The different roles of physicians in driving American Healthcare innovation

Chris:

Tariq Chaudry, Tariq is a physician entrepreneur and a serial healthcare innovator both inside and outside of health systems. He's a pediatrician, turned intrapreneur and leader within Kaiser Permanente Quality Officer, startup entrepreneur and advisor, and also exploring the world of institutional investments with angels and VCs. That's a long way of saying he's seen, evaluated and done digital health innovation from just about every angle. He has a lot to share about his journey, learnings and advice for digital health entrepreneurs to read Welcome to the pod. We got to know each other last year, when I was curious about physician entrepreneurs and their motivations and needs for help. And we had a conversation that really inspired me to know people like you exist, are successful and motivated by all the right reasons, so Tariq, can you please introduce yourself to our audience?

Tariq:

Yeah, I think you, you touched on a lot of the things I do, but I'm originally a pediatrician by trade and a hospital doctor. I've had lots of experience in health care systems, I worked at Kaiser Permanente for 15 years, as a, not only a clinical physician, doing frontline work, but as a physician leader. And then I started dabbling in solving problems, I started becoming a quality improvement specialist, a safety expert. And some of the problems I solve happened to involve innovation, and technology. And then I found myself becoming what we call an intrapreneur. And we can talk about that in a moment. But really using technology to help solve problems, and help drive a lot of the work we're doing. It really kind of inspired me and kicked off my passion to pursue that more. So I ended up moving to Lexington, Kentucky, and joining University of Kentucky where I'm the chief quality officer and a vice chair for quality and safety here, and also joined startups as an entrepreneur. And I started advising both formally and informally, various startups, and really exploring the world of venture capitalists, and industrial and institutional investing. So it's been a great journey, and I'm learning every day and I've making mistakes and failing and then you know, iterating, and moving on. And it's just been an amazing journey,  I'm even more passionate about the digital health space and the future that can come with really getting health care plugged in, in the right way, into digital technology.

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Chris:

Right, you have a fascinating journey. And I'd love to unpack that a bit. So doctor to intrapreneur, to entrepreneur than medical officer to startup advisor, now looking at investing roles. What inspired you along that journey moving from one role to the other and what did you do in those roles?

Tariq:

Yeah, no, I think that's a great question. And I think as you know, as I was thinking about this, it's not really discretely moving from one thing to the other. It's kind of a continuum, just kind of a blend. As I go through my journey, I'm starting to morph and evolve into different things as I, as I pass through, and I don't completely leave anything behind. I just kind of like add it to the evolution of the things that I'm doing. And so I think, you know, I think the thing that's really inspired me to kind of jump in and do all this work was that I really thought of myself as a problem solver. And initially, as a clinician, as a physician, I wanted to like, fix hard problems. And I would look at things that were not working in our system. And you know, they were driving human error. And it was the only solution was someone just had to work harder and faster. And they could never be tired, they could never be subject to like the stressors of the environment. And I was like, Wow, this needs a systemic thing. Systemic change, a protocol, a way that we all do things together. Some of that involves technology, and some of it doesn't, you know, and so, I started I, you know, eventually at one point, I was solving , trying to solve different poems with the EMR, and helping like, you know, work on asthma care, or sepsis in pediatric patients, and then one day, you know, I happen to be an transport physician. So we would go help transport sick kids from an outside ER where they didn't have pediatric services to a pediatric ICU within the Kaiser system that had more services for really, really sick kids. And there was basically no situational awareness in the ambulance, they did everything on paper, and the rest of our ecosystem worked in a digital world. So I said, it can't be that hard to create,  make the ambulance part of the ecosystem. And so basically, when you worked hard and got a grant, and you know, you learned how to pitch and got money and help design a system to put the EMR in ambulances so that our teams that were taking care of the sickest patients in a box traveling 70 miles an hour, you know, in the middle of nowhere in California could have, you know, access to the tools of the electronic medical record or know what someone's drug allergies were and know how to dose medications, you know, could see the information that was happening. And the people, people could look into their ambulance and see what was going on. And you could, when you were on your way to pick up a sick kid, you could know what was happening in that other Kaiser er, and react and, you know, in that whole journey, and getting that operationalize, that was like my first intrapreneurial startup, and that word means based on doing entrepreneur, like activities, but I'm working in a company I haven't left, you know, but I had to pitch it, I had to build stakeholders, I had to engage everyone, I had to get the grant funding, I had to sit down with the engineers, I don't code. So I sat with them in our corporate offices, you know, basically programming the different tools, went back to the nurses and staff and figured out how to design it right, using human centered design principles. And I wrote in those ambulances too, when I worked with them, and I knew if I created a product that didn't help them take better care of kids, that I was failing, right? And so under those basics of that journey really inspired me to want to do it forever. And I knew at some point, I think it was in 2012, that I wanted to do this at some point, you know, like, through my, I wanted to become a person that did digital health. And I didn't know how I would get there. But I was like, I gotta do this. So that's kind of what inspired me.

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Chris:

Gosh, yeah, I love that. It goes, in retrospect, now that I know more about that product. It seems so obvious, but it's only obvious when you're on that frontline experiencing the problems. And I love that you're saying it's about solving problems for people. And I've always internally hypothesized that physicians should be some of the best healthcare innovators because they understand problems so intimately, from so many important angles, so a front row seat and ear to the patient's problems, but also that boots on the ground reality of the physicians challenges and challenges inherent in the US healthcare system. And so much about digital health innovation today has to solve the patient's problems, but working within those realities and constraints. So I guess a follow up question is, do you feel like being a physician has given you an advantage in being a digital health entrepreneur?

Tariq:

That's a great question. I'd say almost yes and no. And the reason I would say yes to that is because it helps you like in this particular example, it helps me think about dynamic problems. And I basically spent my entire career you know, maybe it's a clinical focus. Or maybe it's, you know, as I become a physician administrator, I'm working on solving operational or staffing problems, or how do I get my team to be inspired to do the work when they're tired? You know, like solving all these difficult problems, I think is part and parcel to being an entrepreneur, it helps you think about things, you know, and I've always been a problem solver that kind of tries to turn, you know, yes, I hate to think outside the box phrase, I think it's overused, but try to look at a prompt from different perspectives. And most importantly, try to look at it from the perspective that you don't have like a perspective of another frontline person, or the patient, or a caregiver, that is vitally important. And I think it does feel like having to look at the world in different ways can feel you to help solve problems better. The drawback for physicians is I think that we become entrenched, we tend to become entrenched in our own beliefs and our own data and our own evidence. And it is in because we have a belief that we were trying to use the scientific method to vet everything to validate every single thing to look at the randomized controlled trial, and then when that's done, okay, now we're gonna use it, and 10 years later, when you have your, you've vetted your solution, and you know, but then we're really bad at implementing as well, you know, converting from that as the evidence evolves, and comes out to start using it and becoming early adopters, and then an early majority and moving up the diffusion of innovation curve. We're not great at that. So so it's yes and no, and I've had to change my thinking, to be one where I realized the value of other stakeholders and other people in the process, you have to really understand and break down the process. And think about it from someone else's viewpoint, besides your own being a physician and living that can give you that viewpoint that you really have to work harder, after you develop that initial thesis, you know, and, or the hypothesis and, and make sure that it works for everyone else. And I think that's sometimes the hard work that physicians may not think about. So it can make your job harder. It's you know, and you have to kind of get out of that mindset a little bit

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Chris:

Yeah, yeah, That's interesting that you mentioned that because, of course, in pure startup world nowadays, lean startup is one of the main pedagogies they can follow, which is essentially just the scientific method. Write, build, measure, learn, come up with a hypothesis, figure out what you can build to test that particular thing. And then see if you actually made an improvement. So it borrows very much from that scientific method. But in the pure startup world, you're iterating so quickly on such few variables, whereas in the clinical world, things take time to really actually prove out. So even though the loop may be similar, the speed of the loop or the comprehensiveness of the loop is going to be different.

Tariq:

Yeah, no, I totally agree. And that's why in, in healthcare innovation, I think when you talk to, to investors, or or, you know, people that are looking at other industries, the life cycles of development of these products are so much longer. And that makes it really hard as an investor when they step in, as I now have friends that are VCs, and I talk with them and kind of get their viewpoint of like, when they're trying to, like help a company and help a good idea move forward, they take a lot of risk, right? And it's interesting to look at it from their viewpoint of like, how am I going to, like, take a risk on you, when it's like, put this money in them, and six years later, maybe I'll start to get evidence, you know, or I won't know, for a very long time, whether this is panning out, it's I think that traditional, you know, institutional investing world is stressed by that, you know, because it's a different, it's a totally different beast. And I think there's some approaches that are coming out that are newer, but that traditional model, I think, can run risks to cause, cause issues, you know, and so, so, but I think that's evolving as we speak. And we've seen some instances where when you don't do extreme due diligence, or use some technique to really make sure that the process is moving along in the right direction that you can run into trouble, you know, like, think of like, theranos. And, you know, and even there's a lot coming out about cerebral right now, and some of the things that have happened there, and like, you know, due diligence is very important. And there was, the one other point I wanted to make really quickly is that, you know, clinicians are often researchers, there's another rapidly evolving science called quality improvement science, which I happen to be a quality improvement geek in my, in my roles to change things. And it's a that is a little bit more of a nimble science. And it's a, little bit like a dirty research,  I think it's very akin to innovation. So as I learned that in my quality and safety roles at institutions, and doing a performance improvements are doing using the Toyota method and lean methodologies to make systems better, I think that fits very well with innovation. So I feel very connected to that. Because it allows you to iterate really quickly. You have all these real world environmental factors happening, and you just pivot. And in quality improvement, when you pivot, you basically just track what you you changed, and you try to move, move on. And so the it's not like having a randomized controlled trial, where you have these controlled variables, and then you just let it run for five years, you're constantly adapting, constantly moving, and you're tracking your data in a different way of using like time, something called time order data, or statistical process control where you like, basically see what that run chart does over time. And then if you want to do something, and then your data gets worse, then you stop, you do something you change again, and watch it go up. Right, so you're reacting in real time. And I think that's where there's a nexus between a real similarity between innovation and entrepreneurship, and quality improvement. So those two things, I think I've gravitated toward, like just maybe my personality or the way do you think you need to really connect? And I think that's a place, that's a very interesting place for innovators to be, instead of thinking about, well, you know, I think randomized controlled trials are important because they tell you, okay, this method, this piece of intervention works for this thing, or this medicine works. But it doesn't tell you how people apply them in the real world. And do they take that medication that, you know, should perform so well? And, you know, are they taking their steps? Are they doing exercise? Or are they, how are they doing, psychologically going through a process, you have to kind of see those things every day in real time. And I think that  the innovation if it's going to move faster needs to, needs to, needs to think like that, and quality improvement scientists that are starting to emerge in health care, such as myself, I think are really well adapted to connecting to that.

