[Modern Patient Experience Ep. #1] What if an Academic Medical Center had a Baby with Silicon Valley?

Jefferson Health CEO Stephen Klasko, MD, discusses the big bets he's made for his growing Academic Medical Center from telehealth back in 2013 to their new initiatives to segment patients in order to provide a more personalized experience. All of this is in service of his vision to deliver healthcare wherever and however patients in greater Philadelphia need it.

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Episode Highlights

  • The new Jefferson Health vision is  healthcare at any address. Klasko says they won't be defined by their hospitals or the place where the sickest people go. Instead, they're going to be defined by the care and caring they give. As a result of this culture, they've begun hiring people that really get that and live that. That, then became a differentiator for Jefferson.
  • The U.S. healthcare system has Star Wars technology that's being delivered by a Fred Flintstone vehicle. What he means by that, is that for complicated cases and cutting edge procedures, there's no other country that can compete with the United States healthcare system. But for 95% of people who are just trying to stay healthy, we experience an antiquated delivery system. 
  • Not every healthcare organization will be able to incubate a SaaS startup inside their walls, but at Jefferson Health, Tendo is giving them a competitive advantage in the market. Tendo combines their whole digital innovation and consumer experience team together with 30 people from the Palo Alto and Boston world. "It's helping us have a digital front door. It's helping us consumer segment with all the stores. Gives us the creativity and flexibility of a Silicon valley startup, but with the reputation and the doctors of a top flight top 25 academic medical center," says Klasko. 
  • The key is to create co-development partnerships with companies or developers that learn from organizations and solve real problems with technology. 

 

Episode Transcript

James: Hi, welcome to the latest episode of the modern patient experience by Cue squared. I'm your host, James Furbush and my guest today is the CEO of Thomas Jefferson Health, Dr Stephen Klasko. Dr. Klasko. Thanks for joining us on the show.

Dr. Klasko: James is really a pleasure. It's a, it's really an exciting time to be talking about consumer patient and user experience in healthcare.

James: Yeah, I can't wait. So I wanted to start the show. You know, one of the challenges I think with, with healthcare is that every organization is in some ways very unique, right. And that uniqueness, geographic location, you know, do they have hospitals? Is it urgent care? Almost sort of dictates sort of that, that strategy and sort of the vision that they're going to have. And so I'd love for you just to start. Can you give us an overview of Thomas Jefferson health? You've been the CEO for seven, eight years now. 

Dr. Klasko: It's Thomas Thomas Jefferson University and Jefferson Health. Well, so just the, the 30 second version is I got here eight years ago. We were three entities were Thomas Jefferson university with is a third oldest medical school in the country. The first one, by the way that they thought seeing humans was a good idea before he graduated. And and it was a two hospital system. And then an outpatient group.

Fast-forward, we've done seven mergers and we're now an 18 hospital system. Two campus university, we merged with it with the number three design universities, so that we have the first design curriculum in a, in a health, in a, in a health entity. We have architecture schools. So the whole issue of safe spaces for, for health. We have 16 NCAA teams and we just acquired a $2 billion Medicaid and Medicare advantage plan.

So, so the, the quick answer to your question. We're Thomas Jefferson University and Jefferson Health. I'm the president of the university and the CEO of the, of the health and insurance system. We're a $9.2 billion IDFs in the integrated delivery of financial system with what we'll be in on November, 18 hospitals to campus university with that 8,000 students and a Medicaid and Medicare advantage.

James: So you're juggling a lot to say the least. Yes. Nice. Yeah, that that's good context. So I want to start, you know, we're talking about the patient experience and you know, I'm, I'm kind of curious for you as, as a CEO you know, what's something about the patient experience. It's a commonly held belief that you passionately disagree about disagree with.

Dr. Klasko: Well, I think so, so here's what I'd say. I think that this whole issue of the healthcare is too complex is a widely held belief that we can't do what other sectors do. You know? Like we can't be Amazon, you know, we can't, I think there's a great quote by Sebastian Thrun who's the Google X guy. He said the problem in American health isn't that we aim too high and fail it's that we aim too low and hit the mark. And, and I think that, that, that, that's the issue.

