Category: Medical Device

Demystifying Blockchain and AI in Healthcare with Sam De Brouwer, Cofounder, COO doc.ai

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I have an amazing guest for you today. She is an outstanding contributor to Health Care focuses on the areas of artificial intelligence and block chain. You don't want to stick around. Her name is Sam. De Brouwer. She's a co-founder and chief operating officer at doc.ai,a block chain based AI platform that enables deep Learning computations on a quantified biology to develop personalized health insights and predictive models. She also cofounded Scanadu in 2011 where she served as V.P. of communications until 2016. They've got a fascinating device that has consumer facing mobile medical device that allows to read and understand outcome of a urine sample all through the mobile phone will be touching on some of her experience there. She's been involved in that even ICO's initial coin offerings. We're going to dive into what this very fascinating entrepreneur and health leaders up to. But I want to do is open up the microphones who are amazing guests Sam to fill in any of the gaps of the intro that I may have missed Sam. Welcome to the podcast.

Thank you Saul, very very happy to be with you this morning and your listeners.

It's a pleasure to have you Sam. Anything that you want to share that maybe I left that in your intro?

No I think that's you to know is just that I've been just maybe that I'm being an entrepreneur in tech and science for the last 25 years. I moved to the U.S. in 2011 2012 to specifically moving to healthcare. Before that I've always been in the tech and science. I originally come from Europe more specifically from from France. I'm French.

Fascinating and wonderful company. That's pretty far ahead and their health efforts so it's always great to have the international touch on the healthcare system. And Sam it's folks like you that that help us see things from a different light. So wondering what is it that got you into the medical sector to begin with.

Sam Yeah well that's a that's a great question that's also very personal for me so I have two kids two boys and a pretty grown now but back in 2005 our youngest son has had a very severe accident.

Oh my goodness.

Very very severe brain trauma of brain injury. So he was in a coma. We spent a year in the hospital. And that was crazy. So back then we entered a journey that so many people enter. We chose we were so scared, we were powerless. We did not understand what was happening. I didn't know anything about health care. So the machines, the result,the language and I was coming from tech and science that was was so so I felt so powerless because I had no information no data I had nothing. And so I think what happened there for years with my husband, we kind of with cope with this situation and survive by becoming very analytical about the situation. Yes. And that was that's how it started really. And so I think you know with the rise of the smartphone then you know we were very much following what was happening. You know with sensors becoming cheaper and smaller and the rise of A.I. again. My husband Walter was also my co-founder for the last 25 years happens to have a background in artificial intelligence and so he went through the AI winter as we call it. But then he so is still the revival. So he's coming back and it's just connecting the dots and trying to do something that matters that can help us as a family and our son but also trying to help others and this is how it started really. And so you can see ignorance about the health care we need a lot of research. We knew a lot about the tech and the science and that's how it all started really.

Wow. Sam thank you for sharing that very personal story. And you know the confusion, the just the helplessness that you feel when you're there at that point whether it be you or your or your loved one in your case and you decided to take the matters in your own hands using your science background and your husband using his AI background. Here you are now ten years later founding these companies to make a difference in your life but also in the life of the people that surround you. You've been in this for a decade now. Sam, what would you say is a hot topic that needs to be on leaders agenda today and how are you guys approaching it?

Oh OK so a few things. Number one certainly artificial intelligence. I think that's what is happening right now. So number one when we started the very first company, we started using a lot of machine learning. There are a lot of things that human beings cannot do and you need to augment number one with this scale problem. So there are not enough doctors that's one so you really need. You need machine intelligence to be able to augment and capture older people who need it. But he's also in the entire chain. There are a lot of things a processing It can be reading colors to give a result or it can be processing data to have better models. All that has to be done by machines so certainly artificial intelligence is number one on my list. I think also what is very interesting what I'm seeing right now is healthcare that we did not really see before. So we've been talking about big data for a very long time and we have all been focusing on data. So healthcare happens to be an industry with a ton of data. What is happening is that I think everybody has been focusing on being able to share that data which has been difficult because this is not how the healthcare systems and industry has been designed for it has not been designed for the data are to be shared so pretty hard to you know be there. However what's happening right now is that there is not one industry on the planet that is not using artificial intelligence with the data to have better predictive models. It's the only way and we need to have better results, to be more efficient and to survive as a business. And I'm seeing that happening right now with the health care industry so a ton of data, The AI has become much much better. We also have the possibility to work with better data, structure data. We have learned a lot from there and I see the healthcare industry suddenly really trying to have new predictive models with that data and that that's a new element and that's very interesting for us and it doesn't matter if we're talking about payers or providers or I mean everybody wants to use that data in order to have better models otherwise the data become toxic. There's another thing that has happened recently. I've been working a lot in regulating environments and I kind of like that because regulation can be very difficult when you when you are an entrepreneur. However I think it can be a great source for innovation and we see that with the GDPR for example you know the new regulation coming from Euro, you that it's affecting US companies as well because data is global you know it has no frontier. And so that the GDPR is really pushing a new competition that is key I believe true progress in healthcare is to give people the data back and I think that's you know that idea of you know opting in consent that cannot be used anymore without people's consent. I think that's a great great sea change when it comes to healthcare because you see what I have learned my very very first impression when I was at the hospital with my son is that I didn't have access to my son's data and no one could give me access. And one thing I know as an entrepreneur. One thing I know having built companies and you know having dealing with technology all my life is that you cannot change the date of tomorrow if you don't know the day of today. And I think it really applies for patients and consumers as well. And so I'm very hopeful because today I think that if we are able to enable people to get their data I can be able to store them themselves and play. We need to make it smarter and you know keep on collecting and understanding it better. I think this is really a way for people to be able to change that data. But first they need to be able to collect it. So artificial intelligence certainly are very very high on the list.

Sam you've offered some great great insight here listeners if you're understand today's data you're not going to be able to change tomorrow's data. Good friend of mine always says you got to be able to control the controllables and measure them. Sam give us a case scenario of a client or a type of customer that you work with. What problem do they present with them and how did you help them solve it?

Yes so at doc.ai so we started 18 months ago. We are we are young starter and we've been building building building for the last 18 months. I am very lucky I have an exceptional team and very early on what we understood is that you know when it comes to artificial intelligence, everybody's trying to change behavior or change models. It's very important to understand that you cannot change if you cannot predict and in order to predict with the AI, you need to be able to collect the data so not real one. What our ecosystem allows people to do is simply to be able to collect all the medical data all around coming from all kind of BPIs those owns tools that we have been a lot of course medical records but also lab tests, blood test, urine test, gelati test, your environment will be expose mix, your microbiome information, your physiom, your phenom. So we have developed a system where people with their phone or their laptop can collect all that data in a very frictionless way and store it on their device on their own device that data like I'd spend before is structured so under the form of OMICS our bodies on 10 million of biomarkers and those biomarkers are structured under informal OMIC's and so those are biological field and that structure is very good for the AI. It's numbers, colons, rows. This is a very very good start. So that's number one. What we're doing right now so we are working with companies that are in these in search for new predictive models and those predictive models they can present different solutions or try to develop frameworks for it to see what AI could predict. So let me give you a few example that we are going to announce very soon by the way. So for example can an AI predict your risk for allergies, right. Can an AI predict the most optimal anti epileptic drug you take on the epilepsy problem. There are 26 anti epilepsy drugs. You can ask any neurologist, they will all tell you they were a lot of trial and error. They don't have any model they don't know what to give when they have patients and all of being epilepsy. They just try and see if it works. So this is not precise, right. So we also dealing with physician medicine. At the end of the day it's a fermentations problem. Something the machine can process much better and much faster than the doctor and by enabling people to collect all their OMICS data you also have a better idea from a machine perspective and from a medical perspective the UNICity that person based on her genome or other parameters so that's the kind of models we are talking about. This is what we are being on the platform.