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Chris:

I really love learning about this because both lean startup and these lean methodologies within healthcare, they have the same origin, which is that Toyota manufacturing what you need to do to make incremental improvements along an assembly line or process. But what I've gathered is that quality within a health system can mean something different than the types of variables that people iterate on, let's say in a consumer driven startup. What would you mind expanding on like What does quality improvement mean? When you're trying to do it systematically and iteratively, rather than in extensive trial?

Tariq:

Yeah, well, quality improvement. What it means is you're basically, you can target anything, any process that exists. And you try it, you basically set what we call a SMART goal, where you think about some goal that is attainable, it's very specific, it's time bound, like you're going to achieve something in six months, or three months or 18 months, it's something that you can actually accomplish, like, you're not going to like change the world, we're going to go from 50% success rate to 100% success rate, that might be really challenging to do, right. So you may say, hey, in six months, we want to, we want to improve 10 to 15%, we want to make something 10 to 15% more efficient, or more accurate, as you're going for smaller chunks of goals. And then you're setting up the parameters, your hypothesis that you think is going to get you there. And there may be certain processes, in whatever system you have that can you help get you there. In the, if you think about digital technology, that may be like, hey, if we bring in a, say, a chatbot, or an assistant virtual agent, we're gonna streamline the, you know, the process of making appointments, right? That's a big, huge pain point. That's why people just don't show up to appointments, because like, they're on the phone for 20 minutes, right? You can bring in a technology like you identified as a pain point, you ask the customers, you ask the people in the system, like, hey, the here's our system, there's points that are broken, we're going to target interventions on those broken parts of the system. And then you basically try to get some improvement, you put out your intervention, you measure it over time, you try to shorten the times you're not doing it forever, and then you see what happens. And if you're going in the wrong direction, after you know, you know, several cycles of measurement, whether that's days, weeks or months, and you're not doing the right thing, you turn up and you try a new intervention, or you come up with a new hypothesis that says, Wait, the intelligent virtual agent didn't work. What's wrong about that, you're working, it's like, oh, it's not asking the right questions, or the natural language processing that is built into it doesn't understand a southern dialect, or something, you know, I mean, there are these different things that can just for example, and so you, you make modifications, and you're basically tinkering and tweaking your experiment along the way, instead of letting it run its completion, right. And so that is like innovation. When you're developing a product, right?

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Chris:

Gosh, yeah, it is so much. And I'm happy to learn about this, because the, of course, the healthcare sector gets deemed for being slow at innovation. But I think it's because innovation really depends on that feedback loop in order to know what to do next. And so many innovations are more incremental, rather than all at once. So unless you have that feedback loop, you're not going to go anywhere, very quickly, you're gonna go as fast as that feedback loop is so happy to learn that people like you are really trying to get it right for healthcare, because it is more nuanced than, let's say, consumer startup that just wants more people to click the Buy button or the refer a friend button. There's much more on the line. There's people that need to be trained. But, it sounds like there is this middle ground where you can structure your experiments in a way where no, it's not going to be as fast as A-B testing on a million users and figuring out what works best. But there will be more rigor, but it'll still be much faster than letting as you said things run to their completion. So I'm sure there's a lot of learnings that you've had, as far as the intersections of intrapreneurship entrepreneurship and being a physician. But I'm curious when you first transitioned to being a intrapreneur from being a doctor, could you walk us through that learning curve, those challenges are those kind of transferable skills as a doctor, when you started taking those on?

Tariq:

Yeah, I know, I've been thinking a lot about in the  last couple of days. And like what that started, like what I was, when I did my first project that started in like 2009, versus what I am today, and after going through, like executive leadership training and learning how to communicate better, and it's just amazing that the biggest thing when I started was that I started with a great idea. I was very much in like, I'll bring up the ambulance example again. I was, you know I thought of the idea in the shower one day, I'm like, Hey, why don't we, why are we not doing things differently? And I pitched it to some of my colleagues and nurses and physicians are like, that would be a great idea. But what I didn't realize was I didn't know how to pitch. I did not know how to concisely deliver a quick message that, that demonstrated return on investment and thought about the principles of business and you know, and you know, what kind of, what kind of solutions ,what kind of results are you ,are you aiming to attain, I didn't think about that. And I started out kind of like just sending out big emails to people that I thought were leaders, you know, and it was, I remember I constructed this very eloquent what I thought was eloquent three page email trying to explain why I was doing things. And like nobody probably, you know, and one of my leaders, Diane crag, she's, she was a great leader and mentor of mine at Kaiser Permanente was kind of like, Yeah, this is, you can't sell something like, like an idea like this. The, the real point for me, where it pivoted was running to the right mentor, and a random someone named Dan Chow, who at that time was a physician, innovator and, and a pediatrician at KP. And he's since, since gone on to do a bunch of great things. And I think he's an automation everywhere, right now and just been connected to a lot of different companies. But he sat there and patiently listened to me, and understood that I had a great idea. But even though I wasn't communicating well, and it got me connected to an innovation team internally at Kaiser Permanente, that started to help mold my thinking, and try to teach me how to pitch and, you know, so I got connected to people and had mentors that saw some value. And then they helped me along the way, refine the process, because as a, as a pediatric physician, at least I just wasn't good at being concise or wasn't good at delivering the message. You know, and that was the biggest thing I had to learn is to care to convey the idea concisely be to the point and say, here's the value, I'm going to deliver you. You know, and so that was the biggest learning , the biggest initial hurdle. I went through the next one, as I started to evolve, and I started to get funding, I got this first project done. And I was like, Wow, that's great. then figure out how to scale, then scaling was its own problem. It's like all people were like, Oh, I don't want to do it, here are my environments a little different, you know, and that was challenging getting that first product operationalized. But then I had trouble scaling it. And I kind of learned factors later on that would help me scale it. And then years later, when I was, I was consulting for Southern California, at Kaiser Permanente, which is a sister company, a different vertical within Kaiser Permanente. And they were starting a transport program. And they looked at Northern California and said, well, you can move kids around your system, you have a virtual care system, you can consolidate your resources. And so helping them design their ambulance EHR, was really, really important. And I was able to bring learnings to them and help them scale and develop it. But it took a lot to figure out how, like how to communicate. Now your idea that succeeded to a whole new audience. And you know, it really, you really have to step back and learn how to be inquisitive, you have to not kind of drive your idea saying, hey, here's my great idea, I'm gonna push it down your throat, you know, yeah, that kind of doesn't work with the change management. So, I really next started learning how to, how to bring change management in, you know, and how to convince people of ideas. And I think like the learning the human behavior, the psychology of change, has actually been much more valuable tool than just being a creative thinker, and coming up with this cool idea. And then, you know, having understanding of like, what machine learning is, or you know, what a, what a chatbot is, or how to implement it, it's actually the other intangible things, about connecting with people and developing relationships and, and explaining ideas and driving them. And being resilient. Like, those are actually so much more important than just like, hey, I know how to work, you know, I don't know how to code, you can say, I know Python, right? So I'm gonna solve the actually, much more complicated than that. But I learned a lot of these things along the way, and I'm still learning it and making mistakes. The key is when you make a mistake, you have to learn from it, you know, and do things differently next time. So I don't know if that was a long winded over I don't know, if I hit

Chris:

No, that I mean, I think that makes a lot of sense. Because a lot of the entrepreneurs we work with, they may have great ideas, and they may have a great product in the end. But I think what a lot of people underestimate until they try to get something adopted by people is how hard it is, as you said, to get people to change what they're already doing. And so even if you have the better solution, there is such a high cost to asking people to do something differently, that you can underestimate that friction and the hurdles, you're going to have to go through to get something adopted. So I think it's, it's amazing that you had the opportunity to work through those challenges in an organization like Kaiser Permanente or connected set of companies.

Tariq:

Yeah, and sometimes there are challenges when you, it's sometimes easier to design a solution for someone and customize it, although that's a different lifecycle, because you can really tap into the problem they're trying to solve. Sometimes you're bringing a solution to, some, to a problem that they don't know they have yet. Or maybe there's some nuance, and they don't actually have that particular problem in the same way that your solution is designed to fit, you know, so there's, there becomes a lot of different other factors to consider too, as you're trying to market a product versus designing a customized product with like a technology base, that will work, right?

Chris:

Yeah, and there's got to be an art to that, because that is another challenge that even if let's say, as a healthcare entrepreneur, you happen to get one or two pilots, and you have these co development partners that are going to be telling you how to solve their flavor of the problem. And it is just, fingers crossed that they're going to be really committed to that process, because it takes a lot of feedback and commitment of people going to try a thing and give you, you know, real guidance and how to make it better, or else it's not going to go anywhere, and you better hope, fingers crossed that whatever you build with those first one or two pilots is going to apply to other people with the same problem. And if it doesn't, you're a little bit out of luck, unless you somehow navigate to validating that upfront.

