• 48:09
  stack our nurse practitioners with 30 patients a day with no
• 48:13
  time slots, no time to spend with people.
• 48:15
  And so if, you know, patient John needs somebody to come out
• 48:19
  just to hang out for an hour and kind of get their, their meds
• 48:22
  right from the the hospital stay they just came home from, we can
• 48:26
  go and spend that time with them and by getting their meds right.
• 48:30
  And I'm not doubling up on meds and things like that, which
• 48:32
  happens very frequently. Patients get discharged from the
• 48:35
  hospital. It prevents another Ed visit.
• 48:37
  It prevents A readmission. It prevents John from, you know,
• 48:41
  taking too many medications and getting dizzy and falling down
• 48:46
  and needing a surgery and things like that.
• 48:48
  So you may have just answered my follow up question, which is
• 48:50
  could this same model of having a community of medical
• 48:54
  professionals caring for a smaller collection of people
• 48:58
  work where you're not going into the homes where they're still
• 49:01
  coming to visit you physically in a doctor's office?
• 49:05
  Yeah, I mean that's essentially the and there's other entities
• 49:08
  out there doing that like Chenmed, all clinic based, very
• 49:13
  similar model where you have small panels, people coming into
• 49:16
  the office. Oak Street Health, same model,
• 49:20
  clinic based, complicated patients come into the come into
• 49:24
  the office. Our difference from them is that
• 49:27
  we're actually kind of targeting the same patients, but we're
• 49:30
  we're all home based. So we'll, we'll come out to the
• 49:33
  home versus having the patients come into an office.
• 49:36
  Which one of those models do you think is more financially
• 49:41
  efficient? Our model for sure.
• 49:44
  So you know, you, you talk to to China Metro Street.
• 49:47
  I mean those clinics that they build are not cheap and they're
• 49:50
  building a clinic. It's just a normal.
• 49:52
  So even though your medical professionals have got all this
• 49:54
  travel time, you know going to see folks that the fact that you
• 49:59
  don't have this expensive medical facility wipes out the
• 50:03
  the difference of of those inefficiencies.
• 50:06
  Yeah, yeah, it it really does. And so because of that, you
• 50:11
  know, I think that we are more efficient than those other
• 50:14
  entities. And you know that there's also a
• 50:16
  complicating factor here. So in order for patients to go
• 50:20
  to a clinic based thing, remember we're talking about the
• 50:23
  sickest patients, lots of social issues, potentially lots of, you
• 50:27
  know, comorbid conditions. They can't always get to a
• 50:31
  clinic. You know, you, you're talking
• 50:33
  about folks that maybe they drive, maybe they don't.
• 50:36
  Maybe they have a family that can drive them, maybe not.
• 50:40
  We deal with a lot of homebound patients.
• 50:43
  You know, there's, we have a great success story of a patient
• 50:47
  down in the Cincinnati area that hadn't been out of her house for
• 50:51
  a significant amount of time. I think it might have been
• 50:54
  measured in years, except, you know, they would have a child
• 50:58
  that would take them to some of their doctor's appointments
• 51:01
  every once in a while until we got in the home.
• 51:04
  But we didn't know, nobody knew that this patient couldn't get
• 51:07
  out of the house otherwise because they were wheelchair
• 51:09
  bound and they didn't have a ramp.
• 51:10
  And so one of our social workers called up an organization down
• 51:14
  in Cincinnati and that happens to build people ramps.
• 51:17
  And so they, they literally went in a weekend, you know, took
• 51:21
  them, you know, half a day. They built this ramp and the
• 51:24
  patient was able to get out of her house for the first time
• 51:26
  without assistance in years. And, and it's just one of those
• 51:30
  things, one from like being able to, to go and, and kind of
• 51:33
  recognize that situation and do something about it.
• 51:35
  That patient's life was materially improved by that
• 51:39
  taking place. And, and nobody that patient was
• 51:42
  seeing in a clinic had any clue that that was, was the
• 51:45
  situation. And so you have these patients
• 51:47
  not only in that situation, but also they just can't get out at
• 51:50
  all. Like if you can't get a ride
• 51:52
  from your daughter to your doctor's appointment, you're
• 51:54
  going to miss the appointment, you're going to have to
• 51:55
  reschedule it. Well, that might have been an
• 51:57
  important appointment. And now you're in the Ed two
• 51:59
  days later because you, you missed an infusion, you missed
• 52:02
  some medications by us going into the home.