That's super fascinating Sam and gosh. I mean you put yourself in the shoes of the doctor and the patient and you've got 26 drug options for epilepsy. How do you make the best choice. I like to think of artificial intelligence as augmented intelligence. It's a platform that not only clinicians could use but patients could benefit from?

Totally. So we have we will we really need everybody this is what I love about what we've been able to build so it's not only patients but it's also an end consumers, people who are just interested but also insurance companies, pharma, CROs, patients organization this is fascinating. I think that the fact that there are a few things we have done. You know I like to leverage on what the technology can offer us and there is a new technology, the blockchain it's not new. But I mean we can build on that so we'd be building on the blockchain in the public chain, the Ethereum. And so what it allows us to do really it allows us to do three things. Number one it allows via the smartphone tracks that you can program on the blockchain. It allows to write data matching depending on the problem that is broadcast on doc.ai that people called the data trial you know the question, "Can AI predict this or can AI predict that? You see the set of data that people can share with the project and that can be available for data scientists to build predictive models. So that's that's number one. Number two when you are a research sponsor, when you want to finance that research that as scientists you want to make sure that they reach the level of integrity in the data. You know we want to guarantee the provenance of the data which is exactly what the blockchain is doing again with a smart OnTrack because it's coming from different plats so on the blockchain on the smartphones Ican guarantee that, so the quality of that is that the integrity of good it and guaranteed.

That's a fascinating application of Blackchain.

Exactly. So that's that's very important. But I think for me one of the most important application that is very, very new and that I'm trying to explain. So thank you for giving me the floor today. That's on track for the financial transaction. So at the end of the day what we have built is a platform where we are considering that the medical data ease has value as financial value. So what we have done is we have put a financial value on every single biomarker in your body.

Really.

Yes. And then when the data matching happens when you want to participate in the data trial as a patient or consumer and you get financially rewarded for that. Right. And that's pretty interesting. So that's that's the third smartphone contract that does the financial transaction. And I find it very important for several reasons. I find it very important because I've always believed that people should own their data because it's ours. And also I think people should be financially rewarded when they generate that data and that data is used in the healthcare industry because after all that data already has a financial value we know that.

Right.

The only person that has been left out of the equation is the patient which is a pity because you want that patient to be engaged to be heard. And the last thing the last thing is in the U.S., The number one reason for personal bankruptcy is medical bills. I think that the block chain and the crypto world has this great opportunity to be able to rebalanced assymetry and it has the ethos of the open source movement and the features of the free market and that's the combination I think for healthcare. And it's very interesting.

Folks. We've got Sam De Brouwer here talking about blockchain, AI. Her work at doc.ai. And she brought up a very important stat that two out of every three bankruptcies that happen are because of health care-related issues. So if you didn't catch what we just talked about hit the rewind button and replay it if you want to do that anyway. I think it's worth revisiting the value that she's provided here and her ideas. There's no doubt in my mind Sam, that you've been thinking about this for a long time and I'm very diligently.

Yeah.

So Sam can you give us an example of how you've used doc.ai to improve outcomes. Specific example?

So we have very early as I said we are 18 months young startup so we have built the entire ecosystem. We have given access to our private data to about 500 people. We have a huge waiting lists all the testing went really well. We are actually pushing the public beta early summer so everybody can access. Yes. We have the IOS, via Apple and also the web up so online. It will be for screens free for people to connect at a time and place people own the data. We don't store anything it's on the phone. We are just an enabler. And we are about to announce our very first data . The RB has been approved and so on. So that's very exciting. So I don't know I don't I can't give you that kind of feedback. However there are a few value prob there from the patients perspective as well from the industry perspective where we see insurance is very high.

Now for sure and totally get it right. I mean you guys are early on 18 months in but creating some major traction a waiting list for people that want to get involved. And there's no doubt that the appetite for us as leaders in health care for insights using these technologies is there. It's exciting. So congrats on and building it to this point and are excited to see where it goes from here.

Yeah, will keep you posted Saul.

Please do, please do. And so folks you could find out more about doc.ai at doc.ai. So Sam tell us about a time when you had a setback or failure what you learned from that moment?

So that's hard to tell because that I had so many

If you have to pick one of the many but you feel like okay this is the one thing.

For all the founders out there entrepreneurs. I think it's very important very early on to embrace failure and to fail fast because it will be failure. That's a fact. So I think how they are. Me Really. And so to pick op one, they were all very learnful but one that is very very, I think timing. Don't wait for things which is very hard in health care by the way. that's a big dilemma, that's a big paradox but when you are dealing with innovation, you can't allow yourself to wait until everything is perfect. You have to iterate, you have to test, and iterate, test and iterate. And so when you know in the healthcare area arena it's really hard because there are a lot of things where you can't allow to make mistakes and you have to manage expectations even more than for any other software. So I mean we're dealing with a product that is with either force you can't have to dodge but that's tiny very hard. And I think have made some mistakes there and I just learn from it but there were so many so it's just it's just really hard.

Now I get it I get it. Bottom line is just create, create, manage expectations and you're going to fail. Right? So just get over it, get over it and keep building right. I love it. Sam what's one of your proudest medical leadership experiences that you've experienced to date?

So I think for me also my first medical company, device companies is Scanadu so clearly I think, one of my proudest moment is how we have been able to innovate and comply at the same time she's really really hard and how we've been able to develop that great relationship with EDI to understand what the regulator was expecting from us and what we were supposed to do and being able to build a road map together. I have been with them and it was really was really phenomenal so it's not easy dealing with the regulator but once you get that, it's something to be proud of because you know maintaining law complying is certainly not easy but it's so worth it. So once we do we create such a momentum for your team for the people who support you it's like opening a door that was not open before. So it feel special really.

For sure and I understand that you guys were finally able to get 5, 10k clearance for the product.

Yeah and so did my first company to U.S. Scanadu, just teceive it's 5, 10k clearance for the urine test. So it's one minute urine test, home-based. It's fantastic so well what we've done is we've put all these CTPs on one platform for leukocyte, nutrite, glocous, ketone and protein and you just dip that puddle in the car for you at phone and you wait one minute and it's now on your phone you take a picture of the panel and he tweaks car a change in real time between your phone and in the crowd. And it's parameter is given you a number so you can imagine for conditions such as pre eclempsia during pregnancy. You need to test yourself sample times a week for positional diabetes. There are many things really can you can follow up. And of course it's easy enough to hire a urine test reduce one minutes at a fraction of the cost of what the urine tests today. So I think for patients as well as for clinical research, the true application of artificial intelligence and do in terms of helping people, reducing the time, reducing the cost and of course when you've seen the margin for error because the machine reads numbers, alot of reading the color change only when your eyesight can be predictable. Not really quantifiable unless you go to Elaso.

Yeah that's awesome. What happens if there is like a pink film over the camera. Are there controls that would show kind of hey the cameras now properly calibrated.

Yeah yeah they are a few mechanismand you can imagine that with the yeah that's something also you have to do from a safety perspective. So number one the paddle has a QR code to verify the validity of the paddle because you can only use it once. If the paddle is not valid anymore you can't accuse it so the camera mean the algorithm recognizes that is been really hard to develop that algorithm being able to performing all those looks corridors, light corridors and if there are any elements disturbing the algorithm which will tell you that you have to redo it or take a your paddle or change on time that he cannot actually. But it took a long time. Because t was so into that operating in different light corridors and having central and corrected. That's a pretty heavy job.

