Precision is the future of medicine

Chris:

Michael is the CEO of BASE 10 genetics; a company focused on making genetics testing actionable to improve consumer health outcomes. He's a serial healthcare innovator, both inside and outside of health systems. BASE 10 is his third startup in healthcare. He's directed EHR implementations as a practicing physician, and Michael is active in helping the next generation of physician entrepreneurs both with the society physician entrepreneurs and his alma mater at the northwestern Feinberg School of Medicine. We're here today to hear Michael's learnings and advice stemming from his journey in becoming an entrepreneur, his failures and successes, and his sharings with other digital health entrepreneurs who are just now taking the leap. Michael, welcome to the pod, we got to know each other last year when I reached out to you wanting to learn about the mindset and pathways for physicians that become entrepreneurs. And I found our conversation insightful. And I'm excited to talk around those insights. So starting out, would you mind telling our audience briefly about yourself and anything you're currently working on?

Michael:

Yeah, great thanks Chris, It's a pleasure to be on the cast. Appreciate the opportunity to share a little bit about my personal journey from being a physician to being an entrepreneur, both which quite frankly, could be quite vague for, for folks as to what that means, right, because there's not exactly a certificate when it comes to the title entrepreneur. So my background, I am a internal medicine, geriatric medicine doctor, geriatric medicine is the focus on elderly physiology. It's always been my passion. In fact, I usually tell folks at the age of eight, I knew I wanted to be a doctor, by the age of 12, I knew I wanted to specialize in helping the elderly. So that's exactly what I did. I definitely was not one of those guys, where you know, during college or med school or residency, I thought I would ever own a business, I was so focused on becoming a doctor, that's my passion. So you know, in college, it's not like I had, you know, computer science or other types of majors I was so molecular biology, I didn't take any breaks in between med school and residency, because I didn't need to explore what else I want in life, I knew  what I wanted in life. And it was really only after I started practicing, as most physicians will probably tell you is that you come out to practice on day one, you start to, start, see the brokenness of healthcare. And you start to realize that what they taught you in school, what you trained for years to do, becomes very limited in your ability to change the population at scale. There's only so many of us, there's only so many hours in a day, there's only so many things you can try to squeeze into those hours, and trying to take care of more and more people. While, while giving less and less time is definitely a challenge that every physician will see. And that's why every physician at some point, do say that we want to adopt technology. But at the same time, we're in a very difficult sector, right? Healthcare is not where you can try things and see what happened. Because if things didn't go, well, you're talking about lives, right? So, so on the one hand, healthcare is a space where physicians want innovation, they do try innovation. That's why you see all these new drugs and new devices and even apps right coming to market. But it's also the market with the hardest adoption of those technologies, because people want to be conservative, and they don't want to make mistakes. So it's, it's a very interesting intersection of challenges that I feel physicians specifically, and other clinicians have an opportunity to really make a difference.

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Chris:

Got it and as a physician, you're one of the most highly trained professions that we have in our society and have a lot of skills, the ability to learn a lot in a short period of time or, or you could argue a long period of time. What skills, knowledge or mindset, do you think coming as a physician are transferable to being an entrepreneur?

Michael:

So a lot in fact, I'll even step back and say a lot of doctors, a lot of us, a lot of my colleagues for sure, at some point in time, think about getting other degrees, right? That could include going back and getting a master's in public health, masters and informatics. A lot of physicians definitely think about an MBA right. And one thing I'll say is that, first of all, you know, an MD is still one of the few degrees you can't get online for a reason. It is a very unique set of skills and training experience that just doesn't translate well in an online program so I want physicians to recognize that you have a very unique experience and in quite frankly a lot of other conditions whether you're pharmacists or, or nurse right they they're just,  you'll get those degrees online, you get those by taking care of patients, right, ultimately. So that's a very unique experience that we have to first acknowledge. Now, in order to do that, well, there are definitely a lot of those, what you call transferable skills, right? So we have to have great bedside manners, we have to learn how to get somebody comfortable in sharing information with us what, quite frankly, and if you want to translate that over to say, for example, sales, that's called a discovery phase, right? Like we're trying to diagnose a patient, but there's not a big difference between you diagnosing a patient versus you trying to diagnose the symptoms, and the cause, root cause problems of a business, or a process or an operation. There is no, there's also a lot of skills that physicians have to gather in terms of coordinating the different resources we have, right? So most of us know that sometimes we go over our, where we feel comfortable, we need to get a consult, right, or we need to get more information such as doing a test or doing an x-ray, right? Again,  to get more information. That similar mentality can be translated to business where we can say, Okay, I think I crossed it, I'm about to cross the threshold of what I know, between medicine and what's business medicine, and it's time to get a console, right, it's time to get, I don't have an MBA, let's get somebody with that MBA trainee. They get someone with that law degree. Let's get someone with that pen, patent law firm to come in and, and canceled for me right that's, that's a skill set that we sometimes forget to translate over when we go from being a clinician to being a business owner, but it's there. If you finish med school, you finish residency, if you started practicing after residency, those soft skills are 100% ingrained in you. But it does take some, some deep, cautious, intentional soul searching to say do I have that skill set? And how exactly do I apply it in a different place like entrepreneurship or business?