• 52:05
  You, you have the ability to to take that complicating factor of
• 52:10
  getting the patient from home to the clinic out of the equation.
• 52:15
  And I think that is something that is sort of under
• 52:18
  appreciated as a huge risk factor of patients not showing
• 52:21
  up. If you talk to any physician in
• 52:23
  the country and ask him, you know, how often do all your
• 52:26
  patients actually show up for their visits?
• 52:28
  And you know, there's the reason why a lot of physicians get
• 52:30
  overloaded is because all the patients actually show up 'cause
• 52:32
  they actually kind of operates like an airplane model where
• 52:34
  they'll sell more tickets than they actually have seats because
• 52:38
  they know some people just aren't going to show up.
• 52:39
  But if everybody shows up, then they got to figure something out
• 52:42
  and just work extra. So what's the data show, Greg,
• 52:47
  in terms of improved efficiencies, better patient
• 52:51
  outcomes with your model versus the traditional?
• 52:55
  Yeah. So you know, our model, we we do
• 52:58
  have a demonstratable month over month over month decrease in
• 53:02
  overall patient costs. Now you can make an argument
• 53:05
  like, hey, you know, everybody's costs are going to decrease
• 53:07
  because you're taking the most expensive people.
• 53:10
  You know, when we have a population, we call them like
• 53:12
  engaged and unengaged people. So not everybody agrees to our
• 53:14
  services right away. Like they, you know, we'll call
• 53:16
  them up and they'll, we'll say, hey, we're from Wellby.
• 53:18
  We work with your insurance and you know, we'd love to come and
• 53:20
  see you. You know who, who are you guys?
• 53:22
  Like I, I don't know who you are.
• 53:24
  Like I, no, you can't come and see me.
• 53:26
  You know, like anybody, if somebody calls you up and ask
• 53:28
  you something new, if, if you get them to pick up the phone,
• 53:31
  which you know, I never pick up the phone if I don't recognize
• 53:33
  the number, you probably don't either.
• 53:35
  And our patients are the same way.
• 53:37
  You don't get seen, but we do have a lot of data on them
• 53:40
  because we're already at risk for them.
• 53:41
  So we'll actually look at people that never see us and we'll look
• 53:44
  at people that see us. And we consistently see the cost
• 53:48
  going down to the patients that see us, whereas the patients
• 53:51
  that don't see us see their like level or they're kind of moving
• 53:54
  up a little bit. So we, we have very good data
• 53:56
  that shows our model works. We also have other objective
• 53:59
  data on quality. So like HEDIS, which is a
• 54:05
  Medicare Advantage stars rating. So like there's different rules
• 54:08
  and Medicare Advantage that there's certain advantages if
• 54:11
  you deliver high quality care and quality, They have like 20
• 54:14
  something measures from like, you know, breast cancer, colon
• 54:18
  cancer screening to if somebody prescribes you a statin, are you
• 54:21
  actually taking it? And they, they measure all this
• 54:23
  stuff objectively. The number of stars ratings that
• 54:27
  our patients have are generally, you know, 4 1/2 fish stars out
• 54:32
  of five. And our patients typically come
• 54:35
  in because these are again very complicated patients like two 2
• 54:38
  1/2 stars for that population. And so we're materially like
• 54:41
  even the way CMS measures it, increasing the quality of care
• 54:45
  that's delivered to these folks. Is the data that we're sort of
• 54:48
  talking about in the general sense, is it considered
• 54:51
  proprietary private information or like would you be able to
• 54:56
  send us links to somewhere on your website that we could put
• 54:58
  in the show notes that, you know, people could kind of look
• 55:00
  at this? I, I'm sure some of it's
• 55:03
  proprietary, some of it's out there.