Tariq:

Yeah, and it helps if you're going to be an intrapreneur and stay within a company, if the culture allows you to fail or make a mistake, and then iteratively change and then improve that process. Because it's often going to be a fact that you're not going to get it right the first time. And so that's why that old mantra of fail, fail fast. And then the correlator fail cheaply, really plays a role, You know, in my, my second innovation grant, a Kaiser built that it helped design a chatbot that was supporting new moms and their journey and did a lot of work on breastfeeding. There's some postpartum depression, there were a bunch of features for the baby, it can, it could connect to a call center. And it took a long time to develop this product. Because we kept loading it with all these features and said, Okay, I want to solve this holistic problem. within our scope, you know, we were targeting babies being born to the first three months of life. And we spent so much time in development and it was so long, and we used up so many of our resources. And then we fell across a leadership change in the area where we were going to pilot , that new leader didn't really, wasn't really interested in coming up with a chatbot technology in 2017-18, when now like, these things are like ubiquitous post COVID. But at that time, it was just kind of early and people you know, it wasn't that interesting. So, you know, I didn't follow the mantra of failing early, fail fast and trying to take a minimum viable product, a smaller product with one feature, testing it, make sure the people, your customers, in this case patients and new families that just had babies, like making sure they really liked that. And then you spend the money to add the new product, the new the next phase on, test it. And then the next phase, instead of went like, Okay, we did some prototyping and you know, early stuff and like, okay, we try to add 12 features, or 15 or 20, and then try to roll it out. And that, get that's a lesson that, like I will take with me for the rest of my career. Because we used a lot of ,a lot of our grant money, a lot of time, a lot of engineering resources, and probably should have stopped sooner and then tested, got more traction, and then started building other parts in the roadmap or the vision, right. And so sometimes you're my grant roadmap, like, I want to do this, this, this, and I'm gonna get to here, you can do it in pieces. And you can go more slowly. And when I was more patient as a younger intrapreneur, entrepreneur, innovator, whatever you want to call it, I said, I want this moonshot, right, because that's, that's the only chance I'm going to get, you know, because I'm going to run out of, I may run out of credibility within this big organization, or, you know, and so, so taking things small and moving nimbly and fast, and then testing a lot. And using a minimum viable product, even if it's not your entire vision of what you want to build out, that's a huge lesson that I would pass on to other intrapreneurs and entrepreneurs no matter if you're in a company, or you're external to a company.

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Chris:

Right, Yeah, I like that. And do you find that large organizations that are invested in innovation, like, for example, Kaiser Permanente? Are they becoming more used to that type of more progressive investment? Right, so smaller blocks of let's say, funding or buying to get to a certain point where you don't know it may not be a complete solution, but you're going to know if you're on the right track. And then if you're on the right track, then we're gonna go one step further. And in kind of progressively supporting these types of internal interventions,

Tariq:

Yeah, I think it's interesting at the time when I was there, I could see, I mean, yes and no, there was slow , there was some evolution in that space. There actually was some backtracking depending. It's such a big organization and there's so many different verticals within that organization that it was very complex. And there began to it started with that mantra and then there was like, internal Innovation Grant funding. And then it kind of migrated to a phase of like, well, let's work with the big companies, let's work with like Microsoft and the Google's not, you know, the big mega companies instead of the small, early early startups, because it's, you know, you, you get things that are maybe baked, you're spending money on these things, and then you may not get a result. And, and I think some healthcare organizations aren't necessarily ready to take that, right. So now has that changed in the year and a half since I left, it may be migrating a little bit and you can look at the development of graphite health, which Kaiser Permanente is participating in, which is kind of a, kind of like an app store or kind of like a collection of different innovative, innovative tools. And they're, you know, I think Intermountain Health has joined in some other groups, but they're trying to look at that market mentality of, hey, let's see what other smaller companies out there are doing. So I think it varies, it goes up and down. And it depends on which particular big company like KP, it depends on which particular vertical you're talking to. I try to tell like, when I'm kind of doing informal or formal advising or just talking to other people, I'm like, you know, Kaiser, you want to come to a big company, like Kaiser with, with ideas that are definitely you know, beyond your precede, or your seed stage, you want to get something a little bit, you know, maybe, into Series A, you know, you want to get products, you want to get things working, you maybe have one have gone through an accelerator, or an incubator first, to really makes sure, you have a little bit of credibility, you kind of test this in your products, you know, and you can fly in big corporations, you can find people that are willing to have a little bit more tolerance for ambiguity and tolerance for risk, and be able to take you on and different, you know, different even payers now are, are doing that, like, you know, there's stuff coming out of Humana and, you know, other other signals developing, developing and or acquiring different types of companies that are willing to take some risks and, and, you know, that's these, these new innovative companies are kind of part of that, and, and I think, for healthcare to scale up, it's going to have to take a little bit more risk, or put out some of its budget for r&d, or, or be willing to try new things, you know, the pandemic has just kind of accelerated, you know, what has been obvious to someone like me for years, and a lot of us is that virtual care is, is going to have to expand to, you know, surpass some of the social determinants of health are some of the access issues, you know, you know, that are, that are just, you know, plaguing healthcare, and we're gonna just have to get better, you know, and technology is not the only solution. But it's something that can augment people to, to expand their capabilities more.

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Chris:

Right, gosh, I can tell you, I've learned  so much, your time as an entrepreneur or entrepreneur, from the time you're a physician, just by the language you use and all of the different perspectives you've gained. Is there anything that doctors need to unlearn? Who want to take on the business side?

Tariq:

I, I think Well, I think you. So one thing, physicians tend to have to be forced to learn continuously, because things are changing continuously. So I think, if they have, if anyone comes into it with that mindset, like I've learned everything I needed to know in med school and residency, and now, I'm just going to continue, you know, if someone has that they're sorely mistaken, just for being a physician, that's not the way the world works, you'll learn more after you leave  your formal education and training, you're learning more all the time. And so I think, I think assuming people have that mindset, they need to apply that to things like system change, and technology and, and more physicians need to understand, you know, the nuances of what machine learning is and, and the mistakes, the positives that can happen from it. And then the really, areas where you can fall down upon using technologies like that. And I think opening and being, being open to working with different stakeholders. And again, this is a quality improvement thing. I was teaching at University of Kentucky, I was like teaching a lecture to new leaders coming up with like, here's how you manage change and what a PDSA cycle is planning. So the act and quality improvement similar, and it basically telling people, you have to go learn the process completely, talk to a bunch of different people, the answer is not in your head, if you think it is, I've learned that right now. Right? And I kind of joke, get over yourself. This is not about you, right? And I, and I think that's the biggest thing for physicians to unlearn or anyone that's in leadership position is like, is like you have to go, go down to where the work is. And look at it, be empathetic, listen, learn, because that, you're going to hear the answer, you're going to hear the solution there. Or maybe the people that are in the frontline are going to have the best idea, because they're in it constantly, you know, and so they're going to tell you what's wrong, right? So that's how you can kind of build on it, I think that's the biggest thing, One of  the biggest things to learn and then, understanding that there is a business to medicine, there's a business to healthcare, there's a business to innovation, and you're gonna, you're gonna be better off if you learn what the rules of that game are. If you want to succeed, I push that off for years, and I thought, Oh, this, you know, and I was like, that was part of my reason for wanting to stay as an intrapreneur, because an intrapreneur, you can stay in the company, I still get paid my salary, and I have to do all my other things, you know, you still end up working  80, I worked a lot, because I did everything on the side, right. And I had to do my day job. And I was division chief, and I was a director of a region at one point, you know, did all this stuff, right? And I did that intrapreneurial work on the side, but I knew it's like, okay, well, I know, I got my grant funding, I know, this is easy, you know, and then I know, I'm getting paid a salary. So it's like, okay, I'm fine. But and I was avoiding learning the institutional part of the business, right. So when you go out there the advantages, you know, as an intrapreneur, you know, external now you you're more you're you can be more nimble, and you don't necessarily have to react to all the, the processes that are laid out by your company, which is a good, which can be a good thing can allow some more flexibility. But now you have to learn the business world of data, you have to go get, you have to go fund everything you're doing and you maybe don't, you can't just fill out like several grant applications and get internal money anymore, you know, or be kind of covered and have a buffer. So you have to learn that business world. And some of the best ways are basically talking to other investors or people, you know, that are VCs, getting involved in accelerators and incubators, you know, reading about what venture capital is, I started doing that and I'm like, what, this is how it works. You know, my brother in law's a VC, was a VC and I'm like calling him like to say it's like wait, what's an LP? An LP has to bring, bring you money, and I believe it and then I make money later, but what you know, to join the club, I I have to bring you $100,000? Really that's how, you know, I mean, you know, understanding some of these things and like, assuming it's like, oh, can I be, Im gonna be a consultant for a VC firm? It's like, oh, well, it doesn't work that way you actually pay in? And then you do that. And I'm like, why? But it's interesting to learn some of these things.You know, I think it's important to have eyes wide open about what that is, and what's what's an angel investor, and what, you know, you have to learn that and then start having conversations. And that's going to help you think, you know, it certainly has helped me be more brave at entering the market of, you know, externalizing, and being an entrepreneur, and then learning about what you have to do and how the message is different. And then what we have to do for due diligence, which is actually really important. It's like, Hey, did you actually calculate, estimate how your customers are going to grow? And it's like, what, what do we do? And how much you would charge for, like, helping out some of my friends in a nurse led startup that's actually forming. And then I got them in an accelerator. And I say, Well, you know, what, are you going to charge its customer? What, how are you going to grow the product over time? How are you going to get into pilot studies? And they're just like, I just had this great idea. It's like, hey man, that's this thing. It's like, do you want to do this or not? Why do you want to do this, they're like, Well, I'd really believe this is going to help all nurses everywhere, then this is the work, you know, and so, you know, but it's nice to have people that you can have a conversation like that with that word. And I found people to help me in that journey but it took a long time. And so I try to pay it forward when, you know, when I'm interacting with people, or people call me and try to tell them all that I've learned, and I'm still learning right now, right, but it's helping people to get started or set expectations, or sometimes people are like, gosh, I don't really want to do that. I'm like, that's the most important thing is like, know what this is, if you want to go on that big, hard journey, you know, you it's gonna be less secure, you're gonna make less, but you may be more fulfilled, you know, I was talking to one  my friends Arrupe Berman, who's a great intensivist out of UCSF, and he's, he formed a startup at a time when I was still doing the entrepreneurial, intrapreneurial thing and, and working on my second product over at Kaiser, and he was in the Y Combinator and Assam. It's like, he was just so stressed out, you know, by this, and now I see him later. I talked to him, you know like a month ago. And he's like, his company is really, elemental health is great, great company, doing education for nursing staff and, and doing a lot of stuff virtually. And they're growing. And I think they got, can't remember if they are  Series A, think they got their series A and they're moving on to a B, it's just amazing stuff he's doing. And I was talking to him, like, weren't you scared about the, and he's like, Well, you know, it's it's not the same, I could have made more as a doctor but a more fulfilled, as you know, I've done something that brings more meaning. And I was like, you know,

Chris:

Sounds like the name of the game, Yeah,

Tariq:

Yeah, I could just see in him. He was so relaxed. He was so like, this is the right thing that I need to do. And I was like, All right, my Giddy up, right. And so

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Chris:

Yeah, I mean, in your journey to becoming an entrepreneur, you from intrapreneurship, you became co founder and CMO at a start up? I'm just curious if you can synthesize like, what are some of those learnings as intrapreneur? Or even some of the differences between intrapreneurship and entrepreneurship that you've really noticed?