What we've tried to do, James, is, is really start to look at that retail experience and say, you know, I, what I've told folks is look. I hope that five years from now, or 10 years from now, if Elon Musk brings folks back from Mars to Philadelphia and they say, where's Jefferson, you can't define that. That somebody would say, you know, you know, Jefferson at my home or Jefferson you know, Jefferson at one of 12 micro hospitals, other places were really, really sick people go. I think that's still a 10th.

James: Nice. Yeah, it's not too everyday you get someone talking about Elon Musk, related to healthcare, but I do think that that's the case when you see it all the time, where I mean, think about any experience you've had in healthcare, whether it's just like scheduling an appointment and you've got to go back and forth making phone calls. And it's like, I just need a referral. I just need this. I just need that. It can be kind of a frustrating experience.

And so sort of based on that, that belief that you're sort of talking about that healthcare isn't, you know, the complexity of healthcare is maybe an excuse and a crutch. Can you talk about some of the stuff that you've been doing at Thomas Jefferson? You know, based on, on that belief you know, what are some of the initiatives that you've put forward as a result of that?

Dr. Klasko: So, so when I got here, I made a decision that we were going to be 197 year old academic medical center, thinking like a startup company. So, you know, I, you know, and I remember making a comment that, you know, I'm a, I'm an obstetrician. And when I think over my career of the amazing advances we've made with individual patients, you know, we sort of have star wars technology and our critical thing with a Fred Flintstone healthcare delivery system. So, so, so, you know, what I recognized is, you know, there's, there's several reasons for that. You know, some of it is your. Wait, so you, you know, well, not, not you, not you specifically, you, the patients haven't demanded it.

So, you know, so I mean, I think, you know the patients haven't had, they're mad as hell and I'm not going to take it anymore moment. So, you know, and that's one problem. The second problem is until recently there hasn't been an alternate. Right. So, so if you think about retail, when it was just Macy's Sears Petty's or, you know or target and Walmart, you know you know, our banking, it was, you know, look, you know, I can only get there from 10 to four. What changed banking? It wasn't the technology. It was when banking started to do banking and supermarkets and say, aha, I can CA I can deposit my check at 10:00 PM. I don't have to go to Wellsville. So we're starting to see that I think in healthcare with the disrupters, the one medicals, the Oak Street's, the Chen Medicine is saying, look, why would you put up with that crap? You know, that, that, that your, your traditional healthcare system, you know, makes you put up with now to this point, we've been able to win by saying, oh, you don't want to go there because, you know, we're, you know, we're, we're Jefferson or we're Penn and, you know, but I think, you know, patients are starting to realize just as they deal with banks, it doesn't matter if your name is Wells Fargo or, you know, it's a supermarket bank. It's still at the IC insurance. Still got great doctors, sometimes the same doctors. So I think, and basically the insurers have got through the same.

I mean, think about the 60 bill, but my daughter just had a delivery and I'm not exaggerating she got 60 bills of which 53 of them were from her insurance company saying this is not a bill. So then why the heck did you send it? Right. Can you imagine if, if that happened in any other sector in your, in your, in your, you know, what you do? So, so w w what we've been looking at is we want, we want the patients, the consumers at Jefferson, To be able to access health care the way they access every other consumer good. And what we've recognized is that we don't have the skillset to do that. They don't, they don't teach you that in gynecology school.

We've really partnered with some of the top VCs and founders in the country. So we were one of the, just an example, one of the primary customers of Livongo. Livongo became an, you know, good friend Glenn Tolman as a somewhat diverse. And he really, you know, recognized that, you know, diabetic care in this country is ridiculous. Why? Because we think of everybody as a patient. And what I've told my staff is 97% of people, James in Philadelphia are, are not patients. They don't wake up in the morning, say I'm a diabetic patient, or I'm a congestive heart failure patient. They wake up in the morning saying you know, Steve Klasko or James Furbush. And I'd like to be able to have my, like, to be able to thrive today without health getting in the way.