Fascinating folks the products is called Scanadu. The company is called Scanadu, Sam is part of that one as well. Go to links to doc.ai and Scanadu do and other things that we've talked about AI and block chain here. The transcript everything's going to be shown notes. What would you say. An exciting project within do.ai is today Sam?

Oh we have a few but the first data tools are coming.

That's amazing.

It's just huge. So what is so exciting is the amount of people reaching out to us companies and yeah, we to know where do we sign. This exactly what we've been looking for. I think the 21st century there are few things we have to do differently when it comes to data when it comes to the model when it comes to the ownership when it comes to the inside so much we can do. But there's still a lot of work but at the end if you have the right ecosystem where everybody can work together it's an extra layer. I'm kind of exciting because as I said I think that we've been trying. There are many companies that have been trying to build models based on the data sharing and speed again. Healthcare is not be designed for that. So it's kind of art. However having that extra layer where you enable people to reclaim the medical data. We are always the eyes and becoming the seventh guardians of that data and being able to see a value of that data being able to see that in real time, it its completeness, in its do it but also its real world data and to see the value for third parties so that you can you know get more predictive insights for yourself but also how accurate research I think it's an equation that really works for everybody for all the pieces, the patients and providers the payers the people. So I think, yeah there's something in that model that is really I I'm super excited I don't I don't sleep that muchly. I have to go.

There's no doubt you guys are and some wonderful things over there folks. The executive team over at Dach has some of the biggest brains in the business. Walter who is Sam's husband Sam and Jeremy Howard's work in over there, Alan Green. Check them out. They're definitely a company to follow. They are making some really fascinating splashes in our industry. Sam we're getting to the end here. We've got four questions lightening round style. It's the 101 with Sam De Brouwer on how to be successful with AI and health care. And then we're going to follow it with a book that you recommend to the listeners and then your closing thoughts. You ready?

Yeah.

All right. What's the best way to improve health care outcomes with A.I.?

Oh it's to enable people to own their data and Souths.

What's the biggest mistake or pitfall to avoid?

To believe that to share the data within the existing healthcare system is possible. It's just not. It's not designed for that.

Love that. How do you stay relevant as an organization despite constant change?

Well we are a startup in Silicon Valley. The technology is AI, so by default who we are.

I mean yeah as I said we are filling a little bit every day in order to major in order to book major successful.

What's an area of focus should drive everything in a health organization?

Oh I think the way I look at it but explanation so I think I explained what I mean for that the value of the data of real world data for the people who generate it?

What book would you recommend to the listeners, Sam?

So my latest book is, "Skin in the game from Nicholas Tayeb. He also wrote Antifragile, and Black Swan that spoke to me DPD. I'm an entrepreneur. And so every time I do something I have my Skin in the Game. I'm also a caregiver for my son I was 19 years old today. Now he's doing much better. Isn't it Chinese fantastic. He's a..

So great to hear.

So what I do with health care is also because I have my skin in the game because my son has this skin in the game so when you have your skin in the game, winning of things is slightly different.

Totally agree with you Sam. Folks you could find all the transcript notes show notes and links to the things that we've talked about. Just go to outcomesrocket.health/docai, you can find all that there. Sam before we conclude I'd 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. So my niece and my last in the woods. Health care is really hard. I know so many people tried and are still trying. And I think deep deep inside we are all human beings and we want to do good. We finally have tools that might enable us to create some change. So do not despair. Let's keep moving. Let's move forward and let's try to make it happen. And if we can move the needle a little bit every time it's huge because we are talking about health care. We're not talking about you know small stuff and you can email me directly. I'm just going to keep my name address which samsm@doc.ai. Happy to take your e-mails and answer.

Outstanding. Sam, hank you for that message of hope. There's no doubt you guys are making some strides in this space of helping people own their data and recognize the true value of it. Excited to keep up with the progress. And again we just really want to thank you for spending time to share your thoughts with us.

Thank you so much for having me. I wish you a wonderful day. I love you.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

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Recommended Books:

Skin in the Game: Hidden Asymmetries in Daily Life

Best Way to Contact Sam:

LinkedIn: Sam De Brouwer

Email: samsm@doc.ai

Mentioned Link:

Doc.ai

Episode Sponsor:

Medical Device Design and Development Insights with Dr. Andrew DiMeo, Innovation & Design Coach at Trig

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring healthcare leaders. I really thank you for tuning in. Today we have an outstanding guest. His name is Andrew DiMeo. Andrew is an innovation and design coach at Trig industrial design firm specializing in consumer insights design and branding for medical, durable and consumer products with a background in NYC Motion Pictures. Andrew's last 20 years are in medical innovation including 12 on faculty at UNC and N.C. State North Carolina. His students coursework led to multiple startups including 410 medical and M E D I C and winning national competitions from NCEES and the NIH. He founded the North Carolina Medical Device organization and co-founded EG Gelero. Worked for Alaris Medical Systems as a design engineer, served as a business adviser and speaker for the Wallace H. Coulter Foundation and adviser to the NIHC3 eye program, director of Duke neuro innovations an on the planning team for BME idea. He holds a B.S. in physics English Literature and Secondary Education from UNC Charlotte and an M.S. in B.M.E biomedical engineering from UNC Chapel Hill and also a Ph.D. from UNC Biomedical Engineering Department. You've got a glimpse into this outstanding man and his contributions as well as his very interesting background but what I want to do now is open up the mind to Andrew himself to round out that intro anything that I missed Andrew so excited to have you on the podcast.

Well no, that was awful and very, very, very kind. So thank you so much stuff, nothing to add. I really appreciate you having me on here today.

Hey it's a pleasure Andrew. And you know you've you've been so focused and you've done so many interesting things in the space. What is it that got you into the medical sector to begin with?

Well you know I think I've always been service oriented. So you know my earliest memories of being in college was a tutor, tutor at risk kids in high schools. And I just love teaching, mentoring, tutoring. I don't know. Always been really interested in impacting people's lives to be healthy and happy. And I think I just found that being involved upstream at the Innovation stage of medical device design and development is where I found I could have the biggest impact.

That's pretty awesome. It's at your core and you've just found this this area where you could deliver on that core in a big way. You've obviously made a big splash in the industry work with very influential organizations and companies. Out of all the things that you've seen Andrew just kind of thinking of today. What would you say is a hot topic that needs to be on every medical leaders agenda and how are you guys tackling that at Trig?

Mann So what I'm looking at is a question that's being asked during due diligence over the past decade and whether that's a big company and looking at there as the team due diligence or you know investors to make an investment in a startup. And over the past decade what I've observed is the question primarily going from, hey you you know what's your regulatory pathway to approval. That's what you used to hear. And then it haven't changed too. Is there an existing reimbursement tool for this. But to day to day I feel like I hear over and over again how will this change clinical practice and when I hear that question I feel like the bottom line is that the change from a fee for service to a value based healthcare system shifts the focus to improving outcomes reducing costs and really improving the overall clinical experience. So how do you impact that. How has that addressed. Our approach is to be part of the product development process early enough to truly understand all the stakeholders and to design a form and function into products to maximize the human experience. That's the thing I would be paying attention to today is really thinking about improving the experience for everyone involved and who's using and being impacted by the products that we're making.

I think that's a really interesting call out because when we are not at the initiation phase of that design process, I think we could lose a lot. So what you and your colleagues at Trig are doing is really sort of enabling this value based care through the design itself. Can you share with the listeners an example of how you guys are creating results by doing things differently?