• 55:04
  Like I, I know that on LinkedIn, you know, we've all been kind of
• 55:08
  posting this thing about our, our stars rating because we're,
• 55:10
  we're very proud of that. You know, like we're, you know,
• 55:14
  it, it's a challenge for all Medicare Advantage plans to, to
• 55:16
  deliver sort of high quality and, and, you know, get to the
• 55:20
  five stars. And the patients that we take
• 55:22
  care of, like I said, they come in two 2 1/2 stars are, are
• 55:27
  really the patients dragging down an entire Medicare
• 55:29
  Advantage population for a payer.
• 55:31
  And then by us taking some of the toughest patients and
• 55:33
  getting them to that, you know, kind of highest echelon, it
• 55:36
  really bumps up the entire plan. So we've, we've kind of put a
• 55:39
  lot of that data out there and I'll, I'll try to find you a
• 55:42
  link and send it to you. Yeah, if you can, I think that
• 55:45
  would be neat for everybody to check out.
• 55:46
  I certainly know that I'd love to see it.
• 55:49
  So what is your role then, Greg, as the regional president?
• 55:54
  Yeah. My role is to, to kind of
• 55:57
  coordinate all the resources in a market as well as, you know,
• 56:01
  coordinate things with health plans and, you know, do a lot to
• 56:05
  just make sure the market is running well and making sure
• 56:09
  that we're meeting our metrics and that we're not spending too
• 56:12
  much money. And you know that, that kind of
• 56:14
  thing. So, you know, I, I kind of take
• 56:16
  care of our Ohio market, which is our biggest market and we've
• 56:19
  got like 40,000 attributed patients here, but I'm also
• 56:23
  covering New York, Oregon and, and Utah as well.
• 56:27
  So it's. That's a little bit of travel.
• 56:31
  It is, yeah, it is. But it's, it's, it's very, it's
• 56:34
  very doable. I'm, I'm kind of used to it at
• 56:36
  this point. As I mentioned, you know, from
• 56:38
  previous consulting to Ohio Health, one of the things that,
• 56:41
  that I did there was, you know, there was a lot less travel
• 56:43
  involved by going to Ohio Health.
• 56:45
  Now my kids are old enough. We were talking, you know, just
• 56:47
  a little bit ago, I got a 14 year old, 11 year old and almost
• 56:51
  9 year old and they're, they're, they're old enough now that, you
• 56:55
  know, I can, I can do a little bit more travel and, you know,
• 56:58
  honestly, I don't mind going to Park City, UT at all.
• 57:03
  That's that's not too rough, yeah.
• 57:05
  Our office is in Salt Lake, but we'll.
• 57:09
  You'll divert while you're out there.
• 57:10
  Yeah, you got to put in a little R&R time too.
• 57:13
  So is there a big focus on growth at the moment?
• 57:17
  Yeah, so we've been growing kind of like crazy.
• 57:23
  I mean, and it's been a wild ride.
• 57:25
  I mean, so I've been here a little going on 2 1/2 years now.
• 57:31
  When I joined, there were less than 200 employees at Welby.
• 57:36
  We're currently at right around 1000 employees.
• 57:40
  So you've grown 5X in just from number of employees in two
• 57:46
  years. And I think our overall
• 57:47
  attributed population of patients has grown maybe even a
• 57:51
  little bit faster than that. And so, yeah, it's, it's been,
• 57:56
  it's been a wild growth ride for sure at wealthy.
• 57:59
  What do you attribute that growth to?
• 58:02
  I think we're in the right place at the right time.
• 58:04
  I mean, I think, you know, this home based care is something
• 58:08
  that I think people are starting to recognize for the same reason
• 58:11
  that I just described with, you know, some of the deficiencies
• 58:13
  of a clinic based model for this patient population is one thing.
• 58:17
  Two, Medicare Advantage plans are very focused on their stars
• 58:21
  ratings. And as that data kind of gets
• 58:24
  out, we're, we're getting a lot of phone calls of, of Medicare
• 58:27
  Advantage plans that are looking for that help.
• 58:31
  And so, you know, I think generally you have a space right
• 58:35
  now where everybody's trying to figure out what's the best way
• 58:37
  to take care of these like really sick people, these this
• 58:39
  top 20% of a patient population. And I think there's just
• 58:44
  universal recognition in the the medical community that you can't
• 58:49
  just force these people into a, you know, 30 patient a day
• 58:53
  primary care model and expect to get a good result at the end.