Tariq:

Yeah, I think, I think the one of the biggest things, and I kind of touched on this is the way you deal with funding. And as an entrepreneur, you're dealing, you're basically don't have that company necessary to fund you. Now, if you're looking at institutional money, or angels, or venture capitalists, you have to figure out how to how to really deliver, show the value you're going to deliver, you have to put out a business model, you have to do some things that you didn't like I didn't have to do in Kaiser Permanente, to show like, clinical value, what are my outcomes gonna change? When they get this product? What's the benefit for the workforce or for the patients, Right? So you have to do that, but you have to do another thing in entrepreneurship is you have to explain to people that you're asking for money, right? So how is this going to financially also make sense for me, you know, what's the, what's the return on investment that you're gonna have? You know, I'm gonna get a 3x return or am I going to like break even over 10 years, and why should I? Or should I give you you know, $200,000 or whatever, you know, and so that's a, that's an eye opening process. That is something to understand if you're going to become an entrepreneur and leave the safety of the nest, you should really like learn about that process. Also understand there's other funding sources like you know, there's like grants Just like NIH, Small Business Innovation Grants are a great thing. You know, Robert Wood Johnson grants, there's all kinds of grants available to fund what you're doing that doesn't have to be investor money. And any, because anytime you invest, of course, you're getting away a piece of the company, or piece of your equity. And then, you know, some people are self funded, they just, you know, they built up that big nest egg or they have, if you have a rich uncle great, that will fund you to get out the door. It's great, you just, there's, there's pros and cons for each of these things. So I think that's, that's one of the biggest things to understand about the business component of intrapreneur versus entrepreneur, I think the other challenge can be is that when you're an intrapreneur, you're you're in the company, you're embedded, you're really tied up in the front lines. And so it was really easy for me to follow one of my principles as a leader, and a product designers to like, think about human centered designs, like, go there and talk to the people that are doing, you know, was building a baby app, like, I was rounding in the nursery, you know, and so I would like sit there and be like, talking to families and be like, so what about this is really killing you, right? The process and like, the way breastfeeding goes. And then having my own child, my first daughter was born when I was making that product. And then my wife, of course, I love her to death, but she was colicky. She couldn't sleep, she couldn't breastfeed, you know, and it was really challenging, watching my wife, like go through this process. And I was designing a product at the same time that I was having a kid and learning about all those experiences, you know, and so that was like an immersion in like, okay, human centered design of it all, you know, you can have that experience anywhere. But as an intrapreneur, just the access is easier, it's right there, you know, like, I could jump in an ambulance and go like drivearound with a team. And they'd be like, Tariq, this, this is not good, you need to fix this, you get, you know, looking at the prototype or whatever, as an entrepreneur, it's a little bit harder, because you have to go seek out those groups that are going to allow you to come in and clinically pilot things, the really, the more relationships you have, I think in healthcare, I was watching another podcast talking about relationships. And that's , that's everywhere, right? The business and health, any problem trying to solve, you have those relationships, you have to leverage those relationships, and figure out how to take a little bit of risk to pilot a new technology, or pilot a known technology and try to use it for a different purpose, you know, and get into that space, where then you can clinically validate and say, Hey, we tested this on 50 patients, it looks like there's some promise here, we need to do more work. But you know, thank you, you know, we will write a white paper, we'll kind of talk about it. And maybe we'll try to scale and get into some other spaces, you know. And so that's sometimes a little bit harder. And you have to leverage the relationships that you have within, within healthcare to sometimes do that, or look for interested institutions, or their hospitals with innovation labs, like, you know, CHLA has the kids X accelerator, they're very open to different things like Boston Children's, and, you know, Children's National Washington DC, they're the group set up to specifically do look at innovation. And there are, you know, those institutions can be good to go to as an entrepreneur, so you can kind of overcome that hurdle. But I think those are, those are kind of the two key things that I look at. I'm just going to pause and look at my notes here, because I have a feeling.

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Chris:

Yeah, no, I think those are great. And I think you're talking about that ease of adoption and access, right, which is it does sound categorically different if you're working inside and you're solving an organization's problems, and you have access to people about that problem versus on the outside. And this chicken and egg challenge you have as an entrepreneur of I can't get anyone to want to be the guinea pig for my thing, unless I can show evidence that it works. I can't get evidence that it works unless I can get someone to be a guinea pig for my thing. Yeah. And I'm just curious that whether, you know, and that is a huge problem for these digital health startups, is getting that initial pilot that initial when access to real patients or physicians. And I'm curious if you're kind of inside scoop, working within a health system and how to navigate and how these organizations go out and go about evaluating innovations. Is that really useful to you? I'm now on the other side of the table, of trying to break into organizations and have them use a thing.

Tariq:

Oh, it's extremely useful, I think, I think thinking how, you know, like, I'm at an academic institution now, which is like, very, which is very different than, than being at a very business minded health system. You know, an HMO like Kaiser Permanente. I think that they were, like Kaiser Permanente, for example, is very forward thinking in the way they looked at startups, but they were very tough. If you're a little startup, they were really tough on evaluating companies and , and sitting there watching, I actually was able, I was privileged to be able to attend a lot of work at Kaiser's Innovation Center in Oakland called the Garfield center, and kind of work and get mentored by a lot of startups and, you know, go there and my days off, I mean, you know, and just kind of do that, do that work. And sometimes we would be, like sitting in the Shark Tank like scenarios where we'd be looking at other startups and evaluating them, and having, you know, like little pitch sessions, and you really had to be quite impressive to break in, and really had to get to a certain level where you had some clinical validation, you were showing outcomes that were improved to really break into the bigger company, it's kind of, at least at that time, and so it's really challenging, you're gonna have to bring quite a lot to really break into a bigger organization and bring your evidence. If you, if you do find other other groups, you know, I'm not sure how graphite is its function now, for example, that, you know, Kaiser Permanente is participating in but if you can break in and get into kind of like Design Studio type, or Innovation Studio type scenarios within certain healthcare companies, I mean, that they're going to be more kind of thoughtful or forgiving for your mistakes, and let you just want to work, I think that's an advantage. And there's people doing that work out there, there's more and more of that developing. So, but it's, it's really hard to break in, and you got to bring some evidence. And sometimes it's better to start small, and start with start pilots and other you know, smaller practices and not go for the , I kind of refer to it to KP as the white whale. It's like, you know , you're in a rowboat, don't go try to harpoon the, it's like, you know, harpoon the whale,  start small and build your way up. And then when you get, then you go after the bigger fish, right? Because the white whale can destroy you. If you're not careful, because it's you know, so it's my kind of description

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Chris:

That's great learnings. Fast, And I know, after hearing you speak, there's going to be a lot of people that want to work with people like you. And now you're a chief medical officer of omniscient health and advisor to multiple healthcare startups. I would love to ask some basic questions for, like, really targeted from the people that you work with? What is the role of a chief medical officer or advisor in a digital health startup?

Tariq:

Yeah, no, I think that's a great question. I mean, basically, it's someone there who has some experience in healthcare, it doesn't have to be a physician, it certainly can be a nurse, it can be a psychologist, someone that is has the right amount of expertise for the type of work that you're doing, or has a broad expertise and understanding of how healthcare works and how the healthcare system works, that basically tries to be embedded within your company, and help guide the process and help set you like, kind of set you on that path that kind of follows, follows some of the values some of the, the needs some of the importance of like quality and safety and health care and helps you make the right decisions from a health care mindset. And I think a lot of companies may, you can get that if you're an early company, you can't afford to pay a CMO, like, in my case,, you know, it's one of those things as I was learning, I'm like, Okay, well, let's do an equity based, you know, fractional relationship, you know, as we start out, you know, and then you kind of, you can give away your, I guess, you can say you can start by giving away free samples, just kind of when you get into later stage companies, and you it's often harder for very early stage companies to actually pay the types of salaries that physicians require with other loans and training and, you know, mortgage and kit, you know, it's kind of a different lifestyle, a different thing that you're set up and locked into. So it's a little harder for very early stage companies to bring on CMOS, that are like working as a clinician or working as a doctor. Ultimately, you have to kind of do it fractionally or, or do other things. Or you have to put together multiple different pieces where you're getting little pieces of the pie. And if you ever talk to Arlen Meyers and go to his CMO school, he is an ENT surgeon out of I think Colorado, but he's, he's big in the physician, entrepreneur space. And, and does a lot of like coaching and mentoring and kind of tells us, hey, it's like, hey, this world is different. It's really hard. You know, you can't expect to like go to some like early seed stage startup and say, Oh, just, you know, pay me $200,000 to be here. You know, this doesn't work like that. You don't have the you may not have the resources, but you can you can advise and give advice and guide product development, when you're early on and figure out ways to do that, to help a great idea really be molded into a safe idea that is going to work in clinical spaces, and then set a pathway to like, Hey, here's how you clinically validate a product. We might either want to do a QI project or maybe we do want to do a randomized control trial at a particular clinical institution. And by the way, I know people at this institution. Let me help bring it in and bring a little credibility. So at the end of the day, it's about, CMOs are about credibility in the healthcare space. And, you know, a lot of times people are going to choose to do that later on. But if you're not getting a CMO early in the, in the process, we're having a digital designing a digital healthcare product, you should certainly get a lot of advice and talk to a lot of people beforehand, you know, and then if you, if you're trying to do it, make a digital health product, and you think, you know, because everything about the space, because of your personal experience, I would just take caution, it's like, you know, people's experiences are very unique. And you have to design a product that you want to sell to many people that fits a broad range of experiences. And you may have this really passionate story about and of one or yourself or what your family went through or something. But that may not translate to the rest of the world, right. And so sometimes people, you know, clinicians or physicians or nurses or whatever have seen like, you know, 20,000 examples, right. So they may be able to help you level set as you're coming up with a product. But those people, also CML has to be open minded, and be willing to, you know, meet people halfway and think about things in different way while also being safe, right. Because if you have someone that's like, we're only going to do things, one way we won't change. That's the wrong type of person to try to become a CMO of a digital health startup right? So you have to choose someone that's open minded, willing to work with you and negotiate that burden balance, like get something that works, but also drive the bleeding edge of innovation and take some risk. Kind of weird.

