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: Welcome back once again to the Outcomes Rocket podcast or we chat with today's most successful and inspiring health leaders. I really thank you for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's guest because he is an outstanding contributor in health. His name is Dr. Andrew Lé. He's the CEO and co-founder at Bouy Health. At Buoy Health, they're leading the care tech movement. As opposed to the prevalent view that artificial intelligence and technology is something to be feared, they believe that technology can provide care for people with that aim, they're creating a computerized concierge doctor to provide personalized medical information in place of late night Google searches and scary internet forums. At its core Buie is a machine learning adaptive diagnostics generator with the ability to express compassion and humor and Andrew here is going to walk us through some of the highlights the things that they've been up to and the advances that they're making in artificial intelligence with Bouy health. So without further ado, I just want to give you a warm welcome Dr. Le.
: Appreciate that, Saul. thanks for having me on your podcast.
: Absolutely. So what is it that got you into the medical sector to begin with Andrew?
: Sure. I mean I've always dreamed of being a doctor so I learned from a young age just playing with some toy sets that my parents gave me. You know shots, toys stethoscope and ever since that age 5 I want to become a surgeon.
: Very cool.
: On a single track mind up until the fourth year of my fourth year of medical school until things kind of changed. Obviously I'm still in healthcare but not a neurosurgeon, in a very different career path.
: So what happened? What made you shift from neurosurgery to which you're interested in now?
: Sure. So I was doing my last rotation of medical school in the ER.
: And I was seeing patient after patient coming in having googled their symptoms before making a decision and ultimately guessing as to what they have in order to make a decision. And that gets very often being wrong and that leading to patients who are coming in when they shouldn't have or they were actively endangering their own lives by sleeping something off when they could have come in early and we could have done something less drastic.
: That's really interesting that it just kept happening.
: Again and again. And when you're seeing that you go into medicine thinking I'm going to be the frontline I'm going to be part of the first responder that, you know one of the first responders that gets people to do the right thing at the right time and seeing you know being in the E.R. you quickly realize that you're far from the frontline, the frontline is truly the internet.
: And unfortunately what tipped me over the edge to take a much more risky path in life was my dad he had a mini stroke right around the time I was experiencing this. And he didn't go to the doctor. When I asked him why did you call me or I have two sisters both in health care as a user are you guys working. I said okay, why didn't you google it? And what you said back was you know, what am I going to find on google? And it was at that moment where I knew I had to do something so I took a sabbatical school and started to believe about 5 years ago.
: Man and has everything turned out okay with your dad?
: Yeah luckily it was a mini strokes. His symptoms went away and...
: Thank God.
: Really good job. Thank you, appreciate that Saul, you did a great job persecute episode to take care of himself, doing great now. So, I appreciate you asking.
: Yes absolutely, brother. A blessing that he's okay but at the same time it's like you're getting struck here with a message from patients coming in and then eventually your own dad that just led to the tipping point of saying you know what, I'm going to do something about this.
: Yeah exactly. Exactly. And then once I got started doubting us sailing very low lows. Those highs we get addicted and I remember I went back to medical school to finish a few rush requirements and I went from being very enthusiastic about what I was working on in the hospital to being I could, I was counting down the days just go back to working on Buoy and scaling something that could really change the way people consume healthcare. The way people don't understand disease and ultimately the way that humans basically treat their own illnesses.
: That's super interesting, Andrew and I love your passion for it as you dive through some of the things that you guys have done there, what would you say is the hot topic that every medical leader needs to be thinking about today?
: I mean it sounds really trite but the thing I hear time and time again is about the consumerization of health care. And every time someone talks about that the next five presentations on the about or here are things that are helping the grease the wheels of the system that are servicing the system itself. So I suppose it's helping doctors, helping administrators, helping payers, etc. It can all of the different middlemen that access care. That's still a major driving force of startups these days. But I would say that when every time I do hear the word consumerization it's coming just like the travel industry was offended by the ability for patient you know for people, people to take control of how they travel. People are going to take control of how they consume healthcare and it's just a matter of time.
: That's a good good analogy. I think we oftentimes forget that disruption that has occurred in industries like travel or even the taxicab industry for that matter I think that's more of a common one. But as you think about consumerism in healthcare what are a couple of things that you'd highlight for the listeners that are important?