• 58:55
  You need to be able to spend more time with these people,
• 58:59
  ideally in their own setting, like home and, you know, hold
• 59:02
  their hand. I mean, like, you know, some of
• 59:04
  what we do is, you know, we, we, we, we provide medical care.
• 59:08
  I mean, we've got physicians and nurse practitioners, but I'll
• 59:10
  tell you, like the secret sauce is, is really listening and
• 59:15
  giving the patient and their family the time to, to ask
• 59:19
  questions to, to understand what's going on, to be able to
• 59:24
  work with them to, to hold their hand.
• 59:26
  I mean, like it that, that more than the medical care we
• 59:29
  provide, which, you know, all these patients have 10
• 59:31
  specialists that are providing great care.
• 59:33
  But like nobody's ever tied it all together.
• 59:36
  Nobody's ever asked the patient like, Hey, what, how do you want
• 59:39
  this to go? You know, like what, what is
• 59:41
  your interest? You know, do you understand
• 59:43
  what's going on with you? Do you understand where this
• 59:44
  goes and what do we want this to look like?
• 59:48
  And, and just, you know, being able to spend an hour, 2 hours
• 59:51
  with the patient and their families, which in many cases
• 59:53
  nobody's ever done despite all these complications, that,
• 59:58
  that's really what makes the big difference in, in the care that
• 1:00:00
  we're providing. I think people are recognizing
• 1:00:02
  that you. Guys are looking at the
• 1:00:03
  physical, the social and the emotional well-being.
• 1:00:06
  Yeah, yeah. And I, and honestly, I think
• 1:00:08
  like the emotional part, you know, like you, you have
• 1:00:10
  objective data and everybody likes numbers.
• 1:00:12
  But you know, when, when you go on one of these visits with one
• 1:00:15
  of our nurse practitioners, it's, it's just being there for
• 1:00:18
  the patient, listening to them, you know, listening to their
• 1:00:21
  family and, you know, helping them out where, where they need
• 1:00:24
  help. And you know, that's something
• 1:00:27
  that is is not really capable of being done when you're seeing 30
• 1:00:32
  patients a day. Greg, do you think that this
• 1:00:35
  model could work for patients that are outside of the sort of
• 1:00:39
  20% most ill or do you think it specifically works just for that
• 1:00:46
  population because of all the things we've talked about?
• 1:00:50
  It would have to be different. So you know, our our goal is to
• 1:00:54
  make in home care accessible to everybody in America.
• 1:00:58
  So the model that we're delivering to this top 20% of
• 1:01:01
  patients, like it would not make sense for a provider
• 1:01:05
  organization to deliver me that level of care.
• 1:01:09
  Like honestly, like I'm unfortunately, I'm in pretty
• 1:01:12
  good health. I go to my primary care doc once
• 1:01:15
  a year. They, they do a little blood
• 1:01:18
  work that may or may not be evidence based, but I have to do
• 1:01:21
  it because of health insurance and biometric screening and the
• 1:01:24
  whole deal. But you know, and that's all I
• 1:01:28
  really want. Like I honestly, I don't, I
• 1:01:30
  don't want somebody in my house once every couple months, you
• 1:01:33
  know, for an hour talking to me about my health.
• 1:01:35
  I'm like, I'm fine. I like, how about we skip the
• 1:01:37
  visit? I'm just going to go for a run.
• 1:01:39
  We'll just call it a day. So yeah, like the, the, the
• 1:01:42
  exact model that we're delivering would not work for
• 1:01:45
  everybody. There's a flavor of it that
• 1:01:47
  would, I mean, like, you know, like honestly, my experience
• 1:01:51
  could be improved potentially by going all telemedicine with, you
• 1:01:56
  know, delivery of services to me.