Chris:

Yes, and I think you know, as someone who's been through the startup rodeo many times, one of the biggest pedagogies within startup development is lean startup. It's also one of the most prevalent methodologies in health system transformation. And it is basically founded on the scientific process that you mentioned, which is, if I have a hypothesis, I need to create an experiment, test it out, make sure I'm measuring the impact and then see if it works, and learn from that. And what I'm hearing too, is that you're used to filling your own knowledge gaps or expertise gaps by consulting with someone outside of let's say, just your brain. When, when you need that to fill in your gaps. And that is an incredible advantage that a lot of first time entrepreneurs don't have. How about any of the biases or skills that you had to unlearn? Coming from a physician and making your world into entrepreneurship?

Michael:

Yeah, we definitely pick up a lot of bad habits, right, when you are that vertically trained in a, in a particular field of, of knowledge for years, you definitely pick up some bad habits. And my, my advice to fellow physicians is that much similar to the previous question, where we talked about what are skill sets that are transferable, you also have to realize what are skill sets that are not transferable? Right. So our, our expertise in knowing medicine very, very well doesn't necessarily translate to how that medicine, product, and when I say medicine, I don't necessarily mean drugs. But you know, even if it's a problem, right, so I really understand how to take care of the senior citizens when it comes to dementia. That doesn't necessarily mean that I know how to design an app perfectly well to be utilized by somebody with dementia. I certainly do not know what is the pricing model, when you want to go sell this app to a hospital, versus a doctor's clinic, versus a nursing home versus the insurance company? Right? So we have to be very good at recognizing when we have certain knowledge and skill sets that don't transfer and go back to saying and build a team right just like in that ,  just like in our medicine practice we alone cannot memorize every single medication, drug interaction and everything. That's why we have pharmacists on our team. We alone cannot be gathering information and taking care of the patient in terms of figuring out their, their plan of treatment, while staying at the bedside helping them with, you know, turning over and feeding them right. That's why we have our nurse colleagues who are doing a lot of that heavy lifting for us, right so you always need a team. And I think a lot of physician entrepreneurs when they first start, we go through this phase as of where we need something to hold on to, right, we need some, some some, some sense of self worth and esteem. So we take our knowledge and medicine and we unintentionally and usually unconsciously end up thinking that because I know that very well, I therefore know everything around the business of making this product go to market. And I can tell you that very, very rarely does that actually come true. Most of us, including myself, and others who have become better over the years of being an entrepreneur, is that we have to learn that if we are so, so  sure about one thing, that's usually when you're wrong, right? Just like in medicine, like when you're so sure its  cancer turns out to not be it, right? Oh, you're when you're so sure it's cancer, it's infection, it turns out to be something else. So you never want to be so sure of your, your, your ideas in one day that you're, that you will never be open to potential other feedback. And I think that's something that a lot of physicians do, unfortunately, I will say nine out of 10 of us will make that mistake at least four or five times as we are transferring from being a physician to an entrepreneurial, entrepreneurial role, or perhaps as an Executive leader within a company.

Chris:

Right, unless your doctor house which case the answer isnt always will be

Michael:

And that show basically is the epitome of when, of saying how doctors get you know, you can try to be him, but that rarely ever works out. He's not one out of 10.

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Chris:

Yes, and so yes, there's the difference between understanding your user, let's say the patient that you've been serving day in day out, and understanding how to solve their problems with technology. And there is a difference between understanding the business of healthcare and being able to build a business around a healthcare application. And you built a team that helps flesh out those gaps that you may have. How do you go about building a team, as you're starting a company? What are some of the things you look for? Are some of the channels that you look to?

Michael:

And that's a great question because it really does come down to that, it is about teams. In fact, I will even tell you that when you're pitching to investors, right? Don't get me wrong, they will dig into your numbers. But, at the end of the day, the best products and the best business plans have been destroyed by bad teams. So, at the end of the day, investors, clients look at your team to see if you're able to deliver and by the way, that's very similar to medicine, right? It's not just Yes, I like that doctor. But do I also like this hospital? Do I think this hospital can provide me with the care? Right? So it is a team approach? So let's go back to the basics. So how do you put together a team? Well, first and foremost, you, you certainly have to find members of the team that are brought into your vision, or at least you share a vision, right? So again, it's not my vision, and you guys will have to agree to it. It's more like, here's our vision, we all have to agree to that. What is and you have to be very, you have to be able to articulate that very, very well. Right? Are we here to change x for who? Right? That's, that's the very first thing is making sure that anybody you are meeting that you're thinking about assembling to you, to your team, have the same amount of passion and conviction around that that's the problem that we want to solve. Okay, that's number one. The next thing to do, is to definitely look for members of the team, like I said, you want to build a multi specialty, I'll use that word, multi specialty team, right, you don't want to just find other people who are exactly the same as you, because then that would be the same as if we, if I want to get a consult, I usually want to get it from someone who's even, who's trained differently, or has spent a significant amount of time learning something else, right? I don't want to ask, Hey, is this a heart attack to another internal medicine doctor? Right? Because the two of us are trained relatively the same, right? Versus if I want to say, is this a heart attack? I probably want to consult a cardiologist, right? So it's the same thing. So you want to build a team where it's not just all people who only will say yes to the exact same things you're saying. So while you're sharing the same vision, you don't want the same answers, per se, right? So you don't want to say the way we are solving problem A is always with solution B, you want to agree on problem A being the thing you guys are passionate about solving. But then the solution part, you actually, this is where you want the team to have different perspectives. You want them to approach it from a software perspective, you want to approach it from a pricing and go to market type of perspective. You want to approach it from a legal perspective, right? You are the guy as the clinician who will always approach it from the medical and hopefully the patient perspective and your colleagues perspective. But you need people on the team who're gonna say that's great. Except insurance companies don't care about that. So if you want to sell it to insurance companies, we're gonna have to build it like this. That's great, Michael, But you know, what if that if you're hoping to put this on the shelves of pharmacies for people, people to pick up, then you can't package it that way. Or you can offer these particular things because one, FDA won't allow you or two, it's just not within a model that consumers can easily consume, Right? So, so you do need diversity on your team that will offer you different, different perspectives of how to get to a solution.

