Speaker: 00:00:12

Hello and welcome to Haverin About, a father daughter podcast all about healthcare

technology and the business of selling into it.

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And today we have a very exciting guest.

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have Andrew Tsang who is one of dad, dad, you, you have a sub stack bestie now.

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Andrew's a very interesting writer.

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His style kind of caught my eye as I was reading through.

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And he's new like me.

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So I think he started writing and publishing about a month after me.

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And so we ended up being kind of like, I don't know.

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emotional support animals for each other.

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Well, this conversation was fascinating.

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We covered everything from, oh, just everything when it comes to healthcare.

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If you think about this 4.9.

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trillion with a T trillion with a T.

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dollar industry that we work in, how it goes from that 4.9 trillion all the way down to,

as I mention in the podcast, a $22,000 a year janitor and all of the loops and twists and

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turns and squeezes that it takes to get there.

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So I hope you all enjoy.

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As we said, Andrew is on Substack as is dad.

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And all of the links for everything that we discuss in today's program is in the

description As always, reviews, comments, likes, all of those good things always help us a

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lot in order to increase the reach of all the wonderful things that we talk about and

share them with more and more people.

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And so with that said, please enjoy our special guest for today, Andrew Tsang

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The impetus for this conversation with Andrew today is actually one of his most recent

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articles.

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And I'll make sure that we put a link in the description and up here on the screen for you

to be able to find that particularly about what I'll call the macro of the healthcare

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business.

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i.e.

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what is the big landscape all the way up to the US economy level, because I think

understanding that and it helps to inform you about where you sit, inside the healthcare

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economy So Andrew is going to sort of help us through with a little bit about that.

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So welcome, Andrew, and thank you very much for joining us today.

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I know you're a fan of the podcast, so thank you.

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You need to set away getting your merch on our store so that you can really show your

fandom.

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Yeah, thank you so much Stuart for having me on and I'm so glad to join you and Bethany

here.

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uh Yes, Stuart and I, Substack besties.

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And I really do appreciate you for that because that's kind of where my heart is right

now.

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Like my mind and my business is on like LinkedIn where you can find me as well.

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where my heart, where I started to write was on Substack and Stuart has been an immediate

supporter and with your support, feeling very inspired to.

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continue to research, share my perspectives, discuss a lot of things about healthcare.

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maybe I'll start even there, kind of where I'm at in the end here.

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I started doing a lot of research and write-ups on long-form essays.

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Who reads that anymore, right?

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But I wanted to do that because based on my experience as a healthcare consultant across,

with a dozen years of

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know, provider, payer, pharma, even a little bit of like policy experience and really

trying to demystify and clarify some of the complexity around healthcare.

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And I think more important than all of the technical jargon and the economic and all that

stuff, I think there's like a heart to it.

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So the way that I've always wanted to do that and I get back to the idea of my heart being

on Substack is trying to make it

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relevant to people.

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And I think that's really the most important thing in an industry that really is

fundamentally about lives and people.

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And, you know, obviously there's a lot of money and politics and, you know, very tough

things about it.

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But I think we need to understand all of it together in order to make it a more successful

system.

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When I think that's one where, you know, and maybe even if you see the title of this

podcast, you're like, economics, oh, macroeconomics, oh, right?

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Like I had to take an econ class in high school.

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I don't want to think about that again.

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And with everything going on right now, politically, it's a very easy time to put your

head in the sand and be like, no, not interested.

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And for certain things, that's fine.

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If you need to do that to get through the day, you know, you do you, but.

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If you are in healthcare technology, if you are selling in healthcare technology to these

CFOs and these buyers who their hospitals are going to live or die based on what is going

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on on a macro level, you do have to be aware of it.

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You do have to kind of understand where does the money come from that you're trying to get

a little slice of the pie out for your

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SaaS solution, your AI thing, your whatever it is that you're trying to sell, your little

slice of the pie, where does that come from?

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It's so important to understand that.

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Yeah.

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And I think that was that was one of the reasons I can I did an article which I called the

Knights who say no!, which was really advising people, you know, to to sort of like think

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about as they get their fan, their sponsor inside an organization, be a physician or a

business department manager, whoever it might be, that there is still a lot of hurdles to

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cross internally to try and get consensus because health care organizations are very

consensus driven

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But I then wrote a follow-up called uh the Pauper CFO, which is even once you get past all

of those gatekeeper type people, you can still get to the CFO and he goes, yes, a great

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idea.

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Yes, an awesome return or impact assessment in terms of what the outcome could be.

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Guess what?

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I have no money.

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I just don't have any money.

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sorry, you know, because this happened, that happened, the other happened.

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And I think that's what we're here to talk about today.

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saw an article in Becker's today where the AHA is actually suing the federal government

because of changes that they're proposing to the 340B reimbursements, which effectively,

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it helps a lot of the smaller rural critical access hospitals be able to recover

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, monies related to pharmaceuticals that they might dispense to patients as they're being

discharged from hospital so they can continue that course of treatment.

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And that was the original intent.

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It's become way more complex than that.

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And so the federal government is trying to of like correct it a little bit.

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And of course, in that correction, it's upsetting the apple cart.

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And that may seem completely irrelevant to you selling your

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little medical device or your consulting services for whatever it might be.

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But for that CFO, potentially, they're about to lose one to 2 % margin off their bottom

line because those reimbursements are suddenly going to be held up.

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And how does he deal with that as a cashflow issue or even potentially a loss of revenue

issue?

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So I think that's why it's so important to understand this big picture that we're about to

go into.

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So now I've plugged my sub stack.

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Why don't you

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tell us a little bit about the analysis you did and the genesis for you creating this

article because it is absolutely fascinating.

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The methodology you use to try and illustrate to people what is, well, I'll let you

describe it.

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Yeah, well first of all, I enjoyed your article and that's how I knew it was a kindred

spirit.

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Because I agree, when you're inside the walls of a health system, it's completely

different.

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You're inside the castle, right?

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And to Bethany's point too, it's very easy to be so caught up in just like palace intrigue

or whatever.

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It's hard to understand the macro scale, know, the fiefdoms and the kingdoms outside the

castle.

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And one thing that really draws me to it, having been a consultant,

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I've been in a lot of different castles, right?

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I might be on one side of the fence in a provider organization.

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trying to maximize billing, right?

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And let's get more revenue.

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And then I might go to the payer and then like figure out ways to do utilization

management and cost containment.

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So for me, just as a personal effect, it felt like, man, I'm just like pushing the boulder

one way and pushing it another way.

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I'm like, what does everybody do in here?

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And I could feel a lot of people in healthcare probably have a similar sense, right?

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Like what is the contribution here?

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And as I was thinking through that and developing my kind of soul searching writing, I

decided to kind of map out some of these things, right?

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One,

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I really looked at one thing at a time.

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Like initially, maybe I started looking at how does employer money go to like the

hospitals.

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Maybe I looked at how different government programs then uh ultimately provide funding for

health systems for like safety net funding and different things like that and all the

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cross subsidization economic mechanisms behind that.

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But that's boring stuff.

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Anyways, really what I wanted to do was take all that really complex stuff and then like

put it into like a really clear way.

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Well, the funny thing about the US healthcare system is it's obviously not clear.

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in the illustration that I ended up doing it painfully.

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So, so, um, just to talk real quick thing about my methodology and won't bore you with the

fact, but, um, I made this thing and I looked at it I was like, what is this thing?

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It's so tight tangled up.

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looked really like a knot.

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and that really summed up US healthcare well.

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So then I ended up looking at some other countries to see how other people do it a little

bit.

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And it's so much more clear and simple.

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the UK is a lot more direct in how they have a single NHS with some private insurance.

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Germany and their namesake of the Bismarck model has really an efficient German model as

well.

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Although it is...

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quite complex as well too, because you have to pay attention.