So he started his company just based on, I'm going to treat diabetic patients as people. And he said, I'm going to beat you, Steve. I'm going to beat your traditional health care system, because you can only think of those patients come to my office, come to my ER, come to my come to my hospital. So he created an 18 and a half billion dollar company just with that realization. Right. So, so I think that that, that we're trying to be, I tell, I tell my staff that that's the way to answer your questions. We want to be Target or Walmart because when Amazon disrupted retail, there were, you know, Sears and JC Penny said, boy, what a stupid fad? You know, people always wait in line for two hours a day after Thanksgiving, who's going to shop in their pajamas, watching Game of Thrones, you know on nine.

Well, they were wrong Target and Walmart said, we're really good at what we do. And our stores really matter. But we also have to get into this game and be just as good as Amazon on the stuff. That's what I tell people about Jefferson. Somebody, God forbid has pancreatic cancer or prostate cancer. They don't care what our digital strategy is. You know, they want to go to the best of the best pancreatic cancer surgeon in our hospital. But for the other 97% of people, I want them to view Jefferson as their health partners. So, cause I believe that when they get sick, then they'll just come to us. They're not going to go up and down this Google expressway and say who's got the coolest billboard. So, so for us, probably the number one thing that we've been getting involved in, which is very unusual in healthcare, very usual in anybody else. You'd interview is consumer segment.

James: Yeah. So say more about that.

Dr. Klasko: So, you know, It always makes me laugh when I see a billboard, you know, Pleasantville General hospital, we are patient centered. Like, what the hell does that mean? First of all, are you patient center for somebody like me, a 67-year-old with two apple watches and an oura ring? Are you patient centered for a 35 year old, you know, disengaged person that it doesn't think about their health? Are you patient center for a 75 year old with ovarian cancer that, you know, only gets online to, to, to see their, their unbelievable, cute grandkids, you know? Which one are you patient centered? Well, Amazon is, you know, has about 1 million, 987,000 types of us, you know?

So at Jefferson we tried to consumer segment, you know, sort of in our infancy, starting to think about like six types of patients. You know, how am I going to get out to a, a 28 year old obstetric patient where everything she does. is is online, you know versus how am I going to be the best place for, you know, a geriatric patient that, you know, wants to either stay healthy or has a chronic disease. Very, very different ways of mark it. So we don't do any billboard marketing. We don't, we don't do the 32nd commercials on morning, Joe of somebody having cancer, walking into our cancer center and walking out smiling. We don't do any of them because. Frankly, you know, anybody, anybody that's smart, doesn't recognize them. And then the second piece is since we take here so many underserved folks, we need to figure out how to get to them. And some of that is community health partners and, you know, folks that don't have broadband and you know, how can we get to them? So we really try to think about the end user at the beginning.

James: Yeah. So, I mean, that's, it's interesting, right? Cause there's probably enough data out there. You guys have probably access to from EMR and all the technology that's been put in place. You now have a health, you know, health plan, there's data there, you know, but how so, but it sounds broadly like thinking about, you know, it's like, I mean, is it an access play, right? It's it's almost like how you bring Thomas Jefferson to these different patients and how they need it. I mean, it's. I mean, it's a fascinating, you know, I'd love to hear more about that effort. Cause I would imagine it's not easy, right? It's easy for Livongo. It's easy for ChenMed or One Medical when they're a much smaller organization, probably harder when you're trying to move the Titanic.

Dr. Klasko: No, you're exactly right. Look, we have 35,000 employees or gone through a second, third year of a pandemic. You know, we can survive without doing that. And so exactly to your point, you know you know, we have faculty and chairs that, you know, look, I invested $35 million in telehealth James in 2013. Literally my faculty thought it was like, I was teaching Satanism. Like, are you crazy? You know, like, like, you know, we're a hospital system. Like w you know, why would we do that? So I think, you know, some of it is, is, is one of the things that happened. James, it starts with the mission. Right?