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Chris:

Right, and I think that makes sense, and that's why venture capital and other investors look at the team, above and beyond any other factor, when they're trying to evaluate which companies to invest in. Because as they say, the best-laid plans of mice and men go to waste. Or, as Mike Tyson said more eloquently, everyone is willing to get punched in the face. And it's the quality of the team that is going to adapt. Now speaking of being punched in the face, per se, you're a serial entrepreneur, and you have probably many learnings in route or times that things didn't go as planned and you had to adapt. Could you share with the audience? Just a few lessons you've learned from failures or challenges that maybe made you stronger in the current startup? 

Michael:

Yeah, some of this, some of the things we, we touched on a little bit, definitely my earlier failures were due to poor teams. And I'm not saying it's because the people that are recruited so that maybe I wasn't even evolved enough as a leader to leverage that team. So that's something to be aware of, if you could put together a great team. And if you're the leader, and yet you have poor organization skill, too much ego, right, too much, again, too much conviction, conviction is good. I mean, but too much conviction, where you're unwilling to bend can mean that you can have a great team, but they're just, you know, they're they're marching to your drum not to drum up the team. Right. So, so a couple of my earlier failures, I would say, was due to having a great team, but perhaps not leveraging them very, very effectively. Okay, and on that part, there's, there's only a few things you can do. I, again, we're talking about degrees, I don't think they necessarily teach you that by getting a degree, I've seen plenty of people with degrees, I get MBAs that are poor leaders, that are poor organization that have poor inspiration, right? So you know, you, a degree doesn't necessarily give you that, per se. So it's something that you have to you have to do. But this part, I guess we can also say that physicians are also very good at we're good at finding mentors, right. So this is where I went out and found other physician leaders who emulated what I thought I want to become right. So they were very eloquent, they were very empathetic. Yet they were also very direct, right when they want something. So looking for models that you can emulate is very, very important. Early on in your transition to an entrepreneur, the sooner you do it, the better. Because you don't want to make those mistakes. The second thing that I would say, Were punches in the face is fundraising. Very, very unfamiliar to physicians, right. So we don't tend to do that part. Now you could absolute and then you should absolutely have members on your team who are good at fundraising. But remember, if you are the founder, slash co founders slash CEO of the company, at the end of the day, the investors will look to the CEO or the founders as their conviction as with whether they want to invest or not. So you do have to learn how to pitch right, you do have to learn how to talk about your vision. And on this part part, probably the most specific recommendation I can give you is don't be a doctor. When you're doing that, don't me I know you know, your drug and your device or your app inside out. Do not over explain it. That is the same thing as when you go to a patient's bedside, and they say should I take this treatment and you explain the science or the molecular level of the drug, patients aren't going to get it right. Same thing. You want to you want to get very good at explaining what your product can do. For industry, like you have a solar panel. Most of us don't know what solar panels exactly how they work. But we do know that if you install them correctly, they help the environment, they help you with your bills. Right, you don't need to know the intricacies of that, same thing. So when we are when we're the leaders of the team and you are pitching for, for capital, you have to be, you have to go through many many so I can tell you that I at any given year I probably pitch almost 150 to 250 times, to different people you have to practice, it's just like medicine, you don't get good suturing by doing by watching a YouTube and you do one suture, and suddenly you're an awesome, you know, wound fixer, right, you have to do it over and over and over again. So, so be ready to have, maybe not punch the face, but be ready to have a lot of slaps when you're out there doing your pitches, but it's a necessary part of your job as the leader of the company to help to help get the resources your team needs to grow.

Chris:

Got it. And whether we're talking about role models, or mentors, or CO founding team members, how do you go about looking for those people?

Michael:

I love your questions, Chris. So at the risk of being being hated on by very inspirational colleagues, right? Here's what I would say early on, in your entrepreneurial life, you can get inspirations from the physicians who are on stage, but guys, those are the shiny, shiny stars. I mean, they've gotten to a point where they're just giving TED talks, right? Like, that's great. But remember it before they got there, they did a lot of work of actually accomplishing things before they get there, those are not the guys to emulate, right? Because then you might be able to emulate their, their communication skills. But, but aside from that, it's very hard to emulate those folks. Right? So. So the folks you should look for are probably folks that are in your industry, right or in your sector. I'll explain that in a little bit more what that means. That are probably just a couple steps ahead of you. Right? So for example, if you are a researcher in academia, and you're researching the next compound, or, or something to become the next drug, right, what you want to do is you want to network with physicians who are probably two levels above that are they have already created one, they've commercialized it maybe they've been, they're now acquired and working for Pfizer, right? Those are the guys that can really help you understand what are your next two, three years going to look like as you're going from a clinical researcher or a site, a medical researcher to taking your product to, quote unquote, in a market or an exit, right? If you are thinking about building a software app to do XYZ, there are physicians, there are CMOS that are, there are other companies that are maybe not the same map you're doing but are doing some sort of app, right, so, so you can talk to them to see how you can get up there. The other thing too, you can look at is go outside of physicians don't always think that MD is only one. So later on, I learned that actually, it's very helpful to network with, quite frankly, anybody who's doing something that you're thinking about, but don't come from empty backgrounds. So if you're really interested on how do I productize an app? Well, there's a whole industry of product managers and, and and app developers that you can talk to and say and they can tell you like this is how we got to our success, right? So definitely think you definitely have there's definitely models out there. You don't have to look for the shiniest star on stage, because then chances are those guys are, first of all, they're probably too busy. And even if they like you, they can probably only give you a little bit of time, right? But you can usually look on social media, like LinkedIn is a great place to look right, you can literally be very specific about who you're looking for, and what software are on what kind of industry what sector, and you'll get a whole list of them. Right? It just takes some time to go through that. And perhaps the last feedback, I will say is just off of what I just said is you got to learn to network. I can only speak for myself that when I, when I first graduate out of residency, right? We spent so much time training, we only go to medical conferences. And when we go there we only present research papers, right? So when I became an entrepreneur, I went to health tech conferences and VC conferences. And I really felt like I was in, like in middle school game where you had this party and you didn't know who to talk to, and nobody's looking at you. Because they all have their own cliques, right. So you have to learn how to network and you can't remember you, if you, if you became a doctor, you have to have some sort of great bedside manners, right? Patients have to not have been scared by you nurses have to like to work with u, ICU got some people skills, right. So be confident in that. You just got to learn to apply that in a, in a non medical setting. So one of the exercises I recommend a lot of anybody, entrepreneurs, physician or otherwise to do, is make it a point on LinkedIn twice a week or thrice a week to connect with somebody who you don't know and sincerely get to know them. Don't go into it with an agenda that you want to have business or pilot or get advisor is nothing. Just go in there and be sincerely interested in what that person do and learn about what they do. And if you do that twice a week and that's something I started 10 years ago, I still do that today. And if you keep doing that, you're going to realize your skill, your ability to understand someone's background, make those connections to maybe your own business, but maybe someone else's business is going to start to happen. And that network as it grows, is going to become extremely valuable to you. When it comes to wanting to assemble your team or, or wanting to find models that you can emulate, and, and so forth. So learn to learn to network, guys. It's fun, and it's, it's really absolutely going to go in to help you.

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Chris:

Thank you, Michael. And, yeah, I'd like to shift gears a little bit towards your journey to success with base 10. But as we do that, I think it'd be helpful for our audience and for me, to define a few of the things that you work on. So starting with, what is precision nutrition? So why is that important?

Michael:

I'll tell you like, even right now, when my current company based in one of the learning that we're learning is how do we message ourselves? Because it's very, it's very clear that on our, on our, on our public facing website, sometimes people think we're genetics company, we are, we do we do genetics? Some people think we're a software company we do, we do do software. So I always say personally, right now, one of the things I'm learning as an entrepreneur or entrepreneur is marketing messaging, right? Like nothing to do with medicine, but just how do you talk about yourself? Who are you, right, as a, as a, as a company to the outside world. So precision nutrition is actually just a small piece of what base 10 is focused on base 10, on our broader vision, want to solve the problem of where there are great precision technologies, but they don't become standard of care? Right? So genetics is an example of one. Genetics was I think the human genome project was done in 2007. Right, we mapped the human genome in 2007. That was before the first iPhone. And yet most of us do not have genetic testing as a routine part of our healthcare. Right. We may be screen babies for some things, we may be screen adults, for some things, definitely use it for cancer when we're trying to figure out your chemo. But, but, genetics as a technology is extremely cheap and extremely powerful. And yet, somehow after this many years, we're touchscreen phones are everywhere. We don't have genetics everywhere, right? So base 10 was founded to try to figure out how can we help bring technologies that are like genetics,but  could but it could be a drug, it could be a device, it could be anything to, to the common market faster. Okay. So, along those lines, we do believe that there is a lot of correlation between nutrition and genetics that have been well researched, and yet, underutilized, right? We only use it for kids with genetic metabolic disease, right? This kid was born with literally some sort of deficiency where they can't process meat protein, and they would die if you gave them that, right. When would you use an extreme example, but there's a whole range of folks, especially as we get into aging, right, where figuring out your genetics and correlating that to your nutrition is super helpful, but we don't, we don't do it, right. Same thing with medication genetics, so we are what we call pharmacogenomics. In fact, nowadays, the data is getting better and better where genetics as in terms of determining whether you're going to respond to certain psych medications are extremely powerful. But we don't do it. And we don't do it on everyone. We don't do it on people with the diagnosis of a mental health condition that need that medication, right. So it's one of those things where that's what base 10 is built to, to figure out how we can commercialize how can we use software as the foundation of creating a platform on which all these technologies can be plug and play, whether it's genetics, whether it's wearable, whether whether there's a new vaccine, right? How can we plug these things in into the continuum of a patient's care so that these technologies instead of staying on a shelf somewhere that the doctor doesn't even know about? Or an insurance company they know that they could, they can pay for to make the patients even better? Right? How do we use software to create that foundation so that these things can come to life sooner into the market?