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They've got like 100 something different insurance companies is kind of a good burden

there too.

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But in the end, it was all better than what we have in the US.

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And that's really what I was trying to illustrate

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it's interesting that you said after, you know, I think we're probably of a similar

generation, similar age.

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I think when a lot of people have entered health tech as 22, 23 year old, you know,

optimistic 20 somethings, I have noticed a lot of people when they hit that, that kind of

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10 year mark pause and either stay with it and they keep going, but they do kind of have

that, huh, hmm, this has all been, hmm.

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interesting, or they just leave.

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I've had a lot of friends who have left in the last few years who have gone to other

industries because they're like, this is too, it's too hard, it's too complex, and it's

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only getting more and more complex by day.

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So it's interesting that somebody else had that kind of, you know, after a decade or so

like,

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that's also true of a lot of very large corporations.

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If you look at the history, thankfully, you know, with this gray hair, I've seen a lot of

stuff.

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And one of the things that becomes very apparent is the number of like mega corporations

who go, we can crack healthcare.

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We've got all these other industries we're doing, eh, healthcare.

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This is gonna be a piece of cake.

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And they come in and it's like, I've watched several, like McDonnell Douglas back in the

day, you know, thought of like, IBM has been in and out of healthcare in various ways, not

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just as an IT provider, et cetera, but trying to sort of like come in in a much grander

way, like three times in my career.

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And what happens is a bit like, you know, what they did with Watson Health, you know, in

and out in three, four years.

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know, because they come in with a...

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grand plan, they're really excited, they make big investments, they make acquisitions.

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And then suddenly they realize, this is hard.

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And they suddenly like, you know, of like fall out of love with it and back off.

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But Andrew, uh

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I'm curious about the lessons that you drew from your own experience once you actually saw

the diagram and went, aha.

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Yeah, I mean, that was the one thing that I uh struggled the most with too, because when

you generate this, I almost think about it like the cables under your desk kind of thing.

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And every guy, I feel like goes through a phase of like, I need to organize my cables and

make them neat.

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But that's what it was like building this diagram.

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was like, my god, all these things in my life, why do I have this plugged in?

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And that's a big part of the experience when you're going through it too.

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When you work in a hospital organization, you are just like one, it's a mess.

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These are like 10,000, 20,000 person organizations.

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It's hard to understand how it all flows to you, right?

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You might have your thing and your thing is very big, but it's very small in the grand

scheme of just even that organization.

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And then if you look at the region or your state, it's even a big, just a part of that.

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And then all across this $5 trillion industry,

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I think what struck me and it's always struck me is kind of the scale of it.

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I'll kind of do just an aside here.

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Originally, I tried to write it up like Carl Sagan's like pale blue dot, you know, like,

yeah, in this flow is like, you all these claims getting denied and in this flow is like,

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you know, where Metformin was being prescribed, right?

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And so that is true.

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So you can get really lost in it.

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What's nice about it is it is like a piece of art, like a Rothko or something.

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The more you look at it, the more things you can see.

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And I love how you actually took inspiration from an actual piece of art to to title this.

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So do you maybe want to explain a little bit about that?

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Because I think now that people have seen the diagram and we'll be drilling back into in a

few seconds.

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But talk a little bit about the piece of art that inspired you to then name this creation

you have made.

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Yeah, so I'm a big fan of when I do AI generated stuff, I try to make it more artistic.

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And I was thinking about different artists and stuff.

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I was inspired by, this scientist, Ernst Heckel, I don't know if I'm saying that last name

right, who did these really detailed scientific drawings of different life forms in the

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1920s, something like that.

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And I think that's kind of what is representative of it.

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There's like this organic activity kind of happening in the US healthcare system.

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People are like, why is it designed so poorly?

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I feel like it kind of arose organically in a very crude way.

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And then we also sew it together, almost like this Frankenstein.

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Maybe it was like Halloween when I wrote it, so was inspired by that too.

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So yeah.

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if you look at the more you study the US healthcare system and you look back and we always

should learn lessons from history.

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As you look back at well, when does this come from this piece come from?

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Where's the legislation behind that piece?

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Where?

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Why did that go that way?

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And if you start to unpack all of those threads, and as you say, I mean, almost like doing

autopsy on it.

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you start to understand the nature of it.

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So I honestly thought that that pen and ink drawing as inspiration for you to then name

this your diagram, I thought was uh inspirational.

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Do you want to share what that name was?

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Oh yeah, An abominable creature.

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Yeah, which I thought was, yeah, like I said, a little Frankenstein-ish, and then the

tentacles, right?

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So it all kind of like flowed together there.

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Yeah, that's all.

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if you look at one thread, you I love some of the insight that you had about the fact

that, you know, there's taxpayers is where a big chunk of this starts, but then also

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individuals and families.

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And I'm like, wait, I am both of those things.

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And so just realizing how much it is, we are feeding into the system.

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And I think

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If you look, if we're just looking at the US here, right, the rest of the world has other

systems that may or may not be better, but looking at the US, we know we have an aging

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population right now.

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And it is very scary if you look at this, because we are going to have, you know, as the,

the, the boomers retire.

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Yeah, it's coming.

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And there are, yeah, dad, what are you going to do about this?

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We're gonna have to look after you.

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I actually because now that I actually just qualified, sorry, I'll let you get back to

your point in a second.

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But I just qualify is it's like, actually, I can see I'm going to be OK for maybe five to

10 years.

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It's what then happens.

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So I actually think the Gen Xers are in way more trouble than than we are, because we're

all going to start dying off one way or another because natural lifespan.

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But, you know, I think that for a lot of people,

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um coming down the pike more rapidly, the people that are in their 50s, that's the

generation I feel concerned for.

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mean, people you and Andrew's age have got time to revolutionize our society and change it

and do all the things that we've failed to do for hundreds of years, but never mind, you

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can live with uh optimism and aspiration.

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But I think that that's the gap is gonna happen is that the people who have

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just retired, know, we've been hit 66 last year, 67 this year, et cetera.

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They're all going to be okay for the next little while.

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And you know, I've got, you know, four more years to hit to 67, you know, two more to get

to 65.

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So I don't have to face up to that and I intend to keep working.

217

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So hopefully I won't be relying on Medicare.

218

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And that's, think you draw a really good kind of point there because when you look at this

like tangled financial flow diagram, right, which in itself could be really boring if I

219

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was just like, Hey, look at this Excel sheet, right?

220

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Like, Oh, good.

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Isn't that interesting?

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Right?

223

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Like, it's not interesting.

224

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You see yourself in it somewhere.

225

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And I see myself as a participant and a recipient in this system.

226

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I see myself as a contributor in this system.

227

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Like you said, I pay taxes.

228

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I got a job and guess what, my job takes money out of my paycheck to pay for this, right?

229

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They gotta pay Medicare taxes, they gotta pay payroll taxes, they have an employer premium

that's tax deductible, so good for them, but that's money that could've went to me

230

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instead, but it didn't.

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Then I gotta pay, it's out of my pocket, and I gotta pay my taxes, and by the way, just

for anyone listening, I'm not an anti-tax person.

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What I'm trying to say though is that ...

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You don't even realize how much you are part of this, feeding into this East in a lot of

ways.

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And then more importantly, if you work in healthcare and you're selling a solution or

you're working with a client and healthcare is, know, obviously we know all the stats, 20

235

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% GDP, blah, blah, blah.

236

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All your customers and clients are recipients of this as well in some form or another.

237

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And in a very difficult way, right?

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I don't know about you guys, but luckily I think this podcast is for insiders.

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I don't see a lot of my customers lush with money right now.

240

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It is tight out there.

241

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It is tough.

242

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So when you look through this diagram, what are you really learning?

243

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What are we really seeing here?

244

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It's not like some money laundering or some ill intent.