We changed our mission when I got to Philadelphia, every single academic medical center had the same mission. We'll be the premier academic medical center in Philadelphia. And the way that they defined that was US News World report. And I had funding think about that. None of that has anything to do with the patient. No. The first thing we did is said our, our, our mission became we improve lives. Why can't improve lives without thinking about the end user. So then that changed everything. It wasn't about where are we in an ice funding where we, and then, so, so, and then we basically said, you know, our model is going to be healthcare at any address that we're not going to be defined by our hospitals or the place where the sickest people go. We're going to be defined by the care and caring we give. And we started to hire people that really got that. And then that became a differentiator for us.

And then, so probably the thing that's happened most recently, that that will be really exciting to your listeners. So Hemant Teneja who is the managing principal of general catalyst. He was along with Glen Tolman and the founder of Livongo. He was also the initial investor in Airbnb, Warby Parker and stuff. He wrote a book called Unscaled and it was about those companies.

You know, it used to be, if you wanted to build a bigger, better hotel chain in the Marriott, you have to build a lot of hotels or better, bigger, better, you know a lens shop that LensCrafters, you have to build a lot of stores, this whole thing, we should build no stores and you customize and personalize. So through a series of events, we, we became really good friends and it was sort of funny because he said, well, In some respects. You're the opposite of my theory. You've gone from two hospitals to 18 hospitals. So it's like, dude, that's the opposite of unscaled. But everything you talk about is healthcare at any address, which is what we're talking about. So, so we got together, we wrote a book together called Unhealthcare: a Manifesto for Health Assurance. And then we started to say, you know, part of that book was, well, what if we took the best of both worlds?

What if the Silicon valley entrepreneur and CEO of an academic medical center had a baby? What would that baby look like? And we created that baby that baby's called Tendo. It's a company we started together. It's basically taking our whole digital innovation and consumer experience team together with that 30 people from, from general catalyst that came from, you know, the Palo Alto and Boston world. Exactly the airport. It's easy for them to think about this. It's hard for us but then the head of that, a guy named Dan Goldsmith sits on my case. And he's leading our digital front door and our access entities, not from the outside, not from a company, but leading it from Jefferson, leading this company.

And then what's cool for the company that we're co-invested in. He can then go and say, Hey, look what I did for Jefferson. Look, what I did for this barge and turned it into a creative, nimble, flexible place with great access. And it's number one in market share because it's easier to access and then you can go and sell that, you know, and, and we're invested in that. So it's really, it really is the epitome of our book, of the best of both worlds. It's helping us have healthcare at any address. It's helping us have a digital front door. It's helping us consumer segment with all the stores. Creativity and flexibility of of of a Silicon valley startup, but with the reputation and the doctors have a top flight top 25 academic medical center.

James: Yeah. That's crazy. So, you know, I'm curious, so, you know, General Catalyst, I mean, do they have a different way of thinking about these issues? Right. Cause I mean, so much of, of, I mean, right. It's like agile thinking or, or, you know, how they design products and. Get those products to be sticky with, with people and, you know, get past the gatekeepers. I'm curious, you know, what sort of thinkings did they bring to the table that you guys have, have learned and applied it at your institution?

Dr. Klasko: Well, yeah, look, I think that the the, the general, there's a couple of things about what's happening in health. VCs today. And that is that first of all, there's unlimited money. So if you put A and I, and this in the title, you're going to get a hundred million dollars. Now that's probably a bubble that will last forever. I think we're, we're, I'm very impressed with the general catalyst team and it's true of Andreessen, Horowitz and Oak and others. But the team that we've had the most experience with general catalyst is they've recognized the need for uncommon partners. So what you know, with us in a few weeks, We've really created a consortium of the willing, what are the incumbents who want to jump into that? So now we get to share.