It's about sort of a non dualistic approach or a holistic approach. I'm going to take a step back and say hey you know the last 12 years I've actually been on faculty at NC State teaching design and innovation and what it really came down to is multiple mindsets and collaboration and what I mean by that is you know we need to be innovative outside the box thinkers while at the same time being comfortable in a highly regulated environment. And that's not so easy to do to do both of those things simultaneously. We need to embrace all of the different mindsets that we ourselves can deploy or those that are on our team might have. So so things like exploring with a scientific mindset, solving problems with an engineering mindset, understanding users needs and generating solutions with a designer's mind. And considering the business case, the economics, the legal aspects are found that when this is done will this type of multiple mindset approach and collaborative approach. We have a real shot at developing iconic solutions.

It's that window wing approach right having different hats on. To be able to get the result that you're looking for.

Yeah, it's not compromising too. It's kind of interesting that oftentimes you'll hear sort of a non dualistic approach be a compromise you know like you've got to be confident but humble and you might say that in sports or something like No you don't need to be confident but humble, I'm going to be confident and humble, it's about getting all the way. Like all in all in outside the box and all in following the regulations right, you know it's really interesting when you can bring it together in a holistic sense.

It really is. It really is. And so you've taken this career and sort of you've been in and out of industry as well as academia which I think provides for a really cool mix of those two spaces. What would you say something that has happened already that you learned a setback in one of those areas that you learn from that's made you a better designer or a better contributor.

Yeah you know if I told you all the failures you probably have to start a whole new like failure podcast, failure rocket.

Failure rocket. Nobody wants to be on that one, right but we got to embrace it.

No but all kidding aside of course failed many times. And learning from those failures is really really important. And the one that jumps out to me when I ask this question is going back to my earliest days as a design engineer at Alaris Medical Systems, I was young, I was fresh. I didn't have any experience at all. And I was put on a project to lead and develop a new vacutainer and you know vacuntainer is like the vacuum filled container to draw blood.

Yes.

And the whole idea was, hey you know make this more user friendly for the phlebotomists make it more comfortable for the patient. You know you make it you know it could be done on one hand you know et cetera et cetera. And I went back and forth between patients phlebotomists patients, phlebotomists you know trying to understand how this product was going to be used. And got it, got it really far along into the product development process. And we were, we were making soft tools you know building you know production like products to get into the hands of the users and get some some really good feedback. And when you're that far and it's pretty expensive to the company. And as we get deep into the product validation and verification testing there was a hiccup and it was it did not fit in the centrifuge at the lab, headed it totally kill the project and it was just horribly embarrassing as a young design engineer.

That's tough.

It was and it opened my eyes early to this whole idea of really understanding all of the people that were going to be impacted by the product that you were developing and all the way down to this idea that that there's like real humans inside clean rooms assembling product all day long and you know what impact are you having on their lives. You know like are you causing these folks to have arthritis because you're designed something that is just a pain to put together. Who are the people working in the labs that are processing samples as they're coming through. You know it just really opened my eyes to have to have a full appreciation from you know initial sourcing and materials to disposal, you know what impact is this product going to have on people's lives. So yeah the lesson like the journey map following the patients, the payers the providers and all the impact of stakeholders. And considering every piece of that was a big big guy there for me.

That's such an interesting lesson. Andrew appreciate you sharing that. Wow. And I'm sure you've been able to pull from that experience to help all the designers that you've trained in your in your years as a professor there and now back in industry. I think the same problem applies listeners you can apply this not only to design but also a patient going through the care continuum you know whether it be an episode of care or just taking a look at them if you're payer or an insurance provider really and like Hey where are they going. Long term care where were they before. And it's the same process that we've got to keep in mind. Like Andrews is reminding us it's that big picture and understanding how to impact whether it be a design or a patient really great share. Andrew Thank you for that.

Thank you.

So you hit that big bump. The product did it and I'm not launching because of that?

Yeah it was a complete failure. You know we canceled the product.

You couldn't you couldn't have changed the size a little bit and saved it?

Now that just. Yeah wasn't that easy. And you had as far as like a new product development team was considered before you knew it I was pulled onto a sustaining project and you only get to cut your teeth so many times. Cradle to Grave product development project. I got to work on different projects there at Alaris, got a designed patent on a vial adapter you know worked on some really cool projects. But that particular one was just it just didn't happen.

Yeah. Hey I totally get it. And now you're better for it. You know we learn more from our setbacks than our successes. But let's talk about success. You've had a lot of those successes in your life in this medical field. Can you share with the listeners one that you're most proud of?

I guess coming into this especially over the past 12 years. My proudest moments have been when when the students have achieved some success you know won some national design competition. But the one that stands out to me is for ten medical and this is there's a story that exemplifies what happens when students and faculty make it real. Not an academic exercise. What happens when hospitals and caregivers open up their doors to collaboration. What happens when an entire ecosystem of academic and professional resources come together to move ideas from the bedside to the bench and back to the beds. So 410 Medical has a rapid infusion device for circulatory shock rapidly and fuse sailing through a hand pump. So this project started out in the classroom in my classroom many years ago with students doing observations at a local hospital and it turned into an international design excellence award for Trig, the company I'm working with now and how that made it from students observing a doctor to start up company to raising money, even just all the pieces coming together for this story including the local universities down here have angel networks so there's Duke Angel Network, Carolina Angel Network, Wolfpack investor network, Israel Lams and associated folks of the local university system who have no network to finance startups that are associated with the various academic institutions around here and in this particular case and 410 Medical. All three angel networks came together and invested in the product.

Nice.

Trig industrial design came in and took it to the finish line. We've got you know local manufacturing here in North Carolina Raveling medical one of the best contract manufacturers in the country right here in North Carolina and they're manufacturing it. So from from final manufacturing, packaging, distribution, all the way back to the day that it was conceived to the financing they got it there. It just took an entire village the villagers the RTP region to get this thing to market and it's saving little kids lives. And to think that what started up as a school project is saving, saving little children's lives now is just awesome.

That's awesome. Pretty story and 410 medical is that still the company's name Andrew?

Yeah yeah. 410 medical you look it up you can probably find it right like and I think it's for medical or medical care.

Love that folks if you're curious about 410 medical. one of Andrew's proudest accomplishments I've got a pretty cool website ,410medical.com ,saving children. Pretty amazing feat that you've done there with the collaboration of your students and local industry. And now you're at Trig which is kind of cool. Tell us about an exciting project that you're focused on at Trig?

Yeah you know so something that I'm really excited about working with some of the most amazing industrial designers in the world here. These guys are just unbelievable. But you know I've been tossed around this idea I called the diligence dashboard. I don't know if you're familiar with the business model canvas. To those that might have might have heard of business model canvas. It's like a visual aid to go through a business modeling exercise and really really useful tools. These visual tools, I've been dreaming up this dashboard that takes design thinking and put together diligence factors that you would for medical device product development like regulatory reimbursement intellectual property market and technical risk. And what I say about this dashboard is that industrial design plus the dashboard allow you to present a flight simulation mode before you ever take-off. So if you think about this if you can really define a really well unmet medical need and start to conceive of solutions for that need industrial designers are just brilliant. First of all understanding or defining that need and then coming up with realistic renderings of what the solution might look like. But before you ever spend a minute investing real hard design development resources into it you can start to map out these areas of risk and get a good visual understanding of what the journey is going to look like and see can you do the flight simulation mode on multiple options. See if you've got an opportunity to take off on one and then keep your eye on that dashboard while you're in flight too coz you're going to usually typically have to make some course corrections along the way. So that tool is something that I've been conceiving of for a long time but it's really taking the expertise of what's under the hood at Trig and putting it together with the deep medical device to and an experience to develop new new tools to help help get products to market.