245

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I mean, there's just a lot of inefficiency I can see for sure.

246

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Absolutely.

247

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think one of the, and this is going to be the big contentious statement.

248

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So we'll make this a, you know, one of those viral clips somewhere.

249

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What people don't realize, and this is what you said in the article is we already have

effectively a socialized medicine system.

250

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It's just grossly inefficient in terms of we've dressed it up in all kinds of ways to make

it.

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for various political perspectives and so on and so forth over the year.

252

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But there's already a huge imbalance between younger people who typically are not

consuming healthcare but are contributing a lot to it.

253

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And then as you get into your middle and later years, you start to become a bigger

consumer of those services.

254

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And then as you become elderly, then you become a very big consumer.

255

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of a lot of those services through the Medicare system.

256

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And so the challenge is we've dressed it up in all kinds of ways.

257

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We've made money flow in multiple ways.

258

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And as you've just pointed out, the healthcare industry is in your pockets multiple times,

both through direct taxation.

259

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through the direct pays that you make in your deductible payments and your out of pockets

and whatever you're doing with that nice little bit of tax free cash that you get from

260

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your FSA, you're paying all of that money out into the system in addition to your taxes

and in addition to this and so on and so forth.

261

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So I think that that really was one of the sort of like, you know, real contentious things

because when you did the comparison with UK and Germany, why don't you talk about that?

262

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Yeah, I mean, I'll throw it out there too.

263

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I want to hit on this kind of silver tsunami point we were building towards as well,

because I think that's extremely relevant.

264

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Because, well, for one, in the US, every single day, there's 10,000 new Medicare

enrollees.

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And 10,000 people are eligible for Medicare.

266

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They're turning 65 every day.

267

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So that's like million, or 360,000 new Medicare.

268

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members every year, right?

269

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And yeah, they're going to need things like more complex care, long-term care.

270

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And I'll tie this back to the point that you just asked about with other countries.

271

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Look at Germany.

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They literally have a tax that goes, nope, this is going right to long-term care.

273

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It's very clear and apparent.

274

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everyone, employers and employees, they pay their piece for their health care, their

mandatory health care contributions.

275

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and they know that there's a tax that goes right to long-term care and that's how they

spend it.

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In the US, it's bizarre, so you have to think about it, right?

277

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Imagine if you're a vendor who's running a uh nursing home or retirement home or something

like that, right?

278

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And you're like, oh, Medicaid cuts, what is that?

279

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That's not me.

280

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What my diagram really shows is that we're all connected.

281

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It turns out that Medicaid, like 22 % of it feeds nursing homes.

282

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Right?

283

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So when you hear about this, the one big beautiful bill act and the Medicaid cuts, you

have to know that this is going to impact seniors too.

284

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It wasn't just all the, you know, the work requirements and the undocumented immigrants.

285

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It's all connected.

286

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And I find it both, I guess, in the way beautiful because it's like, Hey, look, we are all

connected.

287

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We, all in this together.

288

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There's so much healthcare that's like me versus you.

289

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And I know in other countries, it's probably like that too.

290

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But at least when I look at.

291

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other countries, right?

292

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Like Germany, which we just mentioned, or we looked at how like, even in the UK, I think

they manage a lot of public health very provincially.

293

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In the U.S.

294

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it's not like that at all.

295

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Like we've got like, lot of hospitals taking care of like social determinants or doing

some public health stuff.

296

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It's very complicated here that we never really figured out.

297

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And don't get me started on mental health.

298

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You know, think that I mean, I started my life as a psychiatric nurse and I was a

community psychiatric nurse in my little car and going and visiting patients around the

299

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community, keeping them supported out there and, you know, giving them their kind of

weekly medication injections to try and keep them stabilized on long term.

300

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And that was, you know, something that was handled relatively well there.

301

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we know here in the US, mental health care is abysmally funded and organized, And many

charities try to fill the gap to be able to, you know, assist there.

302

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But I thought the elder care one is interesting because it's those hidden aspects.

303

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One of the things, as I was looking at the diagram over the weekend and reflecting on the

last month of political activity here in the States, and you had all this argument and

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debate was if

305

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essentially dressed up as opposition to the expiry of the ACA Obama, of rebates or

assistance for health care insurance.

306

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And when you look at that, and you see it as 90 billion in comparison to the entirety of

the rest of health

307

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earlier.

308

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um is there more that you'd like?

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Because I was going to move on to, well, how can people practically use these insights in

their tiny little narrow focus?

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of trying to engage with a healthcare Abominable creature to look for their commercial

opportunities.

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do you want to talk a little bit about how you can use this diagram to gain perspective

312

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from your perspective, whatever it might be.

313

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I'll tell you right now, yeah, and you're right, like aside from this academic, stargazing

marvel that it is the $5 trillion healthcare system.

314

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I mean, that number is incomprehensible, right?

315

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I may as well be like, oh, it's as a Jupiter.

316

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And you're like, yeah, Jupiter is huge.

317

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I have no idea what that means relative to my life.

318

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I think a big part of it is being able to see the forest from the trees a little bit.

319

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At least practically, that's my advice, is to kind of step back and zoom out and

understand what piece you're contributing to and what's the larger thing at hand.

320

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I think it doesn't hurt to, you know.

321

00:25:40,646 --> 00:25:42,898

stay on top of the news and know a little bit of history.

322

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That gives you lot of credibility in this industry.

323

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To your point though, know a lot of, at least myself when I was like a 20 something out of

college, was like, healthcare just hasn't had a smart guy like me fix this.

324

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Like if I just got programming to this thing, it would solve it.

325

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If I made an app, don't worry, we got this, right?

326

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There is no shortage of hubris in healthcare, believe me.

327

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Exactly.

328

00:26:04,907 --> 00:26:09,779

And then it turns out once you like start studying it, history of it, I think that's a

real underrated thing.

329

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mean, Americans generally don't really think too far beyond maybe even a couple of

decades, but like even think beyond a couple of decades, you learn a lot about how we all

330

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got this way.

331

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So anyways, let's get off my pontificating for a second.

332

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Practically, if I do understand some of this stuff, I've seen a lot of success in my

experience.

333

00:26:28,880 --> 00:26:31,712

talking to like, I don't know, for example, like a CISO, right?

334

00:26:31,712 --> 00:26:41,860

Like a information security officer about like different cyber breaches in other parts of

the country and understanding, okay, why is the technical infrastructure built this way?

335

00:26:41,860 --> 00:26:44,462

How does the money kind of flow into that?

336

00:26:44,462 --> 00:26:46,003

How does that get funded?

337

00:26:46,003 --> 00:26:48,275

And what are the reasons for the information flow?

338

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That gives me a lot of credibility in those conversations.

339

00:26:50,958 --> 00:26:53,350

Or maybe I'm working with a pharma company.

340

00:26:53,350 --> 00:26:57,714

And I remember we were pushing for getting this cell therapy facility live.

341

00:26:57,714 --> 00:27:06,842

And that was really exciting because cell therapy, I won't go too much into the details of

that, but it's just like you're taking someone's blood and you're teaching it to fight

342

00:27:06,842 --> 00:27:08,873

cancer and then putting it back into the person.

343

00:27:08,873 --> 00:27:14,926

So I was working with a bunch of project managers and scientists and they're like, yeah,

we got to these deadlines.

344

00:27:14,926 --> 00:27:18,518

And I'm talking to the director and I'm like, no, we got to...

345

00:27:18,518 --> 00:27:22,401

We got to move this stuff up so that, you know, FDA has come in, we got to get this right.

346

00:27:22,401 --> 00:27:24,033

know, someone's life is on the line.

347

00:27:24,033 --> 00:27:29,187

And that gives you a lot more credibility when you're working with these people who are

really mission driven, right?

348

00:27:29,187 --> 00:27:33,661

Those are the people who have kind of like made their careers here and they're not trying

to make the buck.