Chris:

Right And can you give an example of how it works? So how you've plugged in some of these new Precision nutrition or medication into the continuum of care and from a user's perspective, or from the industry's perspective, so

Michael:

based on naturally so we've already entered the era in medicine where human beings cannot be relied on as the most updated and most reliable source of knowledge. Okay, I know a lot of physicians may disagree with me on that because some of us is our ego, right? We're the top of our class we memorize more than everybody else. And that's why we're doctors. Okay, got it. However, right? We're talking about an age where, look how quickly in COVID we came up with vaccines. Look how quickly the scientific knowledge of understanding this virus progress every single week. And if I asked today, today being you know, August 1 of 2022, how many of you physicians on the phone know everything you need to know about monkeypox? I bet you a lot of you will be ensure that you are the most up to date, you're like, Oh, I'm gonna consult an infectious disease doctor good answer. Because chances are, we aren't staying up to date, as much as we hope anymore. Again, human beings, limited hours limited brain cells can memorize everything right? So it is a time in healthcare where software has to help take over that. Right. So instead of having the the human human person, again, whether that's a nurse or pharmacist or doctors, I talked about doctors, but it's really all of us right in the clinical world. You can count on us to remember everything because we probably didn't read about it because we were too tired yesterday, taking care of patients to read. We may not have remember when we're that tired that oh, the next treatment plan is this right? So is that's what base 10 is trying to do. We're trying to create a a standard safety net in terms of medical knowledge, let the software stay up to date with what is supposed to be done next. But let the clinician let the human beings decide whether the information presented is enough for them to make a decision going forward. And that's the basis of base 10. We call ourselves a decision support platform. We bring in updated knowledge and algorithms. So and then those algorithms monitor the data to say when do we think there is a case of monkey pox, for example, even if you as a physician ever seen one before? Because I can tell you right now, I haven't seen one, since I've graduated years ago. Right. So I haven't seen what I'm seeing now. But like that's something I'm the expert in monkeypox. But if the software can say these are all the signs and symptoms, that could be monkeypox, capture that and flags a case and the physician and get to say, well then based on these information that does look like it. And in fact, I don't even know what the next test diagnosis would like what we test what I do to confirm monkeypox, and the software actually suggested for you. That's great, right? Because then that that allows you as a clinician to say I'm processing the data to make a decision as to what we need to do versus spending the time grabbing the data. And trying to identify a case, which like I said, is just unscalable given the limited number of clinicians we have these days.

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Chris:

And we talk a lot about the business models of healthcare on this podcast, whether that's fee for service or value based care or direct to consumer, can you just walk us through maybe one or of Base 10’s use cases and who you offer your services to, who the users are , is the patient involved and

Michael:

So there's a lot of go to market strategy guys and believe me, thats a, there's a lot of startups that I would say, you know, you pick the wrong go to market strategy, or you pick the wrong sector to go into, you could definitely, you could definitely have a great product and still fail. Okay, so something that I would say, just as if you were taking notes, go to market strategy, super important. Make sure you have a good team that helps you figure that out. Okay, so in terms of what we designed, as, as clinical decision support software, if you will, you could in theory, apply that in many, many different settings. But what we decided to do was focus on the nursing home or the long term care sector. One because I'm a geriatrician, that's my area of passion, right. But the other part is because we do see that the care of our elderly in this country, despite us being a very technologically driven society, we don't see those technologies necessarily being incorporated into the care of the elderly population, which is why you will see the bad outcomes that we all heard about around the news, right regarding when COVID happens in the nursing home, how many people die there, right or when there's an outbreak how, how it took it took a long time before we know it happened, right? Those are all examples of where there's not a strong presence of technology to help deal with the lack of staffing, the lack of human beings that could keep that process up. Right, so, so for base 10, what we have done in the last three years was to focus our technology platform and helping the nursing home sector. And it's the same thing we just talked about where we're able to grab data from the patient's chart. So the nurses are going about doing their work, they're charting if the patient's feeling well, not feeling well, what did they do, they're doing the regular work. But that information is coming into our software, and the software is processing and saying, what do we think is happening with every single one of those patients each day, right, and the ones that look like they're about to have problems with a certain whatever, right? infection, or, or heart failure event, whatever the case may be, it's flagged to the provider, along with all the information to say, here's what you can do next. So they don't even have to spend too much time thinking like, Okay, do I get a test? Or do I get a medication going ? Or do I get an echo, it's recommended in there if you agree to it, or you just click and it goes, right, so so it's really shortening the amount of time it takes for us to react to when someone's not doing well, in a nursing home or in a nursing home setting. So that's been our focus for the last two years, because of the pandemic. And we've done well, where now we're expanding to even more nursing home facilities throughout the country, we're probably going to triple the number of nursing home facilities on our platform this year. So it's very exciting times for us. And but it's just, we're just happy to see our vision come true, right, we want to help the elderly population, we want to lower the, the death rate that happens right in that population. And we're, we're, we're happy to see that what we're doing is contributing to that along with our nursing home partners and clients.