So HCA just did a deal with General Catalyst, with a company which was a fire layer on top of epic or Cerner. So you're not just stuck with a tyranny and the legacy EMR. This is an example, right? I think what, what, what Hemant recognized is while it's great to create things like Livongo and Calm, and Oscar and all these things that are going to bring in billions of dollars. You're not going to transform the health system with that fragmented approach. So his point is how can I, how can I bring them together with a place like Jefferson that really changes our whole mindset. And that's, that's, that's where I think about the morphing of the, you know, the founder brain with with the academic medical center brain. And then the other thing is we get a chance to co-invest. So it diversifies our portfolio at a time where, you know, revenue in the traditional healthcare ecosystems is, is, is really being challenged. Right. So, so I think it's an exciting thing. And then it also brings. Predictive analytics and social determinants and population health. Academic exercises to the mainstream of clinical care payment models and medical education, because I brought those two worlds together. So to me, that's, what's exciting.

I think at the end of the day, when you look five or 10 years from now, when the revolution happens you know, there will be serious and tennies of incumbents that will go away. There will be incumbents like ours, that, you know, our targets and Walmarts and create the best of both worlds. There'll be some startup. That you know, were really go-go startups that didn't last, you know? And there'll be some startups, you know, that, that, that, that people say, wow, you know, they really, you know, just like, look, I'm old enough to remember, you know, the, the whole search piece.

Google was not anywhere near in like in first place. It was like, CompuServe. Those Google was smart enough to say, you know, we're not a search engine. We're going to be the first place you go to on your computer. So they were the one along with Yahoo and, you know, a few others that really had the lasting piece. Right. So to me, that's, that's what we're trying to do. We're trying to create a Pied Piper effect of other VCs.

I don't ever want to be at HIMSS you know with eight hundred and seventy, twenty eight year olds telling me to buy their app and it'll transform healthcare, you know, to me that, that's what I want to get rid of.

James: Yeah. I mean, if I had never had to go back to HIMSS ever again, I'd probably be okay with that.

Dr. Klasko: The key is to create these co-development partnerships. W w with, with folks that are, that really get that piece of it, what they get out of it is they learn from us of what's our real needs, right. They're not sitting there in Palo Alto, developing, you know, with the, with a 28 year old, you know, amazingly smart software engineer saying, this is what I think Steve needs, you know, they're literally in my shop say, oh yeah, You know, this wouldn't work because patients don't view things that way, or the doctors don't view things that way. So they get a lot of intelligence. It's like, you know, it's like invasion of the body snatchers, you know, we're, we're the alien gets into a human body. Right. You know gets, gets to learn what humans do.

James: That's that's so great. I want you to come back real quick. So investing 35 million in tele-health back in 2013 to your point is a little bit crazy. Yeah, playing the long game. It was probably good that you had that infrastructure and investments already in place in the last 18 months with the, with the pandemic and stuff like that. Where have you, I'm curious, you know, the concept of like a hospital system without hospitals, right? Airbnb owns no hotels. Uber owns no cars.

Dr. Klasko: Yeah. Health healthcare at any address. That's, that's the Jefferson model.

James: And so where has, so making that initial investment, you know, where have you guys evolved that sort of tele-health program access, you know, care at any point? You know, I'd love to kind of just dive into that a little bit more. I mean, what does that program look like? For patients.

Dr. Klasko: Yeah, so for us. So for us, we made a decision at look here's. I think often the problem James, is that we take the easy road. Like there's so many hospitals that say. Isn't it great. We're doing tele-health you know, and what they did was they bought American well, or they bought Teladoc. They're not doing telehealth. They're basically having some, you know, that from Ohio answer the patient's calls at two o'clock in the morning.