349

00:27:33,661 --> 00:27:44,270

Those people really are the ones that can make the right decisions, kind of pull the

levers to move mountains, garner the like political will to kind of unblock the thing

350

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that's in your way.

351

00:27:45,212 --> 00:27:53,447

And I think having that macro understanding gives you lot of empathy to what they're

facing and therefore will make you more successful in your career.

352

00:27:53,447 --> 00:28:03,345

Well, it lets you understand, but it also allows you, I mean, a large part of selling your

or consulting is about establishing credibility.

353

00:28:03,345 --> 00:28:13,684

And the truth of the matter is the fastest, easiest way to do that is to be able to as

quickly as you can demonstrate that you get it.

354

00:28:13,684 --> 00:28:21,091

You understand their business perspective because if they feel like you're just there to

shill

355

00:28:21,091 --> 00:28:28,984

your latest, you know, pitch, your toy, whatever it might be, your service, then they'll

tune out really quickly.

356

00:28:28,984 --> 00:28:37,169

And I've seen it so many times in the flesh is that you're there and suddenly they've

picked up their phone within 15 seconds.

357

00:28:37,169 --> 00:28:38,300

And that's it.

358

00:28:38,300 --> 00:28:48,133

You know the meeting's over because they're already distracted by whatever the heck it is

that is priority in the top 10 and you are priority number 42.

359

00:28:48,133 --> 00:28:52,766

they're just being nice to the department manager that is hosting your meeting.

360

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And so I think that, particularly in the provider space, that's why it's important to try

and establish that credibility to understand where your solution, your consulting

361

00:29:04,322 --> 00:29:08,945

engagement, your value proposition fits against that landscape.

362

00:29:08,945 --> 00:29:14,860

it's not just, I would say to Bethany, one of the things that disappointed me about

363

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the HLTH conference is so many of the vendors I interacted with, the people who were

manning the booths, so therefore it wasn't typically executives, were just trying to

364

00:29:25,569 --> 00:29:28,371

convince me about the features of their widget.

365

00:29:28,399 --> 00:29:32,261

And I'm going, that's cool.

366

00:29:32,261 --> 00:29:40,384

And yeah, I've got another t-shirt that is a Havering t-shirt from Bluey, and I'm sure

your daughter is at that age.

367

00:29:40,384 --> 00:29:45,384

And my favorite character in all of Bluey is Unicourse.

368

00:29:45,581 --> 00:29:50,632

And his favorite saying, and he's the puppet, bandit, the father, uses in the show.

369

00:29:50,632 --> 00:29:54,623

And his favorite phrase is, and why should I care?

370

00:29:54,623 --> 00:30:04,654

And that's really a lot of times when you are making a pitch and you're engaging with any

buyer, but particularly in the provider space, is they're like, you know, they're looking

371

00:30:04,654 --> 00:30:05,805

for the so what?

372

00:30:05,805 --> 00:30:06,494

Where's the beef?

373

00:30:19,266 --> 00:30:24,172

You know, whatever catchphrase fits your generation, they are really looking for that.

374

00:30:24,172 --> 00:30:24,703

375

00:30:24,703 --> 00:30:36,014

CFO Pauper was inspired by another substacker, Trey Rawles who writes very, very long form

analytical type uh essays,

376

00:30:36,014 --> 00:30:47,521

But what he said in that article that inspired my CFO Pauper article is that essentially,

you are looking, number one, there's that tiny sliver of discretionary spending that

377

00:30:47,521 --> 00:30:49,812

everybody is chasing for as a vendor.

378

00:30:49,812 --> 00:30:57,799

But secondly, what the CFO is gonna pay attention to is show me how you can replace my

spend elsewhere.

379

00:30:57,799 --> 00:31:01,493

If you are not displacing a cost I already have,

380

00:31:01,493 --> 00:31:08,410

and hopefully giving me additional ROI, then I am really not going to pay attention to

this.

381

00:31:08,410 --> 00:31:15,367

Generating additional revenue, the revenue side, that input side of your diagram is

getting really choked these days.

382

00:31:15,367 --> 00:31:21,813

The federal government and the commercial insurers are really, they're starting to push it

down.

383

00:31:21,813 --> 00:31:26,557

So therefore generating additional revenue is not a sure fire area.

384

00:31:26,557 --> 00:31:34,178

If you're able to show that you can displace another cost that they've got, then I think

that that's something that then starts to get their attention.

385

00:31:34,178 --> 00:31:35,769

that resonates so true to me.

386

00:31:35,769 --> 00:31:48,037

Like you said, I've worked with this CTO in this hospital and we were working on, you

know, just like all hospital systems ebb and flow with IT, this contract renegotiation and

387

00:31:48,037 --> 00:31:50,028

like application rationalization.

388

00:31:50,028 --> 00:31:53,296

my God, every CIO wants application rationalization, right?

389

00:31:53,296 --> 00:31:55,780

Like, yes, get rid of these apps get rid of shadow IT.

390

00:31:55,780 --> 00:31:59,212

So we found this crazy telecom.

391

00:31:59,212 --> 00:32:08,775

budget that we could like cut and it would save like three plus million dollars a year on

like, I think it was like 86 million, let's call it a hundred.

392

00:32:08,775 --> 00:32:20,737

And we had this great analysis and great recommendation that showed how they can be

saving, you know, six percents of OPEX every year and all this stuff.

393

00:32:20,737 --> 00:32:24,479

And after going with the CTO on it, he was like, yeah, you know what?

394

00:32:24,479 --> 00:32:26,373

Like the nuns won't go for that.

395

00:32:26,373 --> 00:32:27,304

And I was like, what?

396

00:32:27,304 --> 00:32:27,804

What do mean?

397

00:32:27,804 --> 00:32:29,175

Like, you know, I'm wearing my suit.

398

00:32:29,175 --> 00:32:30,022

I feel in flashy.

399

00:32:30,022 --> 00:32:30,846

I'm like, what do mean?

400

00:32:30,846 --> 00:32:39,251

Like, yeah, the nuns on the board who are the fiduciary, you know, responsible people for

the health system.

401

00:32:39,251 --> 00:32:43,294

And not only just like the money, they really need to know about the margin.

402

00:32:43,294 --> 00:32:46,727

They need to know, you creating interruptions of service?

403

00:32:46,727 --> 00:32:56,598

Are there going to be any, you know, downstream impacts to kind of ancillary services or

outpatient clinics, right?

404

00:32:56,598 --> 00:33:06,169

This is, I think, an 11-hospital health system here, and the nuns really do care about

those communities, right?

405

00:33:06,169 --> 00:33:15,498

So we had to change our deck, like, to really emphasize, like, continuation of service,

you know, like, how we're going to approach

406

00:33:15,498 --> 00:33:19,721

dealing with the go live and the cut over, like the actual rollout plan.

407

00:33:19,721 --> 00:33:29,477

you know, yeah, the ROI and when they could realize that savings was really the after part

of the argument, because in the end, that's not what they wanted to hear.

408

00:33:29,477 --> 00:33:31,028

Yeah, they want, they know they need to save money.

409

00:33:31,028 --> 00:33:39,764

That's why we were there, but they wanted to know, are you in it to like cash out a quick

win or are you in it to really partner with us and make this thing work?

410

00:33:39,764 --> 00:33:47,095

When I think that's exactly the key, what do the people or the person that you're talking

to, what motivates them?

411

00:33:47,095 --> 00:33:55,226

And that goes back to when I first started in healthcare, I was like a firefighting team

and I would get dropped into a hospital, be like, go fix Dragon for these doctors.

412

00:33:55,226 --> 00:33:56,177

I'm like, okay.

413

00:33:56,177 --> 00:34:00,588

You know, I'd walk around with my bag and I would sit with the doctor and they'd be angry.