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Chris:

Gosh,and how do you find each other? So there's the founder entrepreneur that needs the medical adult in the room to either guide a, like a safe innovation, or how to navigate a health system or the industry? And then and then there's physician entrepreneurs, or maybe not. Maybe they're not founding their own separate company, but they want to be participating, let's say at the CMO level with the startup. How do you go about finding each other? How does a CMO find a start up and under the startup find a CMO?

Tariq:

Yeah, that I'll tell you first off, that's really challenging because you know, being in that space is interesting. And sometimes you have to get luckier you know, like us me connected with a Mission Health was basically this was a lot of the founders that were there with the same founders that I worked with, on KP baby, that chatbot virtual assistant that I was doing at Kaiser, so I kind of like already that it's like okay, I worked with these guys for five years. So it seemed like a natural progression after I left, you know, but that's kind of getting lucky. Right. It's, it's challenging. I think, I think there's a lot of work that has to happen for the the person that really wants to be a chief medical officer or to be involved you maybe your product officer, some other whatever the title is, you really have to decide for yourself that that's what you want to do, and then figure out how to put yourself out there. And physicians have no training in branding themselves, or marketing themselves as those like,  to sit like you're sit there and you're like, why would someone hire me for you know, it's you have to you have to be out there in the space. And, and again, you know, leading to Arlen Meyers he's like, What did he say? Here's some paraphrasing him, he's like, Oh, if you don't, if you want to do this, and you don't like LinkedIn, you are, you are a bit, you know, he would use they're basically like, oh, you're a moron. I mean, I'm just paraphrasing, right? He's just brash in the way he says things like, what are you thinking, you have to get yourself out there. So I think the, the lot of that goes on this, you have to look for people, right in some marketplace. And like, you know, play a marketplaces can be like LinkedIn, you can search or, you know, if you're a physician, you can write, you can be a researcher, you start to publish stuff, figure out some way to get out your ideas out there. And by the way, as an intrapreneur, it's very hard because I was doing things that were like, intellectual property of KP. So I did like 10 years of work on multiple products, and I couldn't externally. So, downside of being an entrepreneur, right, so having to tell stories, and go, you know, I guess, go on podcasts on Persimmon Health, right? So but you have to, you have to wait to tell your story of the things that you believe the things you're interested in the work you've done, and figure out how to tell that story can be publications, writing books, or whatever, but you  have to cut out ,the physician has to put themselves in place where they can be known. You can, so and the physicians can do that. They can join accelerators, that are looking for physician mentors, they can join incubators, they can basically start talking to venture capitalists that they know. And because venture capitalists and angel investors are, they're investing in companies, and now they're like, Well, I want this digital health care company or this med tech company to succeed. And I need, maybe they need someone to help validate their work. So they will be looking for doctors that have the expertise or the desire, you know, so it's basically comes down to networking, right. And so, your physician has to do part of the role to put themselves in this place. 

Chris:

Yeah, that's good to know. And so many startups that we work with are looking for that you know,

Tariq:

And this is what I love doing right. And then on the other side, once you have the, the physician or the CMO, whoever or nurse, whoever doing their piece of the pie, then the founder, the entrepreneur can do their piece, right, which is then to like, work with accelerators that are in the digital health space, or do all the same things or, or search out people that seem to be talking about some of the things they like to do, or writing books or really getting their message out there in your contract. So it's a two way street, right? It's like the entrepreneur, the co founder can't do anything, if there's no one out there, you know, because otherwise, you're just getting lucky, you're like, Well, let me talk to my friend, you know, a friend of a friend of a friend, you know, those things work. And that's how it started. But if you really want to be systematic about it, as you're talking to, like a process systems guy, its like make yourself visible. And in both ends, make yourself visible about what you're doing, what you believe in, and, you know, go to these different sources. And, you know, it's like a market, you can find marketplaces to put yourself together, but it's not well advertised, you have to kind of discover it. And I'd say, like for example, like innovator MD, which is like one of the groups that got me started, they have started kind of a marketplace, where people can put their names out there saying, Hey, I'm gonna, you know, I'm looking for this type of role. And so that's really early and nascent in that process. But you know, that's like another avenue that exists and there'll be more as, as digital health grows, because it has to grow and it has to grow with some clinical expertise in it to really succeed and really do things the right way. And, you know, it's a, its  more of a marriage. You know, it's like, technologists and entrepreneurs can bring great ideas. They have to work with physicians that are physicians or clinical folks that are open minded and want to do it differently, right. And together, when you put them together, you're really going to get products, and you're going to really have chances to scale and develop things that are amazing.

Chris:

Right, so find those communities where people are already going. So that could be the incubators. It could be the investor communities. It could be the innovator in deeds, the society of physician entrepreneurs, but ideally, people who are similarly motivated and engaged and other side will, can find each other there, were people like that hang out.

Tariq:

Yeah. And I think, I think if you're a physician, if you're a doctor that wants, yeah, if you're a doctor that wants to do this, I'll tell you, your whole point. So you, your physician out there, you got to get yourself out there and get it, you know, start talk. But first, think about why you want to do it. Why do you, do you want to do medicine and be an entrepreneur? And what does that mean for your family? And how many hours a week you want to go fully into entrepreneur? Why? What's your vision? What's your dream, what, you know, my mentor, Steve knew thing, who is actually a quality and safety person. What told me, I was at a conference in 2009, Steve newthing is a big leader, international leader, and he works out of the innocence Center at Cincinnati Children's, great pediatrician. And he basically said, you know, I can see, I can help so many people by basically seeing patients like one at a time, and maybe I'll have a huge impact one or two times a month twice, going to my clinic or the hospital or whatever. But it's like, if you build a system that really affects multiple, like, you can, you can help 1000s Hundreds, millions of people when you're like not working, right, it's just exponential. And the impact you can have is really huge. And so that, that is like part of my mantra, like, I want to bring all these things , bring human centered design in to really help more people than I can possibly touch. Right. So that's kind of part of my, my personal vision and my personal mission. And, and everyone will have whatever, you know, whatever that mission is, but you have to go develop one. And you might have to take some time, and really think about what it is you want. And I think that's probably the most important message for physician entrepreneurs is like, make sure you want it. Same thing with going to med school. It's a long, hard road, make sure you want to be a doctor, make sure you want, anything in life you want to do so make sure that that's really something that fits for you. And be aware that it may change five or 10 years later.

Chris:

Yep, yep. Yeah, case in point

Tariq:

And then you just reassess. And then you pivot, just like you do in entrepreneurship or you do in quality improvement.

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Chris:

Right lean, it's a lean lifestyle. Awesome. I was hoping to back out to and just get your general advice for digital health startups and your take on the ecosystems, and you having been on both sides. So I'd really love your perspective on best, what is a healthcare disrupter or innovator? These terms get tossed around? And I'm just wondering if that definition has evolved in your journey from doctor to entrepreneur, entrepreneur, advisor, etc.

Tariq:

Oh, yeah, that's an interesting question. I mean, I, I thought the word you know, there's so many different words, like I was talking to someone else the other day. And I said, Well, you know, are you an entrepreneur? I said, Well, you know, I was, I was an intrapreneur. And then I'm an entrepreneur. I'm in a company now. But they're like, Oh, is the company, did you get acquired? And it was like, Well, no, well, not yet. We're early early in that sick. Oh, so you're not an entrepreneur? And I'm like, Okay, well, I mean, I mean, maybe I guess if you, you know, you can define it that way. I think a nice, like a word that probably fits, it would be like an innovator, physician, innovator, because it's a little bit, a little bit neutral, or enveloped, you know, involved with in spaces. And whether I'm thinking about an intrapreneur, or an entrepreneur and being on both sides. You know, I think that encompasses a little bit of all of that. The other phrase that I like, is also the word about being a positive disrupter. And, you know, with disruption, you're kind of challenging the status quote and trying to, you know, you can, you can be taken two different ways, you can be a disrupter and be the person that complains a lot, and is negative and you're trying to burn the place down. But, you know, if you're, I think, if you're a positive disrupter, you're trying to actually improve things. You know, and I kind of like that, to use that term, personally. You're trying to bring, trying to bring positive disruption to healthcare, because I think it , it tries a chain, you want to change the things about the system that don't work, but do it in a right way. And always have like, an attitude of like, we're going to make things but things are hard, and maybe they're not working, and we're gonna make it better. And like I see a lot of ,when I see a lot of my colleagues are like, Oh, this is broken, mobile, you know, and then they stop and like So what are you going to do? Well, I just wanted to point out like, yeah, everyone's like, Can you, can you, I mean, that's the difference between, you know, I think being like an innovator or someone that's actually changing things. And then just another person in the crowd, or the peanut gallery that's like, complaining about how broken things are, it's like to, it's hard to go out and do those things, right? And you may not do them and you're gonna fail, you know, and you put yourself out there. And it's, you know, it's reputational risk. And it's like, it's hard. But that's, that's what actually changes the world. Right. And I think being innovators, actually, at the end of the day, it should be about trying to do that, or trying to change a piece of the world and make it better. So you have to try so think positive disruptors, like, that's a little bit like why I like that term, there has to be a recognition, plan, and then you got to do something about it. Because otherwise, you're just, you know, so we're just recognizing.