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Chris:

Yes, and usability is often something that comes up in terms of these experiences that have a clinical side, and then have some side on let's say, a patient or a caregiver. So on the patient side, and especially in the elderly population, there's almost no technology, affinity, caregivers or nurses may not be used to a new technology or a new set of data that's come to market and they need somebody to actually humanize it for it to be actionable for them. And then on the physician side, there is this concept of alert fatigue, and people just not having the time to analyze the dashboard themselves. I'm just wondering how much you had to triage those types of user experiences?

Michael:

Yeah, all the time. That's probably one of the hardest thing, if you want to be an entrepreneur in the healthcare arena. Is that you, that the usability, user support, usability or user support user experiences is extremely crucial to the adoption of your, of your technology. And again, that could be a drug too right. Imagine if the inhaler was much harder than if it is to use right now. It's still hard, right? Like we sometimes don't worry if kids don't do it. Right, right. But if so you have to think about if you don't do it, well, then that inhaler doesn't work and you're storing meds in the air, right? So happens, same thing was with software as well. So this is where it's very important early on to make sure that you do have members of your team who have that very specific user experience. That's early on, right? Because early on as a startup, you may not have the money to go through a focus group. I didn't, right. So, but the great thing is that I worked in nursing homes, I have colleagues that work in nursing homes, I have lots of nurses who are in, right. So you have to spend that time to make sure as you're building your product, to show it to as many people that you think are going to be using the product. It's a fine dance, because I know a lot of technology companies and say, Well, you could get too much feedback, then your products score kind of gets a little bit muddied. You're right, it's, but remember, I remember there's a whole pool of talent called product managers, and user experience, you know, development. I mean, that's, that's why you need those people on your team, right? But if you can, if you can get those people on your team, there are vendors, there are their firms, there are design firms out there, there are research firms out there, right, I can help you with this. So, very important to have that. But to get, the only way I can say is no matter how much time you spend designing a product. It's never going to be I'll just say it, it's never going to be adopted. Well, in your first 10, maybe even 100 clients, you're gonna give very, very blunt and very negative feedback. It doesn't matter if you've spent two years designing guys, you come out and they're nurses and doctors gonna immediately hate it. Right? That's okay. What's important is to make sure that you have very responsive teams and the attitude to say, okay, yes, that's bad. Okay. How can we change it within a day, right? So make sure that you're building your Are you thinking be ready, you need to build it with the intent that is going to fail. And that's funny, because that's also medicine, right? Like we doctors don't go and say, All right, I'm gonna give IV fluids, and you think that's going to work every single time? No, we don't know that. So that's why when we give something right to a patient, we have a plan, ABC, and then we have a def, and then we probably have it all the way up to j, right, because we were expecting certain things to not work. And that's a great mentality to have, when you're building products for healthcare, you have to, you have to go into it with the, with the hypothesis that it's going to fail. And if you do, if you go into it with that mentality, you actually spend the time to plan for that failure, right as a as a company is to say, alright, what software doesn't work, or the users hate it, and they stop using it within a day, then we're gonna go with them, we're ready to go through x, or at least you have resources built in, say, we don't know, we don't even know what they're gonna ask us to change, maybe it's just the button. But maybe it's like a whole entire screen of functionality. But you're building it because if you're expecting it to fail, you will be building in the extra resources and time right to, to respond to that. So that's something that I would say usability is key, it will absolutely fail you the first several times, so just be ready for it by having the extra resources and bandwidth rather than hope for the best and then all of a sudden, now you're kind of stuck, right trying to react to something that you didn't have resources for.

Chris:

Yes, and at Persimmon, we often look at startups in terms of three stages. So first is showing proof that a idea has value to some target market, the second is becoming valuable by actually implementing in practice and establishing that eight, it does provide value to that market. And then the third is once you know that achieving scale. I'm curious about that first stage of showing proof of when and how did Base 10 start to feel different than let's say some of your previous startups? How you know you if your were

Michael:

So the concept I want to introduce here is push versus pull. Okay? If you had to push and push and push, now, don't get me wrong, startup  you're always gonna have to push a little bit. Okay, so the product is never going to sell itself. That's not true. It's always you pushing it through to some degree. But how much push? Right? If it's a 100% always you  pushing to get something into the hands of someone, it's always you having to push 100% of time before they use it, then there's probably not a great product or solution problem fit there, Right? It's not to say your solution is bad. It's not working. Right? Just like, quite frankly, I mean, we tried to push patients to take medications, they don't do it, right. Like the compliance is horrible. So the medication is great. But there's something still missing even right now in terms of how medications are given, right? We're still on pills and shots and right ,and vapers. If there's a different delivery mechanism, you could probably make that more compliant. Right. So those are things that to think about. When we as Base 10, when we knew we had a great, well, I'll give you a very, so our technology platform, like I said, you can design whatever disease program you want, you can do a nutrition program, you can do a medication program, you can do a diabetes program. When we came to market, it was around diabetes, right? Because we said, hey, that's ,everybody has a lot of people have diabetes, we can be relevant to the market right away. Within four months of us going to market with our diabetes example, as a program on our technology platform, COVID hits, nobody cared about diabetes, right? Now, if you have a great product, you should be able to address the needs of the market. So we were still dealing with nursing home, they just said, Hey, we don't really want to focus on diabetes, right now we need to focus on this infection called COVID. So we designed an infection control program within four weeks on our platform. And that's when you know, we talked about push versus pull. We didn't have to push very hard. I mean, nursing homes were just basically asking for anything that can help them get control of what's going on. Get visibility to the, to the population get the testing recorded ,reported correctly. Right. So that's when we knew we had a great, great product market fit. And then we were able to take the lessons from that and say, Well, let's not get over focus here. COVID is just another virus. There are hundreds of other viruses and bacterias that affect nursing homes. Can we take the same lessons here and apply it very quickly to those area? Tested it out with just a small subset of facilities? Yes, it does. So we have a product that isn't just COVID it can be for all infections. Let's go ahead and move it out that way. So that's how you can,you can very much use your client to help you see if your product is solving their problems. Because quite frankly, guys, if it isn't, they're gonna say hey, great, but we're not going to use this going forward. At the ultimate, you know, answer to whether you are having a product market fit. They won't come back,That's the biggest answer that