414

00:34:00,588 --> 00:34:05,799

And after sitting with them long enough, they're angry because they are stuck at the

hospital.

415

00:34:05,799 --> 00:34:11,712

after their 12 hour shift and they can't go to their kids' baseball game because they're

still charting.

416

00:34:11,712 --> 00:34:16,084

And that's why they're angry, because they're letting down their kid, they're letting down

their family.

417

00:34:16,084 --> 00:34:24,401

So if I sit with them, whereas before it was like, could I just have a, okay, can I just,

and then I'd be like, look, if you give me 10 minutes, I can add these words to your

418

00:34:24,401 --> 00:34:27,172

vocabulary, your charting will be done and you will go home.

419

00:34:27,172 --> 00:34:31,796

And they'd be like, And I would sit and do it and fix it and sit with them.

420

00:34:31,796 --> 00:34:37,074

And then I would go back a month later and they'd be hugging me in the hallways and

they're like, I've made every baseball game.

421

00:34:37,074 --> 00:34:40,360

I'm like, yeah, yeah, yeah, you have.

422

00:34:40,360 --> 00:34:42,875

it was, what does that person care about?

423

00:34:42,875 --> 00:34:44,898

In the big picture, right?

424

00:34:44,898 --> 00:34:46,411

What does that person care about?

425

00:34:46,411 --> 00:34:55,800

So there's a sales methodology and I've written an article about the many, many sales

methodologies I've been trained in over my career.

426

00:34:55,800 --> 00:35:06,922

But there's one in particular, which was one of the earliest ones I was trained in, which

is big and complex and kind of unwieldy to actually use and manage as a sales leader

427

00:35:06,922 --> 00:35:09,024

called Miller-Heinman Strategic Selling.

428

00:35:09,024 --> 00:35:12,318

And there's an excellent book on it and it's been around since the 60s.

429

00:35:12,318 --> 00:35:17,571

one of the key characteristics in that is what's called personal wins.

430

00:35:17,571 --> 00:35:28,175

Exactly as you say, Bethany, when you are engaging and you're trying to plot a sales

strategy and you've mapped out who all the decision makers are of the different categories

431

00:35:28,175 --> 00:35:37,617

that Miller-Heinman breaks them down into, have to, yes, you're looking at all the

institutional imperatives, you're looking at the business drivers, know, what is the value

432

00:35:37,617 --> 00:35:39,019

proposition, et cetera.

433

00:35:39,019 --> 00:35:40,175

One of the most important

434

00:35:40,175 --> 00:35:41,506

important things is?

435

00:35:41,506 --> 00:35:45,258

What is the personal win for each decider?

436

00:35:45,258 --> 00:35:46,788

Are they looking for a promotion?

437

00:35:46,788 --> 00:35:48,529

Are they looking for more time in their life?

438

00:35:48,529 --> 00:35:49,379

Are they looking?

439

00:35:49,379 --> 00:35:55,142

What is it that is actually important to them selfishly?

440

00:35:55,142 --> 00:35:57,519

Them, not the organization.

441

00:35:57,519 --> 00:36:01,080

Yes, we all like to say, yes, great, this is other.

442

00:36:01,080 --> 00:36:05,263

Some people it is just like the nuns on the board earlier on.

443

00:36:05,263 --> 00:36:08,055

It's their sense of service.

444

00:36:08,055 --> 00:36:11,907

and beneficial good to the population they're trying to serve.

445

00:36:11,907 --> 00:36:16,028

There truly are people who operate at that level and that is their driver.

446

00:36:16,028 --> 00:36:19,120

And you need to understand that's truly their driver.

447

00:36:19,120 --> 00:36:24,583

And it isn't just a motto on the wall of the signage at the front of the building.

448

00:36:24,583 --> 00:36:29,836

Other people, it's much more about their early on their career and they're very ambitious.

449

00:36:29,836 --> 00:36:31,137

They want a success.

450

00:36:31,137 --> 00:36:37,541

Other people looking towards retirement, it can often be, I want zero disruption.

451

00:36:37,541 --> 00:36:39,493

I want no upset.

452

00:36:39,493 --> 00:36:44,147

I don't want to do anything risky because I don't want to that blemish in my career.

453

00:36:44,147 --> 00:36:46,820

But, you know, let me draw this back.

454

00:36:46,820 --> 00:36:48,270

to the more selfish.

455

00:36:48,270 --> 00:36:50,162

We've talked a lot about the provider side.

456

00:36:50,162 --> 00:37:00,866

And you talked to me a little bit about lessons that you think are here for the payers

because they're a large part of the, I mean, they're a large part of the industry that

457

00:37:00,866 --> 00:37:11,523

depending on your point of view, either is the oil in the machine that makes all this

money flow around, or is the Administrative overhead and burden.

458

00:37:11,523 --> 00:37:14,879

that makes this money not get to the front line quickly enough.

459

00:37:14,879 --> 00:37:18,566

And obviously people can take all both those perspectives.

460

00:37:18,566 --> 00:37:21,417

Yeah, I think from the payer perspective and you're right.

461

00:37:21,417 --> 00:37:24,029

It is I think that's the whole point of Frankenstein, right?

462

00:37:24,029 --> 00:37:32,151

It's like, yeah, you have sympathy for the monster a little bit and that's really what it

is It's an abominable creature beef a sympathy for it and like the payers are great

463

00:37:32,151 --> 00:37:40,316

example to in a lot of ways I I've worked with payers and You would think because they a

kind of in a lot of ways control the money flow, right?

464

00:37:40,316 --> 00:37:42,478

They collect the premiums and they

465

00:37:42,478 --> 00:37:48,944

manage the risk and the actuaries, decide how things get paid out and stuff like that,

that they would be flush with it.

466

00:37:48,944 --> 00:37:51,427

But it's actually really, really complicated too.

467

00:37:51,427 --> 00:37:59,133

Well, for one, working at a health plan, you're just subject to a sea of regulatory, kind

of like the river.

468

00:37:59,133 --> 00:38:01,205

You're like a water wheel and it just doesn't stop.

469

00:38:01,205 --> 00:38:04,430

So, sales cycles are incredibly long, right?

470

00:38:04,430 --> 00:38:10,995

We're talking about from one open enrollment period to the next open enrollment period, So

AEP, things like that.

471

00:38:10,995 --> 00:38:18,996

And it's really funny because all the product design, all the benefits design happens

months in the year in advance.

472

00:38:18,996 --> 00:38:28,020

So you might have a whole 18 month sales cycle before your thing even gets believed to be

folded into one of their products, which then

473

00:38:28,020 --> 00:38:38,626

needs to be implemented and then go through all this marketing, legal, benefit design, all

this operations work that takes probably another whole year because everybody's already

474

00:38:38,626 --> 00:38:41,788

preparing for just this upcoming enrollment cycle.

475

00:38:41,788 --> 00:38:49,052

So you're not even gonna make a product available to your market until a year and a half

from now.

476

00:38:49,052 --> 00:38:51,234

And then after that is when...

477

00:38:51,234 --> 00:38:58,656

you know, members and beneficiaries actually start to reap the benefits of that and the

ROI on those things has like a real long tail as well.

478

00:38:58,656 --> 00:39:08,071

So like, if you're a payer, I've seen a lot of health tech companies, kissed a lot of

frogs, let's put it that way, where they're like, yeah, we'll just sell to like United and

479

00:39:08,071 --> 00:39:09,046

let's talk to us.

480

00:39:09,046 --> 00:39:10,592

And I'm like, okay, good luck guys.

481

00:39:10,592 --> 00:39:11,582

You better have some runway.

482

00:39:11,582 --> 00:39:18,616

Yeah, I'm like, you gotta know that what you're up against here, cause like, I'm sure your

idea is great.