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Chris:

So you're just recognizing. So on positive disruption, I'm just wondering your personal outlook on those healthcare innovations and positive disruptions, how have priorities changed, when you look at the need for disruptions or innovations or startups from your kind of 360 degree view?

Tariq:

I yeah, I mean, I think that, I think a lot of the problems with the healthcare system, with a fee for service system being you know, as you hear a lot of people talk about, like a sick care system have been there for so many years, the incentives are such that it's so much easier for the current, the current, the way the system is designed to actually profit or make money from basically, you know, you know, reacting or being a reactive system to when patients are ill, or paying for acute care surgeries. And it's, it's our system isn't designed to take advantage of people doing population management, and really providing preventative health care, which is really going to change, change how healthier population is, it's going to change the the amount of health care dollars, it's going to improve outcomes, right. And it's a different mentality. And there, you know, you know, I keep talking about KP, even though I left, it's just an amazing organization. And like being an accountable healthcare organization, it's integrated. You know, Intermountain Health is another example. And there's many other like, integrated systems that are really taking on the population health mission, and I think that needs to be where healthcare goes. And my, my thesis is that using a tool, right, it's like not people say, Oh, telehealth, that's not gonna, you can't change medicines, like no, but it's a tool in your toolkit. It's like, you're gonna pick up a hammer or a screwdriver. It's a tool that can help the clinicians out there, extend their capabilities, and bridge some of the gaps and solve some of the problems that are , some of the things that really broken about the healthcare system, and maybe use your resources in a more wise way to try to get to some of those outcomes. I think my view of like, a holistic view of innovation is that the pandemic has for these things always existed, and then the pandemic forced people to think a little differently, and they had to right, so that ever, I don't, I don't think it's a revolution, I think it's an evolution. And evolution sped up for this time period, and forced people to do what was already out there. There was a ton of people doing like I was, I would get a bunch of telehealth work at KP as well, you know, and it just never quite took off. And people say, Oh, well, you know, hey, you're using it in your integrated health care, modern HMO, you're not billing for your telehealth. You know, how is that,that doesn't work for me, it's like we're doing the right thing. We're, we're providing you, especially care services in three seconds on demand in your ER, I'm helping you resuscitate an incredibly sick kid, and you have that skill set. And if we do, right, you might be able to keep that kid actually in the community. And instead of driving 100 miles to me over here in Silicon Valley or something, you know, and it's like, well, how do you pay for that? And it's like, you know, part of me is like, was always like, who cares? You're just gonna

Chris:

Right, right we dont pay for something else. Yeah,

Tariq:

Yeah,I mean, Yeah, right. You know, the business reality is like, the way the market was structured is like, it forced you to make these weird decisions. To not, not do the right thing or not, not leverage technology the right way, because your payer system didn't recognize doing the work that way. But that's, you know, and COVID like changed that right now telehealth has become ubiquitous. And I, I don't think it makes any sense to go back. And I think people once you're realizing that they're like, oh, yeah, this makes, why would we do it?

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Chris:

I know it's a bit pointless, but I mean, just because it has a billing code now, right? That's been blessed. But I think the truth is, as you nailed unless you're the one of these integrated systems. Really, the payment system is structured around treating people when they're sick, rather than preventing people from getting sick when they're well, and you're touching a lot on, a lot of these things of techniques and technologies that have been there, but it's just this lack of built in incentive for doing those things, because you're only charged when there's a code, and you're this transactional service or visit that's provided, which is really, I think, holding back, right the the industry from making those, you know, big leaps that maybe you're able to make within KP or inner Mountain is, but from the rest of the people, like your anecdote, they have this completely warped view of cost. The first question they're asking is not how did the patients do? It is ,how did you pay for it? Right ? And that's, that's something I think we need to address. Yeah.

Tariq:

Right, and I mean, I think that's, that's where, I mean, that's just one example. And, you know, it's not like everyone is asking that, but that, but that weighs heavily on the mind of, of our healthcare system , right. And physicians and, you know, administrators trying to design new systems, and it sadly, shouldn't be, you know, and it kind of distracts from the potential that we have to really, you know, I think really, healthcare ecosystems are where the future is. And those ecosystems should be augmented with virtual care, we have all these virtual care tools, whether you bring in , intelligent virtual agents, or chat bots, and telemedicine, you know, bring direct consumer, you know, it's like, almost like, Well, why don't we have medical food trucks that are getting up, you know, that are getting out there to communities and bringing the care a little bit closer, rather than creating the academic center as the senator, like everyone has to drive here to get your care, it's like, let's, we have the capability to get more of that out there to them. We don't know how to bill for that yet. You know, if we do remote patient monitoring, and patient reported outcomes, and use digital tools to get more of the data, instead of seeing everyone, every three months, our system is built to see someone in a clinic visit or see someone in the hospital every ,on these time intervals where their life is changing continuously, right? And everyone's like, well, I don't want to be on call 24/7. I don't want to be, you know, how do I know? How do I build a system around that ? We just haven't designed a system like that we can. And I think we will. And I think there's really interesting ways to make the system work with all the different tools we have, in our, in our toolkit, we can redesign a healthcare system that works better keeps patients closer to their community, is more virtual, tries to break down the barriers of social determinants of health, geography and rural versus urban romance, but we have to, you know, and as I was commenting, I was emailing LinkedIn commenting on a post, you know, yesterday, it's like, you know, you know, I'm in University of Kentucky, where  you with Appalachia, which, you know, Wi Fi, you know, having people's smartphones, you know, that there's a section of the community that's not digitally connected. So if we make virtual care systems that are just, you know, running, and we're doing our care, we are actually also leaving behind populations that you know, have to go to WiFi, or to get WiFi, they have to go to like the McDonald's in their community or something, or some other place just to get wireless, if they have a smart device, right? So we have to like think, also about like, are we, how can we help bring other communities along? Because, you know, digital health isn't going to solve all those problems. So,

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Chris:

That's a great point, Great point. And then you talk a lot about user centered design, which I love that, that's what I studied when I was in college. But I'm curious how your definition of the target user has evolved over the years. So it used to be very patient, physician centric, right? Like those are the two users or maybe, you know, the nursing staff or admins. How was your idea of who you're designing for evolved?

Tariq:

Yeah, I think I've become much less physician centric in my thinking, I think that's all become this kind of like, you know, years later, like, why did I ever think like that? You know, and I've tried to evolve to like with think about care teams, and health care, you know, I should, you know, health care takes a village, we're dealing with someone's chronic disease really takes a village. And it's not just about the patient and doctor, they're at the center of it, right? Actually, the patient is at the center of it. And around that patient is the health care team, which includes the doctor, but there's so many other people nowadays, there's like case managers or, you know, physical therapists, psychologists, you know, you know, licensed LMFT is different therapists that may be involved in their care, and they're, they're all part of that team. And that team has to be integrated and working together just like any sport or any, you know, industry, it's like that team has to be collectively connected, so they can do the right thing for the patient at the right time scale and overcome the patient's personal barriers. And also think about the, you know, I love it. You know what some of the separate to get admission brings in some behavioral profiling and motivational interviewing into some of the tactics that we're doing and trying to think about, why does the patient want to get better? And it's like, we're always like, I want you to take your medications, want should you take your MS drug so you can walk farther and you're, you know, but someone's like, someone's motivation is like, I just want to play with my grandkids. And so maybe we need to, like change our conversation and think about, like, EMRs actually, at the top of the EMR should be like, Hi, I'm Ann, and the most important thing in my life is that I can ride my horse on the way or I can play with my grandkids or I can walk in the park, Right? That's what that's the banner on your EMR. Now you work, work from that, right. And it's like, like, physically putting the patient at the center instead of what we have now. And it's like, people are probably like, wow, what are you talking about? You know, but, you know, that's like, some of the thinking we put into, like, the platform at admission is like, let's think about things differently, flip things on their head, and also think about, like the caregiver, like, the patient, but, you know, I'm a pediatrician. So I think about that, but at all levels, you know, we have our spouses and our families as we get older, you know, we have our children helping to care for us, you know, and so the, the, the care team involves your caregivers, and how do we integrate them in a way that makes sense into that, into that ecosystem? And can the really, the ecosystem, you know, as I'm talking about technology, you realize I'm not talking that much about technology here, right? technology, the technology we have can augment all that, but it's really about a network of people working together to solve someone's healthcare problems. Take that village, right? That like whether you have, you know, when you throw in all the different tools and toolkits you throw in chat bots, and synchronous and AC, you know, telehealth, video telehealth and synchronous care, and an EMR that actually makes sense. And doctors that have time and home health visits and, you know, think about hospital home or getting things out to the patient in the timeliness that they need it and, and having interconnectedness, that we have all the tools to put that together, we have all, we just have to agree that it's like, hey, let's start building that network.

Chris:

Right, and I love that aspect, or that visualization, of user centered design in terms of the patient's real goals, because I mean, you've worked with behavior change before. And the truth is, it's an uphill battle, or just doesn't work. Unless the patient has this intrinsic motivation, towards whatever the you're actually working towards. And so you may have this completely different framing, right, within your EHR, your mental model, as a physician, that is just not going to resonate with that intrinsic motivation of, I want to play with my grandkids. But if it is front and center, like you said, if the patient is at the center, and you get everyone speaking that same language that resonates with someone who needs to change their behavior, right, maybe that will actually make the difference. Speaking, speaking terms that matter to people?