That's pretty cool Andrew. Now if you're a an individual, a leader at a device company or some sort of medical device firm this may be something of interest to you. Go to trig.com. You'll see what the folks over there up to and end this project that Andrew has taken up is fascinating and you guys know Andrew with his background and experience great things are going to happen. Andrew This is exciting. And what's your roadmap like when are you looking to have this done by?

We're implementing it immediately. You know it's it's minimum viable product time. So we've got a version of the dashboard..

That's awesome.

That took us weeks soon as I joined..

Amazing.

Since I joined Trig you know we started packing it right away and it's been continuous, continuous improvement mode. So we're going to be adding to that. Sure.

I think that's so awesome man. And folks when you when you have a product like this that can help you derisk any of your investment. This is a worthwhile pursuit. Andrew this interviews just been a ton of fun man and the time flies. Let's pretend you and I are building a leadership course on design, what it takes to be successful in the med device design. The 101 of Dr. DiMeo.

You're speaking my language.

We're going to write out a syllabus my man and we've got a lightning round with four questions followed by a book or two that you recommend to the listeners. You ready?

Sure.

Awesome. What's the best way to improve the design in med device?

Specialization and collaboration it's that end. Right so it can be deeply specialized and collaborate. The best way to go about it.

What's the biggest mistake or pitfall to avoid?

Kind of the opposite of that. All in one all in on specialization or compromising to meet in the middle. I think compromise is the wrong way to go or giving too deep into anyone's specialty areas. There's also a big mistake.

Love it. How do you stay relevant despite all the change?

I'm going to go back to the diligence dashboard. Keep your eye on it. The importance of the indicators change over time. You know we talked about how we went from pathway to approval to the reimbursement. You know now we're really focused on the clinical experience. That's going to keep on changing and what's important on the dashboard is going to change. And so we've got to keep our eye on it, keep adjusting it never get comfortable with it.

I've been that's such a great Kholoud and as healthcare leaders we've got to understand the dynamic of these changes. And I really love what you've highlighted here for us in this dashboard right, whether it be a dashboard that you're working on as an organization you always got to keep it relevant. What scenario focus should drive everything in med device design?

Values. I think core values is the most important thing. At the end of the day where we're trying to improve and improve life extend life, it's about happiness, it's about health. So if we can stick to those core values and do good, then everyone will benefit.

I love that. What book or books would you recommend on the syllabus?

Definitely Zen and the Art of Motorcycle Maintenance.

You like riding?

You know I do and I have been in a long time. I love to ride motorcycles but really you know the book is this is really about. It's about classical thought processes and romantic thought processes as one thing, that they are not they cannot be separated and form and function. This is sort of this whole design thinking mindset form can exist without function and function doesn't exist without form. It's not some kind of compromise. It's not making something functional and then making it look good later. It's not about having something that's beautiful that doesn't function well. It's one thing it's one device that is given the have both. So this book is a really interesting exploration of what is good and what is quality and both a classical and romantic perspective. And I think it's a key read for anyone that's interested in innovation and entrepreneurship.

There you have it folks take note of that and again you don't have to memorize what we just said. Just go to outcomesrocket.health/trig. You can find all of the shownotes, a transcript of our discussion and all the insights that Dr. DiMeo here has is sharing with us. Andrew this is this has been a true pleasure. If you can, I'd love if you could just leave us with a closing thought and then the best place for the listeners could get in touch with you.

Ok great closing thought. I'm going to say this if you're an engineer don't look for a doctor to find the problem to solve. And if you're a doctor you don't look for an engineer to solve your problem for years but work together work together to solve and unmet medical need for a patient that needs it and whether you're a doctor or an engineer designer or a business person or a scientist. Whatever you do for a living work together to solve real medical needs for the people that need those needs solved.

Love that. It's a strong message very consistent with the theme of the podcast today. And Andrew what's the best place for people to reach out collaborate or connect with you?

Feel free to email me andrewdimeo@trig.com, you can go to the trig.com website, you can find me there.

Outstanding and listeners will include that email as well as a link to Trig. But just to clarify Andrew DiMeo it's D I M E O.

Yes.

This has been a ton of fun. Again thank you for spending time with us to talk about design and med device and being impactful. It's been a really insightful discussion.

It's been my pleasure. Thank you so much for having me today.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

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Recommended Book:

Zen and the Art of Motorcycle Maintenance

Best Way to Contact Andrew:

LinkedIn: Andrew DiMeo, Sr.

Email:  andrewdimeo@trig.com

Mentioned Link:

Trig

EG Gilero

410 Medical

Episode Sponsor:

Female Urinary Incontenence Resolved with Bill Gruber, President and CEO at Solace Therapeutics

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I have an amazing guest for you today. His name is Bill Gruber, he's the president and CEO at Solace Therapeutics. They are startup company in the female urinary incontinence field. Bill is the president and CEO of interlace medical. While at Interlace, he raised over 20 million dollars in venture capital for the development and launch of devices for the treatment of abnormal uterine bleeding caused by fibroids. The company was purchased by whole logic in 2011. Great milestone for them and Bill has had extensive experience in venture capital fund raising organizational development product development and commercialization for rapid growth businesses. His mind is where the puck is going and it's a pleasure to have Bill on the podcast today because he definitely comes with that medical device angle that many of you all are interested in. And so it's going to be a pleasure to walk through some of these hot topics with Bill. I want to give Bill a warm welcome to the podcast. Welcome my friend.

Thanks Saul. Great to speak with you finally. And thanks very much for having me. I greatly appreciate it.

Absolutely my friend. So Bill anything that I left out of your intro that you wanted the listeners to know about you?

Yeah there's a lot of scar tissue that comes with all of those all accomplishments. It's all rosy. It's not all rosy. There's a really tough sessions there.

Hey man and we have a section here in the podcast where we will jump into some of the setbacks and excited to dive into that bill. But why did you decide to get into the medical sector to begin with?

Well after college I got a job with Procter Gamble and was selling everything from soap to diapers. And after five years doing that I wanted a change to an industry where with something the more cerebral and also something where I might be able to have a larger impact on people's lives. So Boston Scientific at the time was recruiting heavily on the consumer products and ultimately that's where I went and I was up to Boston Scientific for just about 10 years.

Wonderful. Bill we share that I actually also started with a Cincinnati based company sent to us and I was selling soap and floor mats. And I know the feeling right. That feeling that hey you know I'm doing a great job here but I want to do more. I want to have impact.

Exactly exactly.

Totally feel you there man. So what would you say Bill you've had some success in the corporate world. You've gone into startups and have had success, some good exits there. What's the hot topic that needs to be on leaders agendas today and how are you approaching them?

From my situation, I'm more I've shifted from big company to small companies so much more entrepreneurial and I think there are three things that really have us focused everyday and that's regulatory reimbursement and fundraising hurdles so as we try to build these companies and get products to market the new normal is that you've got to get through regulatory a huge huge bar and then immediately thereafter its reimbursement. But none of those happen unless we can fundraise from venture capitalists or family funds or private equity or anybody else who can give us capital to do that.

What a great raw response folks it's a lot of people go into business and want it to just work. They have an idea it's going to work but Bill definitely takes us through some things that are super important you want to dive a little bit deeper here on some of those Bill and your recommendations to people that are wanting to start- advice the company.