483

00:39:18,616 --> 00:39:27,757

And I'm sure your execution can get there and you're willing to partner up, but you better

have the patience to kind of last through these cycles because that's really what it is.

484

00:39:27,757 --> 00:39:30,350

I see as one of the biggest pitfalls, right?

485

00:39:30,350 --> 00:39:35,315

Is how people get impatient and they're like, my God, how can I just cram in my solution

faster?

486

00:39:35,315 --> 00:39:41,342

And that really is one of the things that is a big blocker for success in the healthcare

industry.

487

00:39:41,343 --> 00:39:55,577

And this is one of those things whereby there's all kinds of innovation where I've been

approached about, you know, a founder, an early stage organization, where the concept is,

488

00:39:55,577 --> 00:39:58,741

I have got this, whatever it is, an app,

489

00:39:58,773 --> 00:40:11,184

widget, a gadget, whatever it might be, that I know from personal experience, because

either a parent or somebody I care and love has been afflicted by this.

490

00:40:11,184 --> 00:40:16,776

And I've come up with this idea that if we'd just done this, it would have made their

lives so much easier.

491

00:40:16,776 --> 00:40:23,839

And therefore, they extrapolated it out to, so that would mean they wouldn't need

admission to hospital

492

00:40:23,839 --> 00:40:27,721

And the problem is they then say, well, then who can we sell that to?

493

00:40:27,721 --> 00:40:34,316

The hospitals aren't going to be interested because hospitals, let's be honest, are really

in the business of sickness, not in wellness.

494

00:40:34,316 --> 00:40:40,181

That is unfortunately just the case, is their focus is on treating people who are already

sick.

495

00:40:40,181 --> 00:40:46,185

So therefore there's lots and lots of the benefit of vaccinations and convincing people to

eat.

496

00:40:46,185 --> 00:40:49,880

really the hospitals are incentivized to treat people who are sick.

497

00:40:49,880 --> 00:40:57,816

They go to the insurance companies and say, hey, I've got this great idea for there are so

many million diabetics in the country.

498

00:40:57,816 --> 00:41:08,132

and therefore this will have this impact and that and that and they extrapolate it all out

and what they don't realize is unless there is an immediate return to the insurance

499

00:41:08,132 --> 00:41:18,688

company to the payer organization whether it be you know a commercial organization or the

federal government they're just going to look at that and go yeah sure that's nice but

500

00:41:18,688 --> 00:41:24,711

it's not going to change my revenue it's not going to sort of impact how the flow of money

is actually going through

501

00:41:24,711 --> 00:41:26,803

the government isn't going to pay me for that.

502

00:41:26,803 --> 00:41:34,840

I can't raise my insurance premiums because the politicians are already beating me to

death on that and I've got all these regulations on my head.

503

00:41:34,840 --> 00:41:45,812

even though it's a great idea and on merit, societally and impact on a very large

population of patients, nothing gets done about it.

504

00:41:45,812 --> 00:41:53,137

You know and those, people who come up with those ideas really struggle because what they

don't understand

505

00:41:53,138 --> 00:41:55,703

is how the abominable creature works.

506

00:41:55,703 --> 00:41:58,246

these value based care organizations, right?

507

00:41:58,246 --> 00:42:07,033

I'm going to take this population of diabetics and make sure that they're getting all of

their treatment and their foot checks and their eye checks and their whatever else.

508

00:42:07,033 --> 00:42:07,944

And then tick tick tick.

509

00:42:07,944 --> 00:42:09,696

And then the insurance company will give me money.

510

00:42:09,696 --> 00:42:12,569

Well, who owns a lot of those VBC organizations?

511

00:42:12,569 --> 00:42:14,070

Private equity.

512

00:42:14,791 --> 00:42:15,772

Here's my hot take.

513

00:42:27,600 --> 00:42:31,843

Does private equity give one hoot about someone's health?

514

00:42:32,464 --> 00:42:33,254

No.

515

00:42:33,564 --> 00:42:38,408

They care about the dollars, which is what Andrew, your whole diagram is showing.

516

00:42:38,408 --> 00:42:48,537

How do I get more of those dollars from the federal government, from these payers to bump

up my investments?

517

00:42:48,818 --> 00:42:58,006

what's sad is I've done so many of these investment consulting calls with these people,

and most of them are willing to learn and listen.

518

00:42:58,006 --> 00:42:59,728

And some of them get so...

519

00:42:59,728 --> 00:43:00,109

520

00:43:00,109 --> 00:43:01,740

just up themselves.

521

00:43:01,740 --> 00:43:05,390

And they're like, well, Epic can just make an integration engine.

522

00:43:05,390 --> 00:43:10,032

Well, the payers can just do interoperability themselves.

523

00:43:10,032 --> 00:43:11,772

Why wouldn't they expand to blah, blah?

524

00:43:11,772 --> 00:43:15,553

And it's like, OK, let's take some steps back.

525

00:43:15,553 --> 00:43:22,056

And so it's interesting to look at your diagram and figure out where is this money going

to?

526

00:43:22,056 --> 00:43:26,077

how much of this money, you when you get to hospital services or something, right?

527

00:43:26,077 --> 00:43:40,570

How much of this is going to clinicians, to staff, to executives, to patients in the form

of pharmaceuticals, to executives in pharmaceuticals, to, you know, again, going back to

528

00:43:40,570 --> 00:43:45,183

what we were talking about earlier, $4.9 trillion, but at the end of the day,

529

00:43:45,183 --> 00:43:53,554

Someone, because I was looking at the job postings for my local hospital just this

morning, someone is getting paid $22,000 to be a full-time janitor.

530

00:43:53,554 --> 00:43:53,977

yeah.

531

00:43:53,977 --> 00:43:56,597

from $4.9 trillion.

532

00:43:56,597 --> 00:44:02,628

Now I live in a low cost of living area, but $22,000 is still a very, very small amount to

live on.

533

00:44:02,628 --> 00:44:03,843

You cannot live on that.

534

00:44:03,843 --> 00:44:11,845

yeah, it's crazy to me how we, guess, collectively as a society value some of this work

too, right?

535

00:44:11,845 --> 00:44:18,730

um Especially even, I'll just riff off your example, like the janitor, that's really

important job too, right?

536

00:44:18,730 --> 00:44:23,910

Like, uh you know, facility cleanliness has a direct, yeah, it's crazy.

537

00:44:23,910 --> 00:44:27,056

I mean, but that's the thing, and that's where I think,

538

00:44:27,056 --> 00:44:29,978

really the broader theme kind ties together.

539

00:44:29,978 --> 00:44:31,018

And I'm guilty of this, right?

540

00:44:31,018 --> 00:44:33,052

I'm a, management consultant, right?

541

00:44:33,052 --> 00:44:33,903

What do I do?

542

00:44:33,903 --> 00:44:37,756

But the whole thing too with this is like, everybody thinks they're all separate pieces,

right?

543

00:44:37,756 --> 00:44:47,275

Like, yeah, if I just strip out this part, like private equity, or if I like just bolt on

this new like acquisition or something like that, it'll, they're not fungible pieces.

544

00:44:47,275 --> 00:44:49,128

They're all like together.

545

00:44:49,128 --> 00:44:54,292

And even like the small role of like custodial, you know, for

546

00:44:54,292 --> 00:44:56,053

Like a healthcare organization, right?

547

00:44:56,053 --> 00:45:07,880

That's a really critical role and to see how we kind of commoditize that with really a low

rate It's kind of crazy to think about how collectively really don't value like proper

548

00:45:07,880 --> 00:45:15,755

healthcare And we value the money behind healthcare a lot more and then we also spend a

lot of money on Just overall the system.

549

00:45:15,755 --> 00:45:20,960

So it's kind of bizarre how we really have it kind of backwards, right?

550

00:45:20,960 --> 00:45:29,166

None of the outcomes related to improving human life are a direct result of all this

spending and financial maneuvering.