: I would say that we really focus on and we really start to understand the is the care decisions. So how patients make decisions about what to do when they're sick is something that has been really ignored for the most part. And let me kind of go into that, to use the analogy of going to the mechanic. The demand for healthcare is very similar to the demand for car repairs in that as of right now it's dependent on an expert telling you what you need. So just as you're going to mechanic, the mechanic tells you need X Y and Z service for your car. It's very hard for you to say otherwise because you don't have expertise in understanding what it means to have X Y or Z broken them in and what it means how to fix. And similarly when patients are trying to consume care whether they go to a walk in clinic you know CBS walking in a clinic and urgent care, in E.R. A PCP, a specialist, call a nurse line, whenever they're essentially trying to access an expert in order to understand what is the next step in order to get them healthy again. And as healthcare. With the proliferation of a telemedicine nurse call centers and even building as many mini clinics and urging care as possible. They're trying to scale the access to those experts in order to help better control that care decision. Now I would say that consumerization will come in the form of better more scalable ways of helping patients make better informed care decisions. And so when we think about what we're doing essentially you could boil it down to. We're providing patients super personalized facts and information that guides them to do the perfect next thing that's going to get them healthy. And in doing so that's going to allow nurses and doctors and care coordinators and health care coaches to really practice at the top of their licenses and to enable to offload the burden of guidance and care decisions away from experts and do it having more scalable AI.
: Fascinating. I think that's super fascinating, Andrew and this is sort of like bringing the power of decision making very specialized decision making, health decision making to the consumer. Can you give us an example of how you guys are doing this at Buoy health and maybe a success story something that you guys have done to improve outcomes?
: Sure. So how we work, we have two different offerings and we have Buoy free and then we have an enterprise solution that we license to hospital systems, payers, self-insured employers, universities, governments even. And just kind of breaking down the two different use cases and talking first about Buoy free, so we released a free version of our product back in March 2017 and by the end of the year we had 2 million users. And this year brought Pacer somewhere between 20 and 50 million users
: Wow. That's exponential.
: Oh yeah. No I appreciate that. And in the short term what these users enables us to feel our machine learning. So the more people use it, the better the product gets. It also enables us to iterate on changing behavior. So like I said we're trying to help people make better care decisions and what that means is if people's baseline ability to make their decisions is core which I would say I there are any number of statistics that support this. The number of ER visits that are unnecessary. The number like we always post is 56 percent. The number of urgent care visits that could have been taken care of and telemedicine a number of primary care visits that are referred to as specialists that are needed by patients that are really are necessary in such at 50 percent. So I would say first off that are under people's underlying to make great care decisions as of right now is low. And as we began to optimize Buoy free what we're optimizing is presenting information in a way that gets people to make better decisions. So that's the purpose of having Buoy free. And the enterprise what we're licensing is the ability to customize the end up point. So if we're educating this person that urgent care is the right next thing to do. Right. From a health system perspective can I now maps this person to the urgent care that I have available and then let them know here's where you should go. And now you have this end to end experience where someone went from being sick and uncertain and scared to being informed and now being empowered to actually take action into the action. So that's what we're working on right now in terms of outcomes and what our success rate is with our early systems that we deploy, we have two systems that are alive right now. What we've been able to show is that we are capturing patient information when enabling a booking at about somewhere between 5 percent and 20 percent of time for patients which it doesn't sound you know if we're to create this on a zero - hundred ABCs scale it doesn't sound great but if you consider that this is a self-served mechanism with no need for human intervention it actually is a huge percentage of the time where we are unable to enact some sort of behavioral change which for us is a super exciting. As you know it's those incremental changes in behavior that really have huge benefits. You know when we played out over millions and millions of people in a way where the marginal cost of the solution is zero.
: Andrew that sounds really interesting and so as you guys continue to be scaled a product, more people are learning about this. How does somebody typically find their way to Buoy? Are you guys doing marketing or are you guys doing word of mouth like what's that look like?