So we basically went all in. We were originally worth the murder. Good. Well, we were an initial investor. We then moved over to Teladoc. We co-developed with them. So not only did we take advantage of both of those IPOs. But we literally, we said we want, when you tell a doc to be Intel inside, I don't want to be a Teladoc customer. I wouldn't create Jeff Connect, which is what we are, which I want to have be the largest specialty telehealth or virtual care we got away from telling us. It's like, you know, we don't get up in the morning. James is, I think going to Telebank is right. It's just the, you know, it's not the bank to 99% home. So that's what we said. We went down to be. A a notice to getting care out to the home, by the way, our most successful thing.

Remember I told you, we merged with the number three fashion design university was we, we created a wearable that became an IPO called eco fiber and the concept of patients going, you know, the pandemic of 2030 while people wearing wearables it'll will measure their temperature measure. The respiratory rate send continuous thing. My car James gets better care though. Cause while it's in the garage, it's sending continuous signals. Am I turn on, says, Hey, Steve, you know, while you were sleeping, my right front passenger tire got a little low. Could you fill it? We will. I'm going to have a physical two weeks from now. And they're going to say on a, on September 8th, You know, your blood pressure is extra calcium score is Y and your post dizzy. Here's what you should do for the next two years. That's asinine. So we've been really building up things around that.

So for us, tele-health is just one vehicle for health care and address. But what, but where we really had an advantage during the pandemic is that it wasn't like we had to activate it. In fact, what, what my Jeff Connect team called themselves was the Nightwatch. If you, if you've ever watched games, Game of Thrones they were the Night's Watch. They were that invisible wall that basically saved the people, you know, from the white walkers. If you think about COVID-19 as the white Walker, you know so all our ER docs were in Jeff connect. You know, we were, we were, we went from maybe a hundred thousand patients Jeff and I have patients from 2015 to 2020 to literally a hundred thousand and three. And, but we had, we had the, we had the supply, so it was, it wasn't hard to do.

We didn't have to go to Teladoc and say, oh, you know, can you, can you get doctors? We, we, we were ready for that. So, so now, you know, now, now the problem is the problem is what happens with payment, right? Because when we first did our teller thing, we came up with a model we're 50% of it. Non trauma, non ambulance emergency patients could be taken care of at home or urgent care. We would have gone bankrupt because insurers would pass $1,500. You know, if somebody shows up to our you, or whether they need to be or not, and only like 90, if they do it at home or do you care. So we start with our employees where we're also the. Or 35,000 employees. So now we've, we've partnered with all these payers where we have taken about 35% of our ER, people that would have shot the, are waited four hours, et cetera, and take care of them in a very consumer oriented mobile deposit type way with much better care, much lower costs and, and a much better system.

James: That's incredible. So, you know, you kind of mentioned you know, the, the pandemic and another pandemic in 20 or 30 years, you know, I know we don't, I'm sure everyone's probably tired of talking about the pandemic. But I'm sure in the last 18 months, you know, you guys have learned a lot on that patient, you know, stuff related to the patient experience, but you know, if we're kind of 20, 30 years in the future and there's another pandemic, I mean, what's something that. Those people in the future will kind of look back at, you know, how we handled things this year. You know, and, and we'll, they kind of laugh about, I mean, is it the fact that, you know, the care it's, it's unconnected, it's, it's, you know, the sort of data and the vitals and things are just not as readily prevalent, you know, I'm kind of curious.