551

00:45:29,166 --> 00:45:38,979

so 2002 I moved from the UK, where I had spent 10 years working in the NHS, and 10 years

selling to the NHS.

552

00:45:38,979 --> 00:45:44,721

And with various propositions, mostly technology driven, but you know, sort of trying to

understand.

553

00:45:44,721 --> 00:45:48,164

And I had also spent a period of time

554

00:45:48,164 --> 00:45:51,696

not only on the national board of the Royal College of Nursing.

555

00:45:51,696 --> 00:45:56,030

So I am getting access to some of that policy experience very early on in my career.

556

00:45:56,030 --> 00:46:05,137

And I got exposed to all of that in terms of that system, which is a very, very

administratively lean system.

557

00:46:05,137 --> 00:46:07,509

And I moved here to the US.

558

00:46:07,509 --> 00:46:11,522

And of course, I had never been a consumer of the US healthcare system.

559

00:46:11,522 --> 00:46:23,508

So I arrive and they asked me to choose my benefits and did What became very obvious to me

as soon as I started engaging with the system just to get your normal annual healthcare

560

00:46:23,508 --> 00:46:27,322

stuff, was suddenly how bureaucratic it was.

561

00:46:27,322 --> 00:46:32,015

And then the longer I'd been here as I'd been through the complexities of my healthcare,

562

00:46:32,073 --> 00:46:40,779

challenges in the last couple of years, as we've dealt with my sons, as we've dealt with

Bethany and the birth of our granddaughter in the middle of COVID, et cetera.

563

00:46:40,779 --> 00:46:53,588

You come to realize how much, how much arbitrage, bullshit and administrative overhead

there is just in playing the game, the dance.

564

00:46:53,588 --> 00:46:57,691

immediately before joining my current employer, I worked for a company called Craneware.

565

00:46:57,691 --> 00:47:04,305

They sold chargemaster reconciliation software, which is part of the revenue cycle in

billing.

566

00:47:04,305 --> 00:47:12,881

Enormous industry just in the revenue cycle operations of the provider organization to do

this dance with the payers.

567

00:47:12,881 --> 00:47:18,726

So there is so much economic friction in the way that money is going.

568

00:47:18,726 --> 00:47:27,902

on the pharmaceuticals, the fact that we've even got a 340B program that needs to be

administered to try and make money flow to these underserved communities.

569

00:47:27,902 --> 00:47:30,873

And then you have to learn the rules of that game.

570

00:47:30,873 --> 00:47:37,747

And then some hospitals are very successful at it and others struggle because it needs to

be worked and you need to understand it.

571

00:47:37,747 --> 00:47:46,795

And some of the smaller hospitals just don't have the staff to be able to press the

buttons to make that system work so the cash can flow to them.

572

00:47:46,795 --> 00:47:58,486

So I think that that's one of the biggest challenges I see with the US healthcare system

is there is this arthrosclerosis in the administrative overhead that is there that just

573

00:47:58,486 --> 00:48:02,554

makes it so difficult and applies across all sectors.

574

00:48:02,554 --> 00:48:05,323

It applies in the payer sector as you alluded to earlier.

575

00:48:05,323 --> 00:48:06,844

They're heavily regulated.

576

00:48:06,844 --> 00:48:14,452

They're constantly trying to work on how can they bend the rules, work around the rules,

maximize the rules.

577

00:48:14,452 --> 00:48:20,432

and you look at the ones who are public companies and they're pretty successful at it.

578

00:48:20,432 --> 00:48:27,137

They're making a heck of a lot of money, you On the provider side, you know, they've got

this arbitrage they need to dance there.

579

00:48:27,137 --> 00:48:31,339

On the R &D and pharma side and the medical innovation side.

580

00:48:31,339 --> 00:48:41,273

They have huge overheads with the FDA trying to jump through the hoops there And then

again, as they introduce products in, whether it be new pharmaceuticals, like, you know,

581

00:48:41,273 --> 00:48:46,357

we've just had this wave around the GLP1's you know, over the last three, four years.

582

00:48:46,357 --> 00:48:53,210

That's a class of drugs that was like a novelty four years ago, a complete novelty.

583

00:48:53,210 --> 00:48:56,462

And now you've got people demanding it and...

584

00:48:56,462 --> 00:48:59,880

Your advertisements on TV, don't get me started on that.

585

00:48:59,880 --> 00:49:06,267

That's one of the things that I just don't understand in this country is the way that the

pharma companies can go direct.

586

00:49:06,267 --> 00:49:12,351

about that, you actually spend more time watching ads about pharma companies than spending

time with your GP.

587

00:49:14,316 --> 00:49:16,468

But look, there's a tentacle we can pull out.

588

00:49:16,468 --> 00:49:24,665

Let's just make it illegal to have pharmaceutical ads on Instagram and television news,

television stations.

589

00:49:24,665 --> 00:49:31,089

And then we've just stripped out like a couple hundred million at the very least, probably

a lot more than that.

590

00:49:31,089 --> 00:49:35,471

uh Let's just pull that old thread out.

591

00:49:35,503 --> 00:49:39,881

If our audience would like to let us know, what do you think?

592

00:49:41,501 --> 00:49:51,685

If you're here in the United States, what's your opinion about these medication and

pharmaceutical adverts that you see on TV for specific drugs?

593

00:49:51,685 --> 00:49:55,246

think, you know, Eli Lilly saying, hey, we're awesome and we're curing cancer.

594

00:49:55,246 --> 00:49:55,606

Sure.

595

00:49:55,606 --> 00:49:55,936

Fine.

596

00:49:55,936 --> 00:49:57,777

Everybody's a little corporate advert.

597

00:49:57,777 --> 00:50:00,649

But if it's a specific targeted drug.

598

00:50:00,649 --> 00:50:03,931

aimed at trying to influence people to go and ask their doctor for it.

599

00:50:03,931 --> 00:50:06,673

What do you think about that kind of advertising?

600

00:50:06,673 --> 00:50:08,584

Let us know in the comments, please.

601

00:50:08,586 --> 00:50:15,040

But any closing thoughts you've got as you reflect on the diagram and the points we've

made?

602

00:50:15,040 --> 00:50:23,334

particularly for our audience as they consider how they grow their knowledge and skills

going forward.

603

00:50:23,334 --> 00:50:31,857

Well, it's funny, I enjoyed this conversation too, because I could riff on the moral

pontificating of the healthcare ecosystem all day.

604

00:50:31,857 --> 00:50:35,059

And that's what we do, I'm Substack, LinkedIn, and things like that.

605

00:50:35,059 --> 00:50:44,613

But yeah, I guess maybe the way I like to think about it too, my initial reaction to

looking at this massive diagram, I was gonna go cheesy and say, oh, look how we're all

606

00:50:44,613 --> 00:50:45,794

connected to each other.

607

00:50:45,794 --> 00:50:48,326

I think if I just wrote that, that would have been...

608

00:50:48,326 --> 00:50:51,639

truly how I felt, but I don't think it would have gotten across.

609

00:50:51,639 --> 00:51:05,911

But really, I think that it's true too, because we had this sprawling conversation about

everything from ads and IT and ambulatory surgery centers closing and nuns, and it all was

610

00:51:05,911 --> 00:51:15,329

related because this is such a huge amount of our economy, of our lives, really the

beginning and hopefully

611

00:51:15,329 --> 00:51:17,410

We get through a good middle of it with this too.

612

00:51:17,410 --> 00:51:19,783

And really all the people that are involved.

613

00:51:19,783 --> 00:51:27,065

So maybe the thing I'd like to close with just as a Pollyanna-ish kind of naive thing to

say is like, you know, try to remember the bigger picture, right?

614

00:51:27,065 --> 00:51:28,548

Everything, every...