: It's a combination of word of mouth and inserting ourselves into the Googling process. OK so we understand 72 percent of americans Google their symptoms first before they do anything else. And for us to want to change that habit it would it's in our opinion that it's foolhardy to just market the heck out of this and say yeah you know next time don't Google, go to Buoy. Especially because most of the time that that marking talk is going a healthy ear, a person who is healthy.
: Our other kind of like real Corton is that people tend to not care about their health mostlike to be sick. So you put those two causes here first when you're sick or googling first. Second, if you're healthy you really don't care about healthcare. The concept of blasting using Buoy everywhere means it's we're not going to have a lot of success to get people to go directly to us in the early days where we really need to do is insert ourselves into the habit itself. So we actually are optimizing finding Buoy on Google and that's how we're driving a huge percent of our traffic. And then over time as you will have a great experience. What we're hearing is a lot of word of mouth growth. For now people are going direct. So it's a real combination of first inserting ourselves into the due process and then writing such a better experience that people end up coming to us directly over time.
: That's cool and eventually hey you know if you guys keep doing what you're doing rather than say hey why don't you google your symptoms. They're going to say why don't you Buoy your symptoms.
: I mean that that's actually with our of our friends of family and people who write to us on our support line that's literally like what they're saying today. So I'm a doctor I used to get phone calls all the time from my family members asking me for stuff. And it's only now I only get phone calls after they Buoy-ed it. And so they'll go and they'll call me and they'll know like they won't asking questions or saying hey check Buoy, Buoy said this.
: I love it.
: Whata are you thinking? Feels great because I told me my family and my dad was sick and now these companies built something that is helping people I love so it's super gratifying.
: Nah it sure is man. And kudos to you and your team for challenging the status quo and doing things a new way. I think it's super super interesting what you guys are up to. Take us to a time when you had a setback or a failure and what you learned from that.
: How long is this? How long do we have? I can start with I guess one of our dramatic failures. We went without cash for about nine months at the beginning from when the started founding the company. And about two months in to those nine months I was working out of our, I was living in my apartment and my co-founders were actually crashing and we were using the Harvard innovation lab as office space and my apartment burned down in a fire.
: No way, are you serious.
: Yeah seriously. My co-founder is actually were picking through the ashes like the ruins apartment with the salvors message. But you know they went back to their respective apartments in other cities and I basically chopped surfed for a solid 3 - 4 months so I was like literally homeless you know trying to get this company on the ground with no funding. At the time.
: So I mean what I learned from that is let's go back let's say the company fails and back. You know just car surfing what a ride. I was already at point. There's only. There's nowhere to go but up. There's a lot of times when I get faced with issues on a daily basis just think that well. It just puts everything in perspective.
: That's for sure and you know the other thing too. I think what you learned Andrew is that commitment that you had to the cause.
: That's true. That's the way you put it Saul.
: You know because if you, if you didn't you would have quickly found a way. Harvard M.D. yeah you've got a lot of ways to make money and so you decided to stick through it and now you guys are moving and shaking and things are looking more promising and even more promising each year that you guys go through it.
: I appreciate it Saul.
: Absolutely. So what would you say one of your proudest leadership moments to date that you've experienced with Buoy.
: I would say there's a couple of moments that really stick out. One I kind of alluded to this earlier but one of my aunts she had some chest pain and they were worried that she was having a heart attack and her son, my cousin basically said Oh let me Buoy it first. Buoyed he did. And Buoy ruled that it was Costochondritis, which is inflammation, the joints that connect the ribs which is really common in something that often gets confused with the more serious. My aunt didn't have the right wrist back to profile to really warrant it nor like does the race entomology that we decided was this doesn't look like something carby after an orgy. So she decided going instead of going to emergency room at 2am to wait till the next morning to her primary care doctor who kind of confirmed what we had said. And my cousin relayed that back to me at the time we didn't have you know, we didn't have users, we're still in the family and friends phase of Buoy. I remember being getting very emotional and just saying we went through all of that. Been at it for at that time 3 - 4 years and honestly I felt like I could have you know we could have failed that day and I still didn't have because we instilled something that help the family member. At this point if we just leave the servers on and just walked away and lay down and be implanted somewhere we would just passively be helping people forever. That just so gratifying to to be able to that to a point where we could help some people. There's always more things that we can improve on and get better at.
: That's fantastic and I'm sure your family was grateful to the resource.