• 1:01:57
  Like, you know, if, if you, if you need blood work, it'd be
• 1:02:00
  really convenient if somebody just came to my house to take my
• 1:02:02
  blood. Now, whether you can make that
• 1:02:04
  work from a business sense or, or whatnot, you know, I don't
• 1:02:07
  know, but we've got, we've got plenty of growth ahead of us
• 1:02:09
  with this top 20% population. And honestly those people need
• 1:02:13
  it more than me. So, you know, I think that's,
• 1:02:16
  that's going to be our, our runway for the foreseeable
• 1:02:19
  future. But ultimately our our goal is
• 1:02:21
  to be able to provide in home care for everybody in America.
• 1:02:24
  Greg, let's shift gears. I'd be curious to hear about a
• 1:02:27
  serious challenge that you've worked through in your life.
• 1:02:29
  What was it? How'd you get through it?
• 1:02:31
  What did you learn? Yeah.
• 1:02:33
  I mean, you know, I, I think like even going back to the my,
• 1:02:37
  my consulting days is a good example.
• 1:02:41
  You know, I, I during that period took on another big
• 1:02:45
  client that was taking up, you know, half my time venture
• 1:02:49
  backed working with Israeli medical device companies.
• 1:02:53
  And it was a really novel approach to how to, to bring,
• 1:02:57
  you know, sort of single device kind of companies with, you
• 1:03:01
  know, really novel things to the United States.
• 1:03:05
  And ultimately, you know, it, it didn't work out.
• 1:03:07
  We that the company ran out of money.
• 1:03:09
  And so, you know, from from that point, you know, having to go
• 1:03:14
  through, as, you know, an executive on, on this team to
• 1:03:19
  not only telling everybody working there that, hey, like
• 1:03:23
  we're closing up shop, then also like effectively firing
• 1:03:26
  yourself. You know, that was tough.
• 1:03:29
  I mean, like, you know, like, like I said, I was spending half
• 1:03:31
  my time with that company at the time.
• 1:03:34
  There's a good chunk of change that I'm like, Yep, Yep.
• 1:03:37
  Greg, you know, you look in the mirror and it's like you're,
• 1:03:40
  you're fired too. Like there's nothing you can do
• 1:03:42
  about it. You know, it was the situation
• 1:03:45
  it was. But, you know, I think what I, I
• 1:03:49
  really learned was that, you know, nothing in the
• 1:03:53
  professional world is really it, it, it's not existential.
• 1:03:59
  You know, it's not like somebody just gave me a terrible
• 1:04:01
  diagnosis that's going to alter the rest of my life.
• 1:04:04
  It, you know, it's, it's something where like, you know,
• 1:04:08
  you learn to appreciate like what's really important and
• 1:04:11
  what's not. And you know, you sort of, and
• 1:04:14
  in the moment it's, it's tough. I mean, like it, you're like,
• 1:04:17
  what am I going to do? And it, you know, it seems like
• 1:04:19
  really bad. And I got bills to pay.
• 1:04:21
  I got to take care of. Exactly so.
• 1:04:24
  But at the end of the day, it's like you work it out and you're
• 1:04:28
  fine. And, and sort of I think that
• 1:04:31
  that experience has guided me quite a bit in, in other things.
• 1:04:37
  It's like, you know, like I, I gave you the example, the sound
• 1:04:39
  position, you know, the feds change the, the rules.
• 1:04:42
  I kind of see the writing on the wall.
• 1:04:43
  I'm like, well, you know, you kind of, you almost approach it
• 1:04:46
  with a, you know, a seriousness, but you got to have a little bit
• 1:04:49
  of a sense of humor about it. Like, yeah, seen this story
• 1:04:51
  before. Let's see where this goes.
• 1:04:53
  And it, and it, you know, I, I think that it, it's one maybe
• 1:04:59
  more optimistic in a professional sense that, yeah,
• 1:05:02
  things, things will land. I don't know exactly where
• 1:05:04
  they'll land. I don't know when they exactly
• 1:05:05
  they'll land, but they'll land. But I think it's also maybe just
• 1:05:09
  appreciate more in my personal life the sort of the blessings
• 1:05:13
  that you have. I mean, like the, you know, I've
• 1:05:15
  been fortunate that, you know, nobody has given me a terrible
• 1:05:18
  diagnosis. You know, knock on wood, that's
• 1:05:19
  not going to happen anytime soon.