Tariq:

Yeah, and, and that may be, that's a big lift, right to, like, get people to think differently about how they, I think that's what, when you talk to patients, you know, like, I like, you know, I recently did a quality improvement course at Cincinnati, and they brought on patient , patients to teach us about what they thought was wrong with health care, you know, you learn something every time you know. And it's like, looking at the viewpoint like the oh, this mom told us this really simple thing, when a kid with a terribly chronic rare disease. And she's like, don't call me mom asked me what my name is, when you come in the room as a new, new health care provider of anyone, because that shows that you care about a relationship, you want to know who you're talking to. And on the street, you even if you're dealing with a normal thing and say hi, you know, I am Tariq or, you know, what's, what's your name? How do you want? What do you want to be called? Right? It's like that little thing is like creating human connections are these things we've like lost as we build relationships, and we try to work in medicine. And it's like, our technologies should think about that too. Because we should be thinking about that, right? And so we can redesign, maybe we can redesign EMRs to work differently. I jokingly call on, call EMRs like an electronic file cabinet. Because I think that's still it's like, you know, what your tabs and it's like, you know, should look like something we see in Minority Report or Iron Man, or should be like that, what why is the patient right in the middle of like, give me a picture of the patient, their, their life is there and then I'm going to understand how to build around solve problems around their life, might be more meaningful or might connect us more and build a sense of trust, which is I think a problem without like a lot of communities to is like we're not, you know, are we doing? Do they really think that we're doing the right thing? Are we listening to them? And if we put the things that are important in their life, upfront in these like platforms, or this ecosystem we built for them, then we're forced to listen. Or we're showing that we're listening to them and showing what's important. Instead of thinking like, Okay, I'm gonna get, I'm gonna get their hemoglobin a one C down. So I'm gonna, here's what, here's what's on my playbook to do, and blah, blah, blah, they're talking about, you know, the hard things in their life and why they, why they can't buy meds or transportation. In other words, like missing the boat and actually changing their life. You know, can we do that differently? I think we can

Chris:

That's great. Yeah. And like you said it and maybe the target user is wrong or underrepresented, like in the pediatrics case, or in the chronic disease for older populations, where, gosh, these people may not be able to use technology. And yet, we're trying to put these patient engagement tools in front of them, where they may not be able to use them, or they may not wake up every day wanting to be engaged. Um, so it is just acknowledging that there will be those people in that circle around the patient, that maybe it is the caregiver, right, that you should be designing for who's going to really be up boots on the ground. Person who can engage with the whole system. And it's more complicated than that or mental model of physician decide, patient decide. Cool, Tarik, I would love to back out to some big picture questions, because I know, keeping you a while, if that's okay. But,

Tariq:

Yeah, that's total, I have a little bit more time. So if we want to do

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Chris:

Awesome, okay, that's fine. So, when we talked last time, you had an observation about the startup ecosystem, you said that actually unicorn hunting may not be the best thing for digital health. So can you please explain what is unicorn hunting and why may not that be the best thing?

Tariq:

So yeah, so this is one of those, this, this will be the controversial part of the interview or things that, you know, my VC friends will be like, why do you say that, but I mean think that the phrase comes up so often when you think about, like the business perspective of what it is and I think we think about a unicorn, you know, the digital you know, as a company that's like, you're getting an investment and it's just blowing up, it is like,it is really giving you a ton on your investment and you know, when we, when I think groups are investing in things are looking for those things that are going to make be really successful, that does translate into you know, financial success and scalability and things like that. And I think that there's in the digital healthcare space or in the in the healthcare space, in general, there's a little bit of a risk of like getting a little bit too focused on okay, I'm looking for the unicorn, you know, and, and we should be looking for things that, that are actually delivering on quality, you know, safe, effective care, and improving access for people or, or streamlining the logistical pain points in the care that, that drives people crazy and drive them away from health care, you know, or improve access or improve, break down the barriers of social determinants of health, like just things that are conveniences make the experience better, it's like, that's where the focus is. I fear my concern is that, you know, when you're looking with, when you're looking at, you know, driving companies and taking the right ideas and funding them, it's like, well, is that, can I sell that idea? Can I scale that they can make money with it? Yeah, and it's a challenge, it's, it's not like, is this the best thing to help our population? It's not front and center. And that, again, that's part of the economics of the business of healthcare in this country, and, you know, you know, in the investment market, so it just makes it a little challenging, I think there's, that's where some of the danger can come in. And then when you, when you, you get companies that have, like, kind of not delivered on the clinical piece of it, you end up with companies that can be like ever, like, Oh, this is great, and scalable, it's a great idea. And did we do our due diligence? Did we really vet out? Is this going to work is, is this do we have evidence that this is making a difference? Because then at the end, at the end of the day, you're going a couple years down the road, that doesn't work? It doesn't drive outcomes. And it's like, has everyone, everyone's wasted their time right? So, or you may have harmed patients, you know, like, there was, there's some stuff coming out to, you know, today's like, you know,  there was there patient harm with, you know, a company over prescribing, you know, medications, you know, without, without due process without really due diligence, and, and looking at clinical quality, you know, and efficacy, so, you can potentially cause harm, you know, and I think that quality, quality and safety has to be part of digital health care. And you might as well bring it in early  and make sure you're doing the right thing. And I think the, the analogy this prior about, you know, it's like not looking for a unicorn, it's like we should look, we should look for like a pack mule. Like, what? What do you what are you talking about? It's like something that it's going to be it's going to be sustainable, repeatable Does, does the work efficiently, carries a heavy load and gets a can do the same thing every time? Right? And we're, you know, we're looking for my daughter's talk about unicorns and being fancy and magical, and, you know, they poop out cupcakes or whatever, but, I mean, we need a pack mule that gets it done, right, that gets done over and over again in a repeatable way and helps you that's not sexy. It's not gonna get that it doesn't get me 100x return on investment. You know, this only gets like 7.5x return on investment. But man, I helped  millions of people with a kiss, it just makes sense, right? In the end, you get, you know, you're gonna end up making a lot you may end up with from an investment or business, they are getting big returns. But from a healthcare perspective, you may end up changing the way. You're changing your entire ecosystem, the way it works, right. But you have to prioritize things differently. So 

Chris:

Yeah, I think it's a great point Tariq and I think it's no secret that even though there's like 30 billion in funding that went into digital health startups in 2021, are really the jury's still out on their impact. And I think it was last week that Rock Health put out an article investigating the impact and measurable outcomes of digital health startups into the conclusion really, but it's hard to tell, because so many are privately held. But they did note that 20% of the digital health startups represent the vast majority of things like clinical trials, regulatory filings and claims on effectiveness. And, they in most of the startups 80% fail this formula they came up with for clinical robustness. And it's not damning by any means, because like you said, results take time within healthcare. But I think it does argue for building that in right, as one of those things that, you know, you really need to look for, for that kind of progressive investment, or at least look for in your unicorns, that it can have that impact.

Tariq:

Yeah, so I mean, I think there's a lot of like investment in don't get me wrong, like not, you know, Pooh poohing the entire investment community, because, obviously, there's people that are doing it, right. And there's people that are really doing due diligence, and, you know, trying to use, like, you know, screening pipeline type systems, where they're using their accelerators and saying, okay, they're vetting companies, it's like, okay, these companies, we've seen, they seem to have do it, right. And then it's clinical validation. So hey, we're gonna, we're gonna put more into these companies that look like, you're just, you're just being more careful about where you're putting your money, instead of like, Oh, that was a great sales pitch here. You know, it's obviously an oversimplification. But I mean, like thinking about what is valued and like, so I think the process of how we create valuation for some of these companies, and how we fund some of these companies, is also important. Who we give it to, are you giving it to the person that really has the best science backing what they're doing? Or is it the person that delivered the best pitch? You know? Or do you need a combination of both? Right, you need to be somewhere in the middle, right. And so I think that's, that's a huge challenge. And I think if you're looking at, you know, that I saw that article, and I'm like, you're measuring what's been funded since 2021? It's like, How the heck are you going to look at outcomes, like from, like, publish this in five years. That's how you get you know, I mean, just like, like in health care, quality improvement, I'll say, it's like, the cycles, like, unless you're measuring data every day, you're usually measuring data in weeks and months, you're not going to know for a long time, you know, that's why you have to be like constantly iterating. And that's why I advocate for something like process improvement. And looking at your data and metrics on a continual way to really know if you're, if you're going in the right track and succeeding, you have to be doing litmus tests constantly,right. And so I think it's more the process, the process of how digital health companies are being funded, how they're growing, that, in the getting the right types of people in the right mindset into growing them, that will probably drive more success, or hopefully, can drive more success in some of those companies.

Chris:

Yeah, think, I think you have the right values. And I mean, I would guess that it's going to be the 20% of the companies that actually built something of impact and value that's demonstrable to the rest of the system, that are going to be the ones that are ultimately very successful, regardless of the unicorn start or not, right? It'll be the ones that actually had the provable clinical outcomes. It'll be the people that created the patient engagement tools that patients will actually use, or the people that create the physician tools that avoid alert fatigue, that physicians or people that work around them, the care team will actually use. And like you said, that's going to take time to play out. And, I mean, it sounds like you know a lot about that process of making sure that you get to those points, right. You know, I mean, I was one of those entrepreneurs that failed my first time, because I thought I was smarter than my users and thought I knew everything and I, you know, I studied design, but that I designed for myself, even though I was at the target user. And yeah, so I think having that methodology, right and those learnings and, you know, being humbled and having the mentorship that you've had is so critical to making, right that that startup journey more of a step by step, right in which you can, with the right process, iterate towards success not to start out with the master plan that's going to be the one that wins five years from now. Because that almost never happens, right?