: I hope so.
: Hey so so Andrew you tell us a little bit more about an exciting project or focus that you guys are working on today within Buoy.
: Right now we are really figuring out how intent changes. So it sounds vague but as I said you know we're really in the business of understanding and changing the care decision and one of the things that we really need to understand is actually how person's intent changes throughout the process. And so what we've rolled out that relatively recently is actually asking people upfront. You're here, what do you intend to do even before going through this process. Then comparing that with what they ultimately did in terms of you know where they seek care, what type of care, where they're diagnosed with and then really seen the delta between their original intent and what they ended up doing. And now that we have that close loop as I said we start to iterate with thirty eight thousand people on site day and figure out how can we make people make better decisions. How do we make them delta between what they intended to do originally was ultimately greater for us that super exciting. So moving the product the way beyond just something that can check symptoms does something that is really guiding people on their journey. Having a real measurable impact on patient behavior is that next step.
: That's very insightful. I think it's given them what they were looking for even though they didn't exactly tell you what they were looking for.
: Right. Exactly.
: Andrew, that's so cool and big kudos goes out to you and your team for continuing this journey. I also personally believe that AI is augmented intelligence not something that's going to replace so I'm there with you guys I'm going to be rooting for you on the front line. And so let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine. It's the 101 of Dr. Le. And so I've got a syllabus that you and I are going to construct through a lightning round. Four questions followed by a book and a podcast that you recommend to the listeners. You ready?
: All right. What's the best way to improve healthcare outcomes?
: Think about the patient outcome in the most transparent kind of truthful way possible.
: What's the biggest mistake or pitfall to avoid?
: Assuming that if you built it, they'll come
: I love that one. Those bad assumptions made so much isn't it?
: Especially in healthcare.
: Oh gosh. Love it man. How do you stay relevant as an organization despite constant change?
: I mean it sounds trite but to continue to a line every piece of strategy every piece of work to improving the patient journey.
: What's one area of focus that should drive everything in a health organization?
: The patient. I'm sorry that must be so boring.
: It's right. I mean it's good. It's good. What is it you know these are intended to just bring out what's at the core. So listeners you very much well know what Andrew here is focused on and why he's doing what he's doing on this syllabus Andrew book and what podcasts would you recommend to the listeners.
: Yeah if designing a syllabus, I would actually read Shoe Dog its autobiography by Phil Knight was that founder of Nike and how their singular focus on the runner the athlete was the main driver of their success but then also just reading about all of the problems they faced to build. Such an iconic company kind of take for granted how powerful and influential they are now. At one time they were reselling asix. So it's such a cool great story really moving in I feel like it would apply to what we're trying to do in healthcare.
: That's awesome. And how about a podcast?
: Besides yours. Besides yours is probably a pretty basic answer but I'm a huge fan of NPR's How I built this. In every episode you hear about kind of in a similar vein a shoot out of fearing who they really are representing and then basing all of the naysayers and all the reasons why they shouldn't be doing something for somebody and then them overcoming it. I listen to it every single day when I walk to work. Just. Kind of get the juices flowing.
: Awesome. Some great recommendations listeners please take note of these things by going to outcomesrocket.health/andrewle. It's Andrew and then le. You gonna find all the show notes as well as links to the books and podcasts that he recommended in this short syllabus that we constructed for you. Andrew, this has been a ton of fun. Before we conclude I love if you could just share a closing thought and then the best place where the listeners could get in touch with you or follow you.
: Sure. Are we just kind of close. Simply by saying that we hear all the time that health care is broken and I think where I came to it was either I was going to continue to be a part of the system that was broken or I was going to make some incremental change or difference. I hope that the listeners choose the of the latter group no matter where they sit right now within healthcare and they can reach me directly firstname.lastname@example.org my email or my Twitter's andrew_q_le You can find me on Linkedin as well. Our website www.buoyhealth.com.
: Outstanding Andrew, appreciate that. And listeners take Andrew's call to action. Get on the active side of the equation and do something for health care like him and his founders have done. Andrew can't tell you how much I appreciate you spending time with us today and we're really excited to follow you and your company success.
: Thanks so much, Saul. I really appreciate you having me on your podcast.
Thank for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.
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