• 1:05:21
  But you know, it's one of those things like, like I, you
• 1:05:26
  appreciate you appreciate every day more, I think.
• 1:05:29
  And you really try to focus on what's truly important and what,
• 1:05:35
  what can, what can be changed, what can be mitigated, what you
• 1:05:39
  know what, what can be figured out versus what can't be figured
• 1:05:42
  out. It, it almost sounds like your
• 1:05:45
  experience as a physician has kind of helped to inform this
• 1:05:50
  perspective. You know, 'cause you said, I
• 1:05:53
  mean, losing a job, I mean, that's, that's a huge stress in
• 1:05:56
  your case, losing a client, you know, it was a huge part of your
• 1:05:59
  income stream. That's a huge stress.
• 1:06:04
  But the fact that, you know, you, you could sit there and
• 1:06:07
  say, at least I'm healthy. I, I don't have a bad diagnosis.
• 1:06:11
  And as a physician, you know, somebody who's worked in the
• 1:06:14
  medical field, I have seen that that story over and over again.
• 1:06:17
  Something that would be well out of my control.
• 1:06:19
  Something is, to use your word, existential.
• 1:06:23
  And so, yeah, I, I kind of get that sense that you are your
• 1:06:27
  experience as a physician, you know is, is kind of set you up
• 1:06:31
  to have that I think, I think very healthy perspective on on
• 1:06:35
  big life events like that. Yeah, I think so.
• 1:06:38
  Now, don't get me wrong, like the the first time it happened,
• 1:06:42
  it, it feels existential, you know, like I can't imagine
• 1:06:45
  anybody who loses a job, loses a big client, has some sort of
• 1:06:50
  major sort of professional set back.
• 1:06:54
  Doesn't in the moment, especially the first time it
• 1:06:57
  happens, feel that it's existential.
• 1:07:01
  And I guess the sort of advice that I would give them is, is
• 1:07:05
  like there, there is another side, like you, you, as long as
• 1:07:08
  you, as long as you allow yourself to get through it, you
• 1:07:12
  will get through it. And, you know, I, I see people
• 1:07:14
  that similarly potentially have that and, you know, really
• 1:07:18
  struggle to recover from it, not just from like, Hey, I need to
• 1:07:21
  find another job or things like that, but that it like it, it
• 1:07:26
  permanently scars them and probably holds them back even
• 1:07:30
  further in the future. And I guess it's sort of like my
• 1:07:32
  advice is like, just lean into it.
• 1:07:35
  I mean, like you, you survived it.
• 1:07:37
  If it happens again and again and again like it, it'll you'll
• 1:07:40
  be OK. And actually the the more
• 1:07:41
  repetition you have, the the more likely it is that you'll
• 1:07:44
  even end up with like an an even better result.
• 1:07:47
  It's interesting what you said, lean into it almost like the
• 1:07:51
  like sort of being afraid of the fear itself is is causing it to
• 1:07:56
  be worse and to stick around Bonker.
• 1:07:58
  Yeah, I think that's that's accurate.
• 1:08:01
  And, you know, like I, you know, I go on LinkedIn and things like
• 1:08:04
  that. And, and, and you see folks that
• 1:08:05
  are, and I, I generally, I, I feel empathy forum, you know,
• 1:08:11
  saying like, Hey, I've had been out of work.
• 1:08:13
  I've got, you know, 800 applications out and, you know,
• 1:08:16
  two people who interviews. And it's like, you know, I, I
• 1:08:22
  wonder how much those folks potentially are holding
• 1:08:24
  themselves back because they're almost sort of either projecting
• 1:08:28
  that fear or projecting sort of a sense of doom or, or something
• 1:08:36
  as they're kind of going through this.