Dr. Klasko: No, I think it will be good. I think it will be the same way. You know, I gave you an illusion to the banking. Think about, think about a pandemic 30 years ago, we would have been talking about people, you know, not being able to deposit their checks cause we didn't want them wanting up on Fridays. I mean, that was a reality. I mean, that's that's, that was the reality. I mean, nothing in the financial world. Nothing in the financial world got disrupted. Right? You could deposit your check because you have direct deposit. You could, you know, go to ATM's. Okay. That the pandemic of 2030 will be that you will go to sleep with awareness. You know, we will, you will, you know, know what your temperature rose you'll know if the respiratory rate rose, you know, you'll have literally, you know your theater, your 3d printer and the internet of things, or internet of you will we'll print out. Customized mask for your face and also, you know, home, whichever COVID 87, you know, pandemic. It is. If, if it's somebody, my age is starting to, you know, we, you know, freak out because you remember the pandemic at 2020, I'll have AI bot psychiatrist in holograms that will be able to say, Hey, Steve, calm down. You know, this is not 2020 anymore. Yet your assisted living facility will take really good care of you. You know, and you'll have, you know, supply chain. We'll, we'll not be, you know, literally let's get all of our nationality from one country. It will be very individualized and customized, like, you know, like, you know, like retail is and what drone delivery of food and stuff. So you won't have to afford toilet paper you know or, you know, or, or line up in the grocery store. So, you know, so it'll be, you know, it'll be over in, in, you know, at least from that. And, and, you know, I think you. And we've already started to see this, but if you think about that seems going from eight year to six month timing, as we start to create, we have a Jefferson's to the bioprocessing. We're one of the leaders in that you'll start to see reactive vaccine bioprocessing in 17. You know, or eight days or 10 days now, what you want, what, what I can't guarantee is that you won't change the ridiculously hypocritic and hypocritical and inconsistent politicians. Cause that'll still be humans. Unless we start to get the Android, Android, governors and ministers years of health. We'll probably, that'll probably still be pretty screwed up, but, but, but as far as the, the health piece of it, it'll be a much more seamless experience. Yeah. And then there's probably nothing we can do about the politicians.

James: So, you know, I want to sort of end, you know, you've sort of talked about. You know, companies, Silicon valley and things like that. And, and unscaled, and, and a few things, but, you know, I'm curious, you know, is there someone or, you know, company, I know you're kind of a big apple fan as well, but you know, where do you kind of look for inspiration as it relates to the, the patient experience either inside of healthcare or outside of, I'm kind of curious, you know, where do you go to sort of find better thinking on how you can serve your, serve your patients better?

Dr. Klasko: Yeah, that's a great question. So what, what I try to do is I try to literally go to the folks that I think are creating disruptive experiences. Interestingly big tech is not that you know, I think, you know, big tech has become almost too big. They've got a little bit of money, but you will get, you know, a Google health has improved. And their director just left. When Amazon JP Morgan and Berkshire got together and formed Haven, literally I was giving a talk and everybody said, oh my God, Steve, why are you even coming to work? Because they're going to take over healthcare. And I remember saying something like, well, it's like the Lochness Monster. I'd probably be afraid of it. If I ever saw it, I don't think I would see it in my lifetime. And that imploded, you know, Apple. You know even Amazon had not really conquered health. So I think, I think what I try to do is get inspiration from what what's happened in other industries, I was very involved with Apple in the pre-iPhone era, which is really where the creativity happened. That going from a computer and operating system or math to a new math of a digital revolution, that's what I've tried to take is we call it the old, the math of inpatient revenue, outpatient revenue in person tuition to a new math and healthcare. So I spent a lot of time. I spent like five days a month out in Palo Alto in Boston, just talking to a lot of smart people, you know you know, been meeting with this group that Andreessen Horowitz is is investing in colony QRX, which is disrupting farmer pricing. There's a company called zip line. That's doing drone delivery for food to get rid of food deserts. Then it's just fun to talk to them and then see how they view. They view us and, and they're excited. Somebody wants to talk to them from, and then among the incumbents, I, you know, it's, I like to talk to like, you know, folks that are disruptive payer world, like Oscar and, and, and, you know, and those kinds of things. Yeah. And then, and then frankly, looking at other industries I've spent some time with the Tesla folks, you know, you know, not, not even one, but you know, you know, that whole. You know, people talking about the electric car and the spaceship and stuff, but the, but the interesting thing for me has been the Tesla experience by the car online. You know, have it delivered to your place once a year, it'll tell you when it needs to be serviced, it's got a, you know, key lock. You don't have to leave anybody key. They'll just pick it up with another Tesla and bring yours back. Like, like as opposed to having a, you know, go to the place, have somebody tell you the parts? Yeah. I mean, you know, you know, it's, it's just easy. So we'll do that. If they could disrupt that, those are the kinds of things I like to learn from.