You know I think first of all the tough part here is to think about the exit before you even begin is first, right. I think one of the big issues is that people start with a great technology and then jump right in. And they haven't thought through the whole problem yet. And I think before you start a company you have to really recognize what are all the risks right regulatory risk reimbursement risk you have biologic risk biologic risk. If that does your when you actually help a patient right then ultimately you have marketing risk competitive risk. Are there competitors out there that you're going to have to unseat. And in the end do you have exit risk to somebody want to actually buy you or does everybody already have a device and you're going to have to go this alone and compete with big companies like Medtronic or others. And so I think understanding all those risks and having a plan to mitigate all those risks is super important when you're starting out a project like we do.

It's a great call out Bill. I'm a big fan of thinking time I learned this from Keith Cunningham and I schedule a couple of times a week an hour to just think through risks, opportunities. And it really helps. You know I feel like we spend a lot of time being reactive in business and if you do some schedule thinking time and are really differentiate you from others out there what are your thoughts on that though?

I agree, that's my treadmill time right. My workout the morning I get all of my work thoughts done right. And so that's why I can't miss a workout because otherwise I don't get my thinking time. So that's really important to me.

I love that man. I love that you've connected it with your physical well-being. Great idea. Can you give us an example bill of a time when you guys improved outcomes and created results by doing and thinking things differently?

I think everyone understands that with medical device companies we have to deliver new products that are less invasive less expensive and safer. You have to have all three of them. I don't think you're going to get by today's world without having those three you use to be able just to come out with some new widget. The doctors would buy it and everything's fine. But I think the world's changed. Historically in the companies I've worked for we believe that the new normal for product development is to have a core competency and conducted clinical trials. And I think that's new over the last probably 10 years or so we've got to prove to the world that what we built works. There's two ways to do it you can do that with commercial success you could just launch it and hope it works and then the world all says this is fine or you do clinical trials and show with data. I think if you fail at the commercial success it's tough to get a second chance. You end up with a bad birthmark on your device and then selling it again after you've fixed it is really hard. I think that if you start with clinical trials it's a safer strategy. At interlace medical as well as therapeutics we focused on conducting clinical trials to release new products without doing these adequately I think just set ourselves up for failure. So and I think we have three constituents all that want that data right so those are the patient the doctor and the payer. Right. So with the patient, the doctor and the pair we've got to really attract those folks. And the problem is as startup company is the clinical trials take money time and talent. And so that's tough because it made more money across the board for us. We just have to raise more, expect to raise more capital. Expect to take more time which uses capital so that goes back to fundraising, right. So I think that if we get the data the clinical data overcoming the hurdles of regulatory reimbursement and fundraising because the fundraising or the people I get money from are going to want to see that same data that those three things are made much easier. So I think we just have to develop a core competency of getting data and that wasn't something that was apparent to me early on 25 years ago when I jumped into this business. But it's definitely the way of the future in my opinion.

Yeah Bill that's a great call out in today's market. We're looking at a lot of different options. We're looking at a lot of shifts, right. We're dealing with digital therapeutics we're dealing with digital technologies and the appetite for venture capital to get into a device company has really decreased. Can you talk to that and your thoughts around that bill?

So let me just rephrase your question so you're saying that's the change in healthcare the hurdles have changed?

Not the hurdles but what has changed is the appetite for venture firms to invest into medical device companies because of the time frame that it takes to see a return?

I totally agree with that and I would say that not only have we watch many many medical device venture firms go under over the last 12 really since 2008. We've seen a real shift in where everybody's getting cash and so that shift now has gone to fewer and fewer venture firms. We're now seeing more family funds coming and participate which is a surprise. We've seen private equity firms that would traditionally only invest in public companies. Those folks are now doing earlier and earlier things because they're not finding the valuations in the public markets that they want to because a lot of the stuff is overpriced and then that's critical to the new market which is strategics. So big companies like Medtronic Boston Scientific and others are actually realizing that in order to see more new innovation come from startup companies they're having to participate at earlier and earlier stages by moving some of their R and D cash to do more venture investments. So I think in those three areas we certainly see that.

That's super interesting Bill and yeah I mean when you get into a large company like Boston or Medtronic, it really becomes more difficult to have that agility that a small company like Solace has to innovate and why not shift funds to a company like yours to form a partnership. So listeners think about that, as you build your company if you're into the device space. Think about what Bill just said. These are pearls that you're not going to want to forget because in his triad that he talked to you about research and reimbursement and the money, you're going to want to keep that in mind. Bill maybe we should level set with the listeners about Solace, right. I gave a little blurb about it but maybe you could help finish that idea. What does Solace do? What problem do they solve? Who do they solve it for?

So the current company is focused on devices for helping women who are incontinent when they laugh, lift something or cough or sneeze. And so the problem there is that it happens to men as well but as we get older our bladders are less elastic. And when we have a insult to the top of the bladder with high pressure that our research can't withhold the urine and we leak and the company long before I got here because this was a bit of a restart when I joined but the company had come up with a device to help attenuate pressure. And what we're doing is simply adding an air filled balloon to the bladder with 30 cc's of air it floats top of the bladder. And every time you laugh cough or sneeze the balloon acts as a shock absorber and it reduces the intra bladder pressure to a point below which is readthrough can now hold it back. So it just looks passively there. Right. And it works incidentally it's placed in the doctor's office and the patients come back on an annual basis and have the old balloon taking out a new balloon dropped off. So it's it's quick and simple and easy and it's reversible. So that adds to the safety component. So we go back and look at it. Is it less invasive? Yes. Is it safer? Yes. And is it cost effective.? Yes. So we're trying to check all three of those boxes.

Got it, very cool very cool. And as we think about the reimbursement piece is this something that insurance pays for is this a procedure that is considered more than you pay for it on your own?

It's a great question and I think that's a huge issue is probably a separate podcast actually that the issue is that we'll have to go out and get a category 1 code for the Medicare Medicaid population. We had a vision the whole procedure to be approximately fifteen hundred dollars. That's with doctor fee and everything else included into that. But what we're seeing in the MARPAT we're seeing in the marketplace more recently even in the last five years is all these patients are now in high deductible plans right. I mean 2000 3000 4000 dollar deductibles we have for example a 4000 deductible here but the company pays into a health savings account. Two thousand dollars a year.

That's generous.

So the problem here is that if we come out any of us come out with a procedure that's a 50 100 dollar procedure. We're never touching insurance money anyway. It's all out of pocket till we get to that 2000 dollar 3000 dollar deductible. So for us we'll go up the Category 1 code for the Medicare Medicaid patient and we'll see if we could get a hickpick's code for those also who may need it. But at the same time we expect that we're going to be patient pay initially. Right. And so we'll have to go to high aesthetic markets, right. We'll be going to markets in Southern California, Arizona the Texas markets end up in Chicago and Atlanta. So you know I think there's people out there with high disposable incomes who have quality of life impact from this condition and so we're going to go there first. And I think we'll see some good results.

Yeah I think that's really interesting Bill and as we think through this segment, I don't know the thing that kind of pops into my mind is like the vasectomy model. Right. Like insurance doesn't pay but you want to impact the quality of your life in a certain way. It's reversible and you're targeting a market that can actually pay for it.

And I think the other thing it goes right back to outcomes right. So now that we're all beforehand insurance paid for it. So we weren't as engaged in the efficacy for cash, right. But now since it's all coming out of pocket people are patients are shopping for health care much more aggressively and their expectations for efficacy are much different than they used to be when they didn't have to pay theoretically it was all running through an insurance company. So it's life's different now people have higher expectations a shot for what they want. They want to see the data before they write the check. Now the reason for more data so again as we have watched the evolution of health care and healthcare delivery I think you know we have a new constituency not just going out and selling catheters to doctors anymore. The patients a big portion on this.