• 1:08:38
  It's like you have to, you have to elevate yourself above the
• 1:08:43
  situation and like really focus on yourself and like what, you
• 1:08:48
  know, personal blessings and what personal is, is really
• 1:08:53
  going well and put things in perspective that like, you know,
• 1:08:57
  if you're, if you're well enough to be posted on LinkedIn, like
• 1:09:00
  you're, you're probably in pretty good health, like enjoy
• 1:09:04
  it. Like, you know, like get out,
• 1:09:06
  get outside, go for a run. You know, so it's kind of my my
• 1:09:10
  sort of attitude about it. Greg, I've just got one more
• 1:09:14
  question for you. But before I ask it, I want to
• 1:09:16
  do 2 things. First of all, for everyone
• 1:09:17
  listening today, this has been a fantastic episode.
• 1:09:20
  Doctor Greg shared a lot of interesting insights into the
• 1:09:23
  industry with us. Who do you know that might be
• 1:09:26
  interested in listening to this as well?
• 1:09:29
  Go ahead and take a moment and hit that share button.
• 1:09:31
  Send it along to them, Doctor Greg.
• 1:09:34
  I also want to let people know the best way to connect with
• 1:09:37
  you. What would that be?
• 1:09:39
  Honestly, it's probably something like LinkedIn.
• 1:09:41
  Fortunately, I have a very unique last name.
• 1:09:43
  You're not going to find another Greg Sachin there.
• 1:09:44
  There is one more Greg Sachin. He lives in Canada and I once
• 1:09:48
  met his boss on a beach in I think it was the Bahamas.
• 1:09:53
  How random, completely random. Yeah, but but anyway, he he does
• 1:09:57
  a completely different field. So if you but yeah, so you, you
• 1:10:00
  search Greg Sachin on LinkedIn and you look for healthcare,
• 1:10:02
  you're you're going to find me. Honestly, like I don't do a lot
• 1:10:05
  of other social like I just I don't I I, I like to as my my
• 1:10:10
  kids say, I like to touch grass. And Sachin for folks listening
• 1:10:14
  and and not watching SAWCHYN and we'll, we'll have the the link
• 1:10:21
  to his LinkedIn profile on the show notes.
• 1:10:22
  But last question for you, Greg. As you look to the future of the
• 1:10:26
  industry, what are some of the changes that you're most excited
• 1:10:29
  about? Yeah, I mean, I, you know,
• 1:10:32
  healthcare's interesting. I mean, first of all, you have
• 1:10:34
  technology. I mean, I think we're really on
• 1:10:35
  the cusp with the combination of genetic knowledge as well as
• 1:10:43
  just advancements in our understanding and, and, and you
• 1:10:46
  know, I hate to be sort of just like living in the moment, but
• 1:10:48
  genuinely AI to really understand things that we don't
• 1:10:53
  understand today. Like I really feel like sort of
• 1:10:57
  human health will be figured out probably in the next 10 years.
• 1:11:01
  You know you mean the. Human health will be figured
• 1:11:03
  out. So I.
• 1:11:04
  Mean. Yeah.
• 1:11:06
  So I mean the drivers of health, which doesn't necessarily lead
• 1:11:13
  to a therapeutic or a treatment or, you know, I think but, but,
• 1:11:16
  but just the drivers. Like cancer is a great example
• 1:11:18
  where, you know, we sort of bucket cancers into different
• 1:11:22
  categories based on where it starts and things like that.
• 1:11:25
  But you know, part of the challenge with cancer is that
• 1:11:28
  it's sort of like cell division gone haywire.
• 1:11:31
  There's different genetic mutations and things like that.
• 1:11:34
  It's it's really hard to get your head wrapped around.
• 1:11:36
  In fact, I don't think any human really can from a, a sort of
• 1:11:41
  personal standpoint of knowing everything.
• 1:11:43
  But like you combine like genetic sequencing, you combine
• 1:11:46
  that with potentially AI and like you're going to have,
• 1:11:50
  you're going to know exactly what's going on with that person
• 1:11:53
  and hopefully how to treat them in a way that's just not
• 1:11:56
  possible today. You know, I, I've, I've, I've
• 1:12:00
  been in sort of like the analytic space and we've never
• 1:12:02
  talked about that. But like that there's always
• 1:12:04
  been an interest of mine. One, one of my major switches
• 1:12:08
  was computer information systems back in the day.
• 1:12:10
  I'm actually only a couple classes away from a degree in
• 1:12:13
  that, but I've seen just even from like when you know, the
• 1:12:18
  hype first started a couple of years ago with ChatGPT.