Tariq:

Yeah, yeah. Yeah. And I think, yeah, showing humility is probably an important thing. And like learning, it's like, you know, I'm never gonna do what I did the first time. You know, I'll make maybe a different mistake. Right? They're gonna make that, that other mistake I made without, with going too big and too far and going for the moonshot. You know, that was too big, early on. And, you know, but there was, you know, and, you know, there was one other story that I wanted to bring up around intrapreneurship versus entrepreneurship, because we're running on time. There was, in 2012, I got married to my wonderful wife, Christy. And one, of one of our one of Christy's my wife's family friends was Jerry Helton, and Connie Helton. And Jerry is his amazing investor. And he's on a million boards, if you look him up, he was, he was the senior VP at Oracle, you know, with Larry Ellison, back in the 90s. And so just a really, like wise business guy, and just to really, like, just wonderful person and, and really thoughtful, so they took us out to dinner to celebrate our wedding because they weren't able to attend and they want to kind of, you know, you know, celebrate us and so I, I just finished this ambulance product, and I was just hot to trot and be like, Oh man and you know, it's like, I want to do this for, you know, I want to be an innovator and maybe I should go and do a startup. And, and I remember I asked him, when we were, you know, hanging around eating dinner and he kind of just in his really gentle way. He's like, he was sitting next to me, he's like, Yeah, you know, I think you, I think I'm just my advice is I think you should stay  and I think you should learn more about the company, you should work on your skills, you should learn more about communicating and pitching, just give it time, do another ,don't like run out there. And I was like, okay, you know, even like, oh, wow, this, this, I should listen to this guy. He's like, you know, he's like a Silicon Valley, you know, kind of legend and is out there. And the best thing, you know, the community and, and it was such great advice to realize that I didn't have all the skills I needed yet. And continuing the intrapreneurship journey allowed me to cultivate more skills, and develop leadership skills and communication skills. You know, that have made me a much better entrepreneur and change manager, quality improvement physician, you know, quality improvement expert and physician leader. And so sometimes, you know, getting, getting that advice and listening to it can be really helpful, because you may need to grow and develop a little bit more. So, like, that was one thing that was really that, that molded my decision to be an intrapreneur, as opposed to just leaping out and going because I actually had an opportunity, and I think it was 2011, 2012 around then, you know, someone's a great startup founder, like say, Hey, you want to join me, join my startup, I need someone to help with my products. You've done some cool stuff, I met you at the Garfield center. And, you know, and I declined it. And I said, you know, I really got to learn, and it's been really fantastic to continue this journey and learn more than if I would have left out left at that time, I probably would just made a huge pile of mistakes, but now not inhabit in the safety of being in a company where I can like, Okay, I'm gonna fall back to my day job of like, running a division, or helping to, you know, be a leader, you know, and gain all that, you know, gain all those skill sets and be mentored further. And even that, even that second startup guy that I turned down, I'm talking to him at, like two hours. Still in contact with him. And we're sharing our, our product development stories and demos. You know, it was like these, these, you can make these decisions, but you should listen to those around you. And I didn't always listen, when I was brash and young, and there's some people out there that really can give you some great advice.

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Chris:

Gosh, I learned that too. I was brash and young, and I would hear people but not be listening to them. And there's that saying that, hey, when a student is ready, a teacher arrives. It sounds like you had some great teachers at those right moments for you. Gosh, so I guess there's two more questions that I have. One is, do you have a single piece of advice that you would give to physicians who want to be intrapreneurs, entrepreneurs who want to be innovators within healthcare?

Tariq:

Yeah, and I kind of mentioned this before, but I think, I think the most important message is to like, essentially know,  know thyself, right? Okay, just think about, you can, you can be good at ideas or code or have some skills or you know, a bunch of skills, but it doesn't mean anything, unless you really know why it is, you want to go and be an entrepreneur, why you want to take that step out. Because, like, for me, like that means like, you know, to really get into it at the level that I want to be transformative. You know, at some point, I'm gonna have to probably leave clinical medicine or make it a very small part, you know, or, you know, small part of the work that I do, because there's just, there's just not enough time in the day, and I thank you, for my family can't work 100 hours a week, anymore, you made that mistake. But, you know, there's, you just sometimes can, can't do can't do enough, or can't do all that, right. So, so, understanding what your purpose is, what you want to achieve, and why you want to become an intrapreneur, is the most important exercise that you need to do first. And if you need to, like, you should probably write it down, and then walk away from then come back and look at it. And think about it, because it's a tough, tough journey. And for a lot of physicians, it's, it's the same as making the decision to go to med school, it is a tough journey. And so you made one tough decision and went down this road. So now you want to, you want to change and, and take on another one, you better have it set in your mind why, right? And then take a pause and think about talking to the people around you have any idea. Because you may talk to your spouse, or you can talk to other people and like, that's not you, you're just being, you know, charmed by this cool idea of, you know, you're like the, like the kind of the high of like getting a successful product or, you know, you're you know, you maybe you got some money out of something and you're like, oh, I can do this, you know, just just take pause and be thoughtful and think about why you're doing it. And then, you know, I think that's the most important thing to do first, because then you can, you can go out there with purpose. And when you establish that that's going to make you do all the hard things that are necessary to really be an entrepreneur, which is really hard. And it's different than what a lot of us learned at our medical or professional health schools or nursing school. Its a different thing , you know

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Chris:

Got it? Well, yeah, I'm hoping some of these physician entrepreneurs come to you for advice on what it's like, during this podcast. Last question, Tariq is, you mentioned this idea of a medical food truck model? And I thought it sounded interesting, just even on the face of it. And I guess just taking out your crystal ball or wish list, like what is your ideal state for US healthcare and a little bit more about what a medical food truck model represents?

Tariq:

Yeah, I mean, that's yeah, I mean, that's kind of a funny little quip that I throw out there. But essentially, the root of it is, I think about, you know, trying to get a healthcare system that is not necessarily centralized around the medical center, that are put in these places where it starts to, you start to build out those social determinants of health, that are then barriers to getting the right care like distance and transportation and, and financial resources, can you get off work to get to something? It's like, how can you get care, the right type of care, and get it spread out to communities and get closer to people? I think part of that is virtual. Right? And so you can, you can do things, if you take care to make sure we're getting the right, do they have do we have to subsidize smart devices or little like Wi Fi, you know, devices out to people that are in communities that don't have them. I think it's, the there's a danger in if you go all virtual, you can't go all virtual, because you need to lay hands, you know, as these providers and have face to face relationships, too. So like the virtual care system, is part of your ecosystem that augments the care that you deliver, when you lay hands on people, right. And I think that care where I get to the medical food truck idea is that it doesn't mean that you have to have somebody drive into your hospital. Why do we have to do it that way? It's I mean, we it's built around resources,  the resource where we spend a lot we spend millions or you know, a billion dollars to build our concrete structure someplace so we can house everyone for our convenience. We put a lot of costs into overhead, but what if we, what if we made those smaller footprints so we decentralized our work? We got out to the community. You know, like thinking about a medical food truck where you're, you're getting out there and communities and using, you know, like working on a mobile health vehicle for University of Kentucky to and so you know, like it kind of continually doing some of those things that are really neat to get out there. So reaching out to the community. Also doing you know, expanding home health services, it's like you can ,you can we do some of this at Kaiser, you throw some of these things in a backpack, and take our router in your laptop, and a little camera, pop it up and, you know, get get providers out there that can do do visits out in the community. And then when you need extra support or specialty support, why not connect with them? You know, people video, can you get remote digital devices? Can you do point of care lab testing? Can you do point of care ultrasound that is in your kits, you know, can you you know, you basically have like a medical Uber service that gets around and gets providers connected to people, you know, so it's just like, you're changing the distance a little bit, but it's not all one way. It's not all, you know, healthcare centric, it's like, you're gonna come here, you know, that may be that, you know, it has to really build on a philosophy of population health management. So you're thinking out there, it's like, your visit is going to be to the home and you're visiting the family, you're not visiting one person, you're gonna see, like, what are all the impediments to health care, that's within the system and within a family, right? Instead of just like, you know, the husband or the kid comes in for the medical visit? And then you, you try to do anything, but if you get out there and see what, what are the conditions are they living in? What are really the barriers to delivering healthcare, making them making everything really patient centric and family centric? You know, I think that is a really nice ideal of like, something that we can get to, it doesn't have to be, you know, people worry about like, what about payer systems and that socialism, at least like silly things, like now you can mean you can have, like a population, Kaiser is very profitable is like, very much capitalistic, but taking a different viewpoint on like, you know, kind of like Scandinavian countries about how they deliver their health care model. So you don't have to, you don't have to, you don't have to like conflate like the way you deliver your health care with your philosophies on , you know, economics, what that means? Or if that's political or not, right? You guys build up things that are different. But it also means that your payers have to recognize a different world. And I think, I think that's, that's really interesting. So it's, it's kind of a fun, thank you for asking that question. Because it's a fun theoretical this conversation to have. And I remember before leaving Kaiser Permanente, I kind of throughout the concept of like, what if we had virtual care children's hospitals? Because we, it's hard to build a children's hospital? And then, you know, for our we took care of like, you know, almost a million children. But where do you put one hospital? And if you put it one place, now, do you make everyone have to drive to it, but what if you virtually decentralize it? You know, I think those ideas like that are really interesting. And it is possible, extremely difficult, but it could be possible to build those things with the times.

Chris:

I think that's exciting, Tarqk. I mean, if there's a web 3.0 Right, crypto, why not a healthcare 3.0 decentralized, community driven, accessible to anyone. I think that's an awesome vision. And I'm happy we got people like you trying to lead us in that direction. Tariq, I want to thank you so much for your time, dropping so much knowledge, your contributions. And gosh, I wish you so much luck in your life as an innovator, and appreciate you coming on the pod.

Tariq:

Chris, thank you so much, really appreciate your time and, and really enjoyed having this conversation and getting to talk about all these things. I think this is fun. And so and hopefully, you know, we'll be, we'll be speaking more in the future or sharing ideas and crossing, crossing paths in the innovation world. So

Chris:

I think absolutely, and I know a lot of startups that would love to talk to you. So we'll be in touch. Thank you, Tariq.

Tariq:

All right. Thank you, Chris. 

Chris:

Okay.

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