James: Yeah. It's almost like with the Tesla too. It's like even like cutting out the dealerships. Right. I mean, that's their big thing or it's, I mean, car sales are not direct to consumer in a lot of ways outside of Tesla. So when you think about stuff like that, I mean, how do you think about that in relation to, you know, your own health system?

Dr. Klasko: I mean, we need to be DD. We need to be DDC. When, when you think about what's messed up about health care, Well, I mean, think about this, the, just the fact that, you know, you have large employers with hundreds of health benefit people just to get through the maze of dealing with a payer. I mean, so you have payers whose job is to get 20 cents on the dollar to make sure that the people that pay for the care, get the care and provide the care. Can't talk to each other. There was a Harris poll done. We're 62% of people thought the way we run healthcare is purposely done to confuse people, to make it more difficult and to make it more expensive. And they're right, right. Why would you have, I mean, imagine if I couldn't buy something on Amazon without going through me. Right. I mean, that'd be asinine, right? Oh, you, oh, you wanna, you wanna buy, you wanna buy that latest book by Michael Connolly? Okay. W the payer, you have to talk to the middleman and he'll, he'll just to be, by the way, he's gonna get, he's going to get $2 of, of the book. That's why we charged $20 instead of $18. They, they, they got rid of layers, has the got rid of layers we added. So I think what you're starting to see companies like AmazonCare and Transcarent, which is a company we're working with out of general catalyst, going directly to employers and saying, look guys, Comcast, or, you know, whatever. You're not good at this. You've got all these employee benefit people just to try to get through the maze. How would that we will get, you know, if a patient needs spinal surgery, we'll get them a second opinion. We'll get them the most efficient place by, by them subscribing to that. You'll see, there's a zero deductible. Cause we're gonna, we're gonna save you. Millions and millions of millions of dollars because of that 30% of those patients that are told that they need spinal surgery, don't need spinal surgery and get it done a different way. So, I mean, I think you're going to start to see that right. And, and the best way to look at it, James is, is when the affordable care act came out, we said, we're going to give more people access. But we're going to turn it down a quarter of healthcare down with dollar and make it easier. You would have sold all your middleman stocks like payers and all your supply chain stocks. Well, that would have been a big mistake because United healthcare is the best stock you could have bought since the ACA came out. Other than an apple. Now, now, how can something get cheaper and better? If the middle middleman has increased by 11 times, if drugs have increased by 11 times. You know, so, so I think, I think you're going to see that that's going to be the revolution. You're going to start to see.

James: Yeah, well, I like it. I mean, it's probably the best way to look at cut, cutting out the fat and healthcare. I will say jumping back to Amazon, I would actually appreciate a man in the middle. It probably helped prevent me from like the one-click purchases that I make on a whim that I definitely don't need.

Dr. Klasko: Well, that's, that's their consumer segmentation. They, they they've figured out people like you and I. And they probably sent us all, you know, oh, Steve did, you know, there's a new Star Trek animated movie out really, you know? Yeah. So, yeah. And it's just click here. Oh yeah, it doesn't there, there it's it's, it's no different than any other addiction, man. It's like Starbucks. They, they, they, they get that out. So when you're walking by and say, yeah, I could use some coffee. It's terrible.

James: Well, Dr. Klasko. Thank you for joining us today. I really appreciate it. This has been really enlightening and insightful for me. So thank you for making the time to chat with us.

Dr. Klasko: James. It's really my pleasure. And I heard you're a child had her first day in kindergarten, so good luck. I'm hoping by the time that she is a teenager, she's got that, you know health care at any address, one stop shopping. And she looks back at at, at the way we did healthcare in 2021 has got, you know, like what a mess that was.

James: I'll tell ya if it's a, if it's more affordable to send her to JeffConnect as opposed to Partners here in the Boston area then I'd gladly do it. So fingers crossed, but appreciate it.

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