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Chris:

Yeah  your users will tell you and they won't come back. Okay, and fast forwarding to today, where you're looking to land three times as many facilities this year as you had last year, you have product market fit, you've proved that you have a viable business. And now you want to scale your business. How has your role or the company evolved? Yeah, now, as opposed to find, I

Michael:

Yeah, definitely I will say, think a lot of physicians, if you, there's always new challenges, if you're successful, you're just gonna meet new challenges, right? So early on in the company, as the physician founder, a lot of the ideas of how a software should be built to manage disease and incorporate new technologies that came from my brain, right. But as the company grew, the needs of the business change. And if you as the physician or clinician wants to remain the CEO, or you want to remain in a certain position title, you have to deliver your duties to that. So as the company grows at Base 10, what it is right now, the CEO’s job, despite me having an M.D isn't to come up with the latest product or disease, per se, I still do every once in a while with the VP of product and VP of engineering. But my job as the CEO is to find resources to enable my team to keep making their work and their creativity happen. That means people, It means money, it means pilots, it means clients. Right? So is that what I went to med school for? No, is that 100%? What I'm, what I'm passionate about? No, I have to admit, I'm passionate about the product that we can design to help patients. But if I want to remain as the CEO of base 10, then my job and my mentality has to shift to saying I need to, I need to serve the company in a different way. And quite frankly, if I can't serve the company that way, I don't want to, then then I need to step down, Right? And that's, that's a real question for, for physician entrepreneurs, if you if you're successful, you just, you get a different problem. Do you want to stay as a physician as the CEO, because in that role, you can't keep going back in the lab every day and seeing what's going on with the development, you can't be going to all the software development meetings and figure out how to like that's, that's not your job anymore. Your job is to raise money, buddy, your job is to be out there letting people know about the company, your job is to get investors to be confident in where you guys are going. And if you don't like that job, then you need to step down as the CEO, and you need to be prepared to do that. Because otherwise you will get in the way of your, of your own company's success. And like I said, that is something that I would say at this point in time I started transition to, I don't hate it, I think it's for me, it's an exciting time to learn a different set of skills. But I do miss my days of having to be able to meet for hours with the product team and a development team and really get into the algorithm and, and figure out like why did this code break? Or why did that button not work. But what they need me to do now as the, as the leader of the company, is to not that, but help ensure their, their resources in terms of talent and finance so that they can keep building what they're building.

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Chris:

Right, yeah and I will echo that experience and having trouble letting go of something that I thought, Oh, well, I still know the most about that in the company, or I still may be the best at that. And I think the answer comes back to what you emphasize, which is team, right? Build a great team and hire people that you authentically believe are better than you in some way. And that will allow you to actually let it go. And be fully confident that okay, now I need to be this master coordinator and enabler of others. And it helps if you believe that that great. So we've talked about the past and present.

Michael:

Yeah, Oh, boy, that's a future you never want to get in my mind about that. It's also the job of the of you as the founder or to to, to think about two years from now. Right? I love what Jeff Bezos sets right like your, your team is executing today what you planned on two years ago, you should be planning what's going to happen two years from now. So sometimes I have to be very careful what comes out of my mouth because it's gonna scare my team into thinking we're gonna do what now? But I always say like, hey, look,  the healthcare is one where you always have to keep adapting. Fujifilm can become a biotech company. Right? Then I'm telling you, like, do you have to be ready to evolve? Future Base 10 I think right now we're still on a great path towards becoming that foundation, right? We want to be the foundation that helps new technologies become a standard of care medicine. So the more disease programs we build on our technology platform, the more different type of technologies genetics, or whatever omics or whatever app or whatever device or treatment comes out, can be plugged into that process, right? So we really want to see that happen for the next couple of years. But as it turns out, you know, as your, as you continue to get better and better at that, you also start to understand the business models right around, well, what could keep your software from getting the data it needs to function, right? And sometimes that means you have additional partnerships, sometimes it means you start to vertically integrate. So the future of Base 10, may also be, in fact, we did last year when we bought our own lab, we're a software company, why do you have your own lab? Well, because we saw an opportunity to improve the flow of the data between labs and our software. And quite frankly, we had a hard time working with other labs and getting their data. And so we said, you know, what, why don't we have our own lab, because by having our own lab, we actually will now get to understand what laboratory information software's look like, which we don't have access to, will actually get into, get our hands dirty, and saying, Okay, if a sample needs to go from this location to the lab and the results back, seamlessly, what are all the data point gates that we have to connect together to make that happen, and we couldn't that by by, by, by working with large vendors not to say they weren't great, some of them worked really hard with us. But at the end of the day, it's still required for us to get our hands dirty being in lab. So we ended up buying a lab, and we're integrating that as part of our business. But the goal wasn't to build a lab, the goal was to, to understand how the data flows between us and I think we're gonna see more of that opportunity for Base 10 coming up.