Such a great call Bill definitely a great call out that we all need to be very aware of. Tell us a time when you had a setback. Bill you alluded to this at the beginning. What did you learn from that setback?

So you know I've read a lot of setbacks and I've learned a ton I think I was vice president of sales and marketing at a company called core tech which was Aspinal products company after I left Boston Scientific we are making a peak implant for lumbar spine fusions and a group of us join the company after that undergone numerous organizational issues and some cash issues run out of money and the product was a terrific idea. However the investors were pretty tired within the investment. They had that for a long time and they were focused on trying to get the company sold and they thought the best way to do this was to generate sales as fast as possible but this product wouldn't approve. It needed a PMA trial and so the company shifted its approach away from developing that implant into something that they knew they could sell which was sourcing cadaver bone implants for spinal fusions. We shifted the company over to focusing on coming out with instrumentation and sourcing the cadaveric bone for these implants and we spent years developing the business we've grown the sales from anywhere 6 million and then ultimately close to 10 million bucks. And the company sold but it's sold for a fraction of what the investors had in it. They get hindsight we should have never taken our eye off the ball right. They should have mopped up the company or are really focused on getting that product out because that was the big value creator was that. So I think what happens is if you start chasing revenue in hopes of just getting an exit you haven't solved the problem, you haven't improved outcomes right you've jumped into the same kind of market that everybody else is in and if you really advanced anything. And so that was great learning for us. You've got to pay attention to the problem you're trying to solve and not just the revenue.

That's really interesting and thinking through it. The distinction made here listeners will highlight something very important rather than chase the revenue chase the outcomes and it just very much in line with why we're talking here is if you're after just dollars more than likely it's going to be tough to get an exit. But if you're after outcomes and you're improving them for less money, smaller incisions less time you're more likely to have that exit success. What a great lesson. BELL Thank you for sharing.

Yeah, I totally agree with your comments.

So what's one of your proudest medical leadership experiences today?

Actually the work we did at interlace medical. This is a company that developed the device for moving fibroids from inside the uterus and women who had abnormal uterine bleeding and we basically just started it with a thought that we looked at six different areas within women's health. When I am just started talking to doctors which is the most vexing problem you have made and started asking them if you had a device to remove fibroids, tell us kind of what what it should do.? How long should it take? How big should it be, how long should it be? Can we use energy? Right. Can we use cautery? What is it that we can do and we just kept asking and asking I would go to urology and gynecology meetings asking doctors you know about this and in the end they helped me write a product's back right. It must have all these things must be able to move or a fibroid of three to five centimeters in ten minutes or less. You know they just basically wrote what the spec was and I had come from the vascular world. I had no no information on women's health and so I had to learn it myself. And so once they gave this spec to us we went out and hired three independent design firms and said here's the spec, come up with as many ideas as you can that achieve the specifications and they gave us back 60 ideas and so we put in a provisional patent on 60 ideas and that create a barbed wire around the space that we wanted to operate in and then we hired we hired an engineering team but only after each of these groups gave us a prototype of the one they liked the best. The idea they like the best and then the engineering team or internal guys took those three prototypes and then started working from there. And then the key for us was as soon as we had a working prototype we went in and did clinical trials and when I say clinical trials we did six patients and we were humbled because the thing did not work the way we expected we would just get our head handed to us and then we go back and spend a month just grinding through all the problems and then immediately we go back do four or five more patients again. And it was only after we did this four or five times that we really had nailed the product design and it was a super symptomatic device. Ultimately, whole logic came running and they took what was a 1 million dollar and trailing 12 month revenue for us and they drove it to where it is today probably around 200 million dollars a year it's become the standard of care.

Amazing what a great story. Congratulations on that win Bill.

Thanks.

And the thing that I take away from this and I think listen you got to think about this too. There's no secret sauce. You know you just got to do the work you got to, you know Bill got out there. He listened to the customer and he tweaked and tweaked and tweaked and stayed in the game until it worked. And I feel like a lot of people either don't listen to the customer and they fall in love with their ideas or they tweak tweak and give up. And you've got to do both. You got listening you get a tweak and stay in the game. What would you say right now Bill you know at Solace is one of the most exciting projects or focus that you're working on today?

I think our focus right now is to get the get our existing product through FDA. And so you know we're a one product company with 18 people here. We're all focused on getting this through a new clinical trial and getting FDA clearance and getting it into the market once we can get it in the market, we'll work on expanding indications and going from there. But right now that's our big effort. We are seriously focused on regulatory reimbursement and fundraising. That's my world very simple.

Bill, I admire your tenacity and your focus. A lot of people just want to have it now. And the thing that I admire about you is just that you see you see where it could be and you're working with your team to get there. So I just want to encourage you to keep doing this because the product definitely solves a problem that a lot of people are starting to have.

Yes. And in fact it goes after those people over the age of 50 primarily and that's a huge population bubble that's growing quickly.

Absolutely. So let's pretend Bill you and I are building a medical leadership course and what it takes to be successful in the business of med device today. It's the 101 of Bill Gruber and so we've got four questions lightning round style followed by a book and a podcast that you recommend to the listeners. You ready?

Ready.

Awesome. What's the best way to improve healthcare outcomes?

I would say spend as much time as possible defining the problem. Once you think you have a solution, test it to failure as much as you can on a benchtop in clinical trials long before you go out to market with it. Clinical trials help you figure out whether it's actually going to work, whether you go back to the drawing board test, fail, test, fail.

Love that. What's the biggest mistake or pitfall to avoid, Bill?

People who start with the technology and run around looking for a problem to solve. Somebody gives them this great plasma energy and then they say let's look where in the body we can cook something or cut something or do something else. They haven't started with a problem they started with a solution and then my friend.

Amen. How do you stay relevant as an organization despite all the change?

I think companies have to stay nimble. I also think that we ought to keep our egos in check. For us here we seek failure to learn what we need to do to be successful. You always have to be willing to change as fast or fashion and the market is changing. As I say to my kids you've got to get comfortable being uncomfortable.

And finally what's one area of focus that should drive everything in a health care organization?

We love bad news early when we love to fail here we love to fail fast. I think if people are always trying to give you the good news that things are rosy, when they're not, it's a huge disservice when you cannot cover problems early you're going to win. If problems wait and nobody tells you about them until the end you usually have fewer options and the options you do have are really expensive.

Bill if I were to ever decide to climb up Mount Kilimanjaro you're somebody that I had tapped to join me.

Thank you.

Because it's life on the line you know and that's what it is with a startup company. And good news early is an amazing thing that I'm taking away from this conversation and sharing with my team, listeners. Hope you do the same. Though what book would you recommend to the listeners?

So the book I would recommend comes from more of an entrepreneurial side which is Negotiating with Giants. By Peter Johnston and I think it's for us, we're a small company and yet we negotiate with huge vendors we negotiate our exits with huge medical device companies and that's just a great great book because it gives you terrific perspective as all the things you need to be doing to give yourself better leverage with the big guys.

Well Pearl would you say you took out of that book that you want to share with the listeners.

I think it's developing a network within all the people that you want to work with and negotiating with a big company, you don't just have one person there you need to build a group of people in there that you have good relationships with and good trust with. People buy from people in the end right and they aren't going to do it overnight and they aren't going to do it when they're pressured to do it. So to think that you're going to walk in and sell a company to Medtronic tomorrow isn't going to happen. You're going to need you know it your two worth of developing relationships and them watching you have success and be having candid conversations.