615

00:51:28,548 --> 00:51:32,801

thing that we're part of, there were decisions that were made in this kind of diagram.

616

00:51:32,801 --> 00:51:36,072

Like we all collectively take part in this diagram.

617

00:51:36,072 --> 00:51:37,514

We make these decisions.

618

00:51:37,514 --> 00:51:39,085

We vote for these representatives.

619

00:51:39,085 --> 00:51:42,506

We patronize these businesses.

620

00:51:42,506 --> 00:51:49,801

We spend our dollars in these places and we utilize healthcare in ways that we might not

even be aware of.

621

00:51:49,801 --> 00:51:54,075

So even though that's an unconscious decision, I think it's really important to think

about.

622

00:51:54,075 --> 00:52:02,156

the bigger scope of things and hopefully, you know, make this system a little bit more

palatable, make it something that we can kind of overcome and make better.

623

00:52:02,156 --> 00:52:04,169

Because otherwise it seems a little hopeless.

624

00:52:04,169 --> 00:52:12,039

So that's always been my goal is to make it like clearer, less complex, and hopefully

create some optimism that we can get through this.

625

00:52:12,040 --> 00:52:13,403

Absolutely.

626

00:52:13,403 --> 00:52:27,455

So I highly encourage all of our listeners and watchers to subscribe to Andrew's Substack

for more very, very smart takes on healthcare and just the world that we're living in.

627

00:52:27,318 --> 00:52:34,926

I would also highly encourage all of you to like this podcast, to comment, to review Five

Star, all that good stuff.

628

00:52:34,926 --> 00:52:39,441

And Dad, is there anything else that you want to add before we sign off?

629

00:52:39,441 --> 00:52:41,213

No, it's been a fascinating thing.

630

00:52:41,213 --> 00:52:49,623

for everybody who has an opportunity to reflect on what we've talked about is maintain

your intellectual curiosity.

631

00:52:49,623 --> 00:52:53,757

Don't just stay locked in your focused little bubble.

632

00:52:53,757 --> 00:52:54,908

Yes, sure.

633

00:52:54,908 --> 00:52:56,169

That's very important.

634

00:52:56,169 --> 00:52:57,121

We all know.

635

00:52:57,121 --> 00:53:06,280

that whatever your priority today is in terms of just whether it's just getting by or

you're looking for your next opportunity or you're trying to help somebody in your family,

636

00:53:06,280 --> 00:53:13,378

whatever it might be, yes, that takes your priority, but open up your mind to

understanding more of this business.

637

00:53:13,378 --> 00:53:16,241

I talk about horizon scanning a lot.

638

00:53:16,241 --> 00:53:25,863

which is you shift your focus from this horizon that's very close to you, you know, the

thing that is most important right now, you know, that is, you know, needs your attention,

639

00:53:25,863 --> 00:53:29,822

but then lift your eyes, look to the horizon, But Andrew.

640

00:53:29,822 --> 00:53:31,666

Thank you very much for joining us.

641

00:53:31,666 --> 00:53:33,684

We've thoroughly enjoyed this conversation.

642

00:53:33,684 --> 00:53:34,850

Thank you guys for having me.

643

00:53:34,850 --> 00:53:36,666

So glad to meet with you all.

644

00:53:36,667 --> 00:53:37,599

Awesome.

645

00:53:38,278 --> 00:53:40,163

wasn't that fascinating.

646

00:53:40,163 --> 00:53:42,940

I told you at the top that it was going to be and it was!

647

00:53:42,940 --> 00:53:46,056

It's almost like I knew these things.

648

00:53:46,123 --> 00:53:48,679

is such a great guy to chat with.

649

00:53:48,701 --> 00:53:52,786

Again, another episode where we could have gone another hour quite easily.

650

00:53:52,786 --> 00:53:53,936

Absolutely.

651

00:53:53,936 --> 00:54:03,200

I think was really interesting to me was just the reinforcement of, yes, you need to know

your tool, your product, whatever it is that you're selling, and you need to know your

652

00:54:03,200 --> 00:54:07,442

company and you need to know the place and the space where your company plays.

653

00:54:07,442 --> 00:54:17,486

But if you are selling to whether it's a hospital or an ASC or a clinic or really anywhere

in healthcare, you need to understand the broader place.

654

00:54:17,776 --> 00:54:26,033

that that organization sits in, the broader things that their executives are considering

and thinking about and having to be aware of.

655

00:54:26,033 --> 00:54:35,923

And the more that you can talk about that and truly be a consultative salesperson and not

just a, here's my shiny widget, isn't it cool, salesperson.

656

00:54:35,923 --> 00:54:38,886

You will be so much more successful in life.

657

00:54:38,886 --> 00:54:42,148

And it takes reading people like Andrew.

658

00:54:42,200 --> 00:54:46,246

and researching and understanding what's going on in the news, What about you, dad?

659

00:54:46,246 --> 00:54:47,790

What did you take away from it?

660

00:54:47,790 --> 00:54:55,038

Well, I think it is back to that thing of and I've had various sales leaders tell me this

in my past, follow the money.

661

00:54:55,038 --> 00:55:07,609

And I mean, that's the whole point of drawing attention to Andrew's way of showing and

illustrating how the money flows through the health care system in the United States and

662

00:55:07,609 --> 00:55:13,429

in the two other countries we mentioned, the UK and Germany, if you understand

663

00:55:13,429 --> 00:55:15,830

how one where that money is coming from.

664

00:55:15,830 --> 00:55:26,937

And I think it was fascinating to really get to that point, which says we, American people

who are paying taxes, who are paying for insurance, who are paying for our out pocket, et

665

00:55:26,937 --> 00:55:32,759

cetera, and for all of our co-pays and our drugs and everything else, we are funding all

of this.

666

00:55:32,759 --> 00:55:37,462

And yet we are not really the customer.

667

00:55:37,462 --> 00:55:38,663

The customer is.

668

00:55:38,663 --> 00:55:44,428

the elements inside this abominable creature that uh Andrew described.

669

00:55:44,428 --> 00:55:48,571

You know, the payers have way more control, the hospitals have way more control.

670

00:55:48,571 --> 00:55:56,797

We, as the consumers of the experience, the healthcare experience, actually have very,

very little control over it.

671

00:55:56,797 --> 00:56:04,122

And yet we're financing it, all that money that's flowing in on the left-hand side of that

diagram.

672

00:56:04,122 --> 00:56:04,943

And so I think...

673

00:56:04,943 --> 00:56:09,805

understanding that even though it seems so huge is really, really important.

674

00:56:09,805 --> 00:56:19,570

And then as you are looking at it, as you described from the other lens, looking at what

the end of one of those little tendrils looking up and how do you try and interact with

675

00:56:19,570 --> 00:56:31,315

that to be able to sell the value and the proposition of your solution, whether it's a

service, whether it's a product, whether it's a technology platform, how are you going to?

676

00:56:31,315 --> 00:56:42,269

impact that and how are you going to deliver a true hard cash ROI that is actually going

to be impactful because that's the fastest way to being able to achieve a sale.

677

00:56:42,269 --> 00:56:53,574

I mean, if you've got something that is a soft impact, yes, you can be successful, but

it's going to be so much harder because you're fighting against the mess and mash of these

678

00:56:53,574 --> 00:56:56,836

tentacles of this abominable creature.

679

00:56:56,836 --> 00:57:06,072

So no, I thought it was a great conversation to have and it's all about being educated

about the business of healthcare and understanding that.

680

00:57:06,072 --> 00:57:09,224

And with that, I would like to thank our visitors for listening.

681

00:57:09,224 --> 00:57:18,301

Please like, subscribe, please visit the Haverine About store and buy yourself some nice

merch to support us.

682

00:57:18,301 --> 00:57:19,923

We would really appreciate that.

683

00:57:19,923 --> 00:57:22,792

But until the next time, keep Haverin!