Chris:

Got it, well, congratulations, Michael on base 10. And I just have two final questions. One is, for those budding physician, innovators, entrepreneurs that have an idea and want to follow in Michael's footsteps, what would you advise is a first step that they can take or a community that they can reach out to?

Michael:

More, even remotely active on LinkedIn, please do. It is, you know, as,as much as LinkedIn has become a little bit, you know, Facebook ish over the last couple of years, it is still a very good professional network, and it is where I would recommend you go to to start. The other thing I would encourage you to do. Yes, so as you mentioned earlier, I am a part of the society of physician entrepreneurs. There, sometimes there's a chapter in it, there's usually a chapter in every state, but sometimes they kind of rise and fall depending on whether the leadership is still around or not. But it's a good place to start if you're looking to connect with like minded physician entrepreneurs who are probably experiencing the same challenges you are to grow. But probably more important than that, I would say is, again, think about, remember, there's a conference for everything these days, right? If you're going to do health care software, there's a health IT conference that you should be going to. If you're thinking about you know, doing a device, there are medical device conferences, you go, you're going to, remember these are not conferences you tend to have gone to in the past purely as a doctor, right? If I was a purely as Doctor, I went to American Geriatric Society Conference, great conference for geriatricians. Probably not the best conference if I'm trying to figure out app development, right. But there is one in October that is literally everything about SAS, everything SAS, now if you want to go there to find developers and investors, absolutely. Is it healthcare, focus? No, right. But that's you have to start looking outside of your comfort zone of medicine for these other networking opportunities. Right,

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Chris:

Right, okay, yeah, you've shared a treasure trove of advice, Michael, and really appreciate that I'm sure it's going to be valuable to all those budding physician entrepreneurs that are listening and myself. I've learned a ton in our conversation. Now, I want to ask one final question that's more about the industry. So the crystal ball question. We hear a lot that US healthcare is sick care, rife with misaligned incentives and all the other ways people say that our health system is broken today. I'm wondering what is your take on that and what would you say your ideal

Michael:

That is a big future state final question. You could have a whole separate, no all good man. You could have a whole separate panel and talk just about that. So acknowledging, first of all, that what I know today is probably still very limited in terms of how the entire US healthcare system works. There, I would definitely say that there is, it is true that there is a massive misalignment within regular regulatory payment models and the working clinicians. Okay, so it is there's definitely a misalignment of incentives. So, for example, in order to help encourage the adoption of new testing technology, like genetics, right, CMS will usually reimburse initially very well for those tests. Why? Because they want encourage labs to put to buy the machines and to offer those tests as a possibility at their labs. However, at the same time, CMS says, for nursing homes , we are giving you a limited amount of money for the first 100 days of a patient's care, right? So you only have this much money for the first 100 days, well, then a nursing home says, Well, with this limited amount of money, I'm not going to go pay 400 bucks for a genetics test, right? Because then that hurts my business. I'm not saying that's bad for nursing homes, they want to do something but maybe they can afford $40, maybe they can afford 100 bucks. Maybe they can afford 200,but 400, right, because that's what the labs billing is not something I can pay for. Right, but the lab was told to bill at 400 because that's what CMS says is what we're reimbursing you in fact, you can't go too far below it, because then you might hit some sort of red flag as of why are you offering the test cheaper than what is right. So that's an example of where we really need more help, there's, that you can't fix right like without we can't fix as doctors, we can't fix that as software developers entrepreneur that is, where the best we can do is try to point those discrepancies out to the payers, to the to the politician to say, hey, we know you had good intention here and that method may have helped with the adoption of the technology at the lab, but it didn't help the adoption of the technology on the physician or nursing home side, because you're missing some piece. Now, we can point out to you, I wouldn't say I'm brilliant enough to figure out exactly how to fix it for you. But that, examples like that exist in healthcare everywhere. And that is one of the reasons why you can have great technologies; you can have great intent, like physicians and payers and regulators all want to make this happen. But we're missing, we're still a little siloed and how these things are happening. So I would say one of the biggest challenges in the US is our payment model. We don't, I know we know there are people who on the call probably feel differently about single-payer, single payer systems. It has its pros and cons. But one of the cons of our system was not being a single payer is that, there is a lot of conflicting payment models that really inhibit the ability for physicians and patients to access new innovation. And that is something that I hope based on will be able to help contribute in some way to fixing , I don't think we're the solution. I think it'll take a lot more than just us to have the ultimate solution. But that is definitely one of the biggest challenges of the US healthcare system.

Chris:

Right, thank you, Michael. I want to thank you for your time, really proud to know you and appreciative of the knowledge that you've dropped on me and the audience. And I know as you're working on fixing the American healthcare system, I'm a big believer that Base 10 is going to be one of those companies that has the innovations ready to really improve the quality of care and clinical decision support. Thanks for your time , appreciate you .

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