• 1:12:23
  Just the advancement in two years has has been unbelievable
• 1:12:27
  to the extent where, you know, AI is effectively replace Google
• 1:12:31
  for me at this point. It knows a lot like in, you
• 1:12:34
  know, what things that you can ask it and it, and it, it will
• 1:12:37
  give you accurate answers on very complex topics.
• 1:12:42
  I think that combined with just knowledge and especially for
• 1:12:46
  complex patients, I, I think we're, we're on the cusp of
• 1:12:49
  being able to put a 400 page, you know, medical record into an
• 1:12:55
  AI and it's saying, you know, hey, this is what this
• 1:12:59
  medications the patient should be on.
• 1:13:01
  This is what's going to happen next.
• 1:13:02
  This is, you know, and it's all probabilistic.
• 1:13:04
  You know, it's nothing's ever for sure, but anything a
• 1:13:07
  physician does is going to be probabilistic as well.
• 1:13:10
  I think we're really on a cusp of, of that happening in the
• 1:13:13
  next, you know, call it 10 years of I've really been able to
• 1:13:16
  figure that out. Is there something that this
• 1:13:18
  combination of AI, analytics, genomic sequencing can already
• 1:13:24
  do for us that might surprise a lot of listeners?
• 1:13:28
  Yeah, I mean, I think that a lot of it's being used right now in
• 1:13:30
  pharmaceutical development. I think that's probably a space
• 1:13:33
  where it's furthest along. Some of it's being used in
• 1:13:35
  cancer diagnostics. You know, like a lot of times if
• 1:13:37
  you if you're diagnosed with a new cancer, they'll they'll send
• 1:13:40
  a blood sample or a tumor sample off to have genetic sequencing.
• 1:13:45
  Even cancer targeted therapies are, are all, you know, some of
• 1:13:48
  them are, are very much based on mutations that you've had within
• 1:13:51
  your, your particular cancer. And it's very targeted in that
• 1:13:54
  way. So I think we're, we're already
• 1:13:56
  doing some of it, but it's it, it's still being driven by, call
• 1:14:01
  it the, the limitations of a, a single brain.
• 1:14:08
  And so we're on the cusp of not being limited to a single brain
• 1:14:13
  or a single oncologist making decision of being able, having a
• 1:14:17
  brain that is legitimately capable of taking in all medical
• 1:14:21
  knowledge known, putting pieces together that, you know, just
• 1:14:26
  because a human brain can not take in all the medical
• 1:14:28
  knowledge ever known and synthesizing very quickly, you
• 1:14:33
  know, what a logical next step might be.
• 1:14:36
  And that, and that honestly, that's something I'm very
• 1:14:38
  excited about from, from that standpoint in, in healthcare,
• 1:14:42
  like I, I, I think in, in many industries, you know, honestly,
• 1:14:46
  it's going to be tougher in healthcare than some other
• 1:14:47
  things. Like, you know, next year.
• 1:14:49
  I, I bet 10 to 20% of Americans are doing their taxes completely
• 1:14:52
  with, by taking a picture and AI just fills it out.
• 1:14:54
  The fact that we're not doing it this year, like I think TurboTax
• 1:14:57
  missed the ball, but maybe they'll get it together for next
• 1:14:59
  year, but we'll see all. Right.
• 1:15:02
  Well, for me anyways. You're here to hear.
• 1:15:04
  You heard it here first, folks. They're going to be doing their
• 1:15:08
  taxes with photographs and AI next year.
• 1:15:11
  It's going to be very exciting to follow the future of AI and
• 1:15:15
  the healthcare space. Maybe we'll have you back to
• 1:15:17
  talk about it at some point, but for now, Doctor Greg Soch and I
• 1:15:21
  want to thank you for sharing both your time and your story
• 1:15:24
  with us today. I really appreciate it.
• 1:15:25
  Yeah. Thanks, Anthony.
• 1:15:26
  Thanks for having me. Folks, that's a wrap on another
• 1:15:29
  episode of the Inspired Stories podcast.
• 1:15:31
  Thanks for learning with us today.