Love that. It's the saying build your well before you're thirsty.

Ah I like that.

Bill, this has been fun. I always leave these conversations with the feeling that man I wish I had more time. Where here to the end. But I'd love if you could just share a closing thought with the listeners and then the best place where they could get in touch with you or follow you.

Yeah I think the big push for us always is know what problem we're trying to solve. You know with all these devices there's always scope creep. Right? And so come back and really revisit the problem you solve and don't get group-think-going stir the pot with your tame pushback. Somebody should always be playing the devil's advocate to make sure the groups going in the right direction and we don't have a bunch of yes men because that just doesn't fly. So best way to reach me probably LinkedIn. I do get all my LinkedIn requests. And I do my best to try to make sure that I'm growing my linked in group and that's how I reach out to a lot of other folks are pretty it's linked to user.

Fantastic. Bill this has been a ton of fun listeners if you want to get the show notes the transcript the links to Bill's company as well as the links to the resources that he's recommended. Just go to outcomesrocket.health/solace, S O L A C E and you'll be able to find all that there. Bill, just a big thanks to you again for spending time with us.

Great thanks for having me on it really appreciate. It's great to speak with you.

Thanks tuning in to 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 to 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 and be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book:

Negotiating with Giants

Best Way to Contact Bill:

LinkedIn: Bill Gruber

Mentioned Link:

Solace Therapeutics

Episode Sponsor:

The State of The Medical Devices Market with Rick Randall, Principal at Riverhead Advisors

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

I thank you so much for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because today I have an amazing healthcare leader. His name is Rick Randall. He's principal at Riverhead Advisors. Rick Randall he has spent the majority of his career managing directing and founding early stage medical device companies that have created some of the most revolutionary medical procedures practiced within the past three decades. Rick has a broad experience as a CEO Managing firms such as Target therapeutics innovative devices Tranz 1 and omni life sciences. Businesses under his direct leadership have achieved 1.b billion in value creation from initial public offerings of stock or mergers and acquisitions. Rick has cofounded three medical device companies which include Conceptus, Cardema and Prograft and he has served on the boards of several additional medical device firms. There's no doubt that Rick has that industry leadership that is so keenly sought after in our industry and it's with a warm welcome that I give Rick. Welcome to the podcast. So excited to have you on.

Thank you so it's great to be here.

So Rick I wanted to ask you what is it that got you into the health care sector to begin with.

Yes I always had an interest in the sciences healthcare. I grew up in rural upstate New York on the lake Ontario border. Looking across the water to Toronto and it was a farm community. And my earliest recollection from professional interests was I wanted to be a veterinarian and later on in life when I was in college I moved over to for whatever reason an interest in ophthalmology, optometry but frankly it was difficult enough for me to finance my way through my undergraduate degree. Then to consider how I was going to get through medical school and beyond. I ended up quitting school for a year and a half and working at a General Motors factory just to enable me to finish my last year and a half and get out with only a loss of of one year so that kind that put a damper on on any kind of medical school or thoughts of medical school. But my first job out of college was teaching biology as a biology major and.

Is that right?

And I taught high school biology and in a school district outside of Syracuse, New York. And then after two years on the job I was dead set ready to enter my third tenure year. The all important tenure year and I'm kind of about that I called in to a number that I saw in the paper and there were ever times for a medical sales job. Yes and I was asked to come in for the interview. I had no intentions of taking the job. Pretty cocky and pretty sloppy about the interview. And that was moving quite nicely. And then the interviewer turned the subject to the income and what the job was like and the company car and free gasoline and all those things and we.

All of a sudden and you're like wait a minute wait.

Wait A minute. The economics kicked in, and then I was dead serious about the interview and somehow didn't blow it and I ended up getting the job. So yes that's how I got into medical technology as a diagnostic sales job first than that I kind of moved up the ladder with medical sales jobs and eventually found I had a real passion for marketing and strategy and moved in-house with C.R. Bard and the rest is history. So that's how that's how I got into the health care sector.

What a great story and thanks for taking us through that interview. I felt like I was there with you. And now all of a sudden you're interested. So Rick you've obviously been heavy into the industry side of things. Med device a passion that I also share. So what is it that you feel is a hot topic that needs to be on every medical leader agenda today and how to approach it?

I think the hot topic today for me is is how in the future I'm the prize student beneficiary of this medical device renaissance that I think started in the early 80s and ushered us into the 21st century. And it's been a great ride. We've done wonderful things with technology and the way health care is provided. Now, it's not even a close resemblance to what it was in the 1970s because of it. But the hot topic for me is how are we going to continue in the U.S. to drive that innovation. How are we going to continue to create a pipeline of innovation it's currently at risk. The real risk is in my view due to a material change in which the way startup companies are emerging medtech companies are finance the venture capital world that I benefited by in the 80s kind of the two-fisted look you in the eye venture capitalists who if they liked what you're all about provided you the money to do what you needed to do. That's kind of dried up. Those folks have fled the scene and the life cycle of a healthcare company back then. You know my first CEO job. My assumption was it will take me four years to get the job done the company could be sold or move on to the next. Well now that gestation period of a company to exit is more in the neighborhood of 10 to 15 years and that's caused a lot of the venture folks to flee. So that's that's my hot topic because I love what we do and I want to I want to see this country still benefit as the leader in creating these wonderful devices that we bring to market and I'm I'm a little concerned that we're going to see a slowdown of that innovation which really doesn't benefit anyone.

I love where you're going with this. And your assessment what is it that has led to this slowdown. Is it the FDA. Is it lack of riders wanting to take risk. What is it?

The FDA is a part of it venture capitalists about a decade ago summarized that to me and I've been borrowing that line ever since. It's an issue of stacked risks so if you consider when I first was in the CEO position the only thing we really the two things we had to worry about were is our device going to work. And secondly I'm real live human beings. And secondly when we get that device through the FDA? Can we get the FDA to agree to clear the device for commercial use. Those were our real risks and that's why you could take a concept and actually be commercial with the device in two to three years and then be taken out by a larger acquirer in your for maybe even take the company public. Well those are the tip of the iceberg. Today they're stacked risks. And it's taking longer to prove out each one of these risks set. So is the concept going to work? Where am I going to learn we can work in human beings? So there's a process you have to go through to even get into the most lenient countries to test the device. Then the FDA risk is it going to require a full clinical study or a 510 Caywood clinical or straight up 5 10k. And then when you get through all of that which is typically years five or six then can you get the device reimbursed? And I think it's that additional stacked risk of reimbursement in our healthcare system that has kind of caused the venture capitalist to finally give up raise their hands and move on to dotcom or technology plays. And that's that's quite unfortunate. But these stacked risks now have gobbled up the better part of a decade of development. And more importantly exhausted some of the funds that used to be available to us in the health care in the medtech sector.

That's a shame. It's definitely a shame and fear patient waiting for it technology or if you're a leader at the helm of a corporation waiting for a technology. There's no doubt that it's taken a lot longer and there's really virtually just every year it seems like there's less mass and almost no one willing to form from a venture side back any of these companies up because of that lag time. What's the future look like in your mind?

Well this is what I'm doing now at Riverhead advisors. I'm I'm focusing my efforts on helping these early stage entrepreneurs. You know I'm a little selective about what I'm helping. What technologies I get involved with but those technologies I believe are going to work and are going to do a service to patients and the system alike. I've been working to really guide them in the right way to approach this so the future to me is first of all I think we're going abroad to cast a broader net as to who can fund these device companies. I've also included private individuals now investor groups for early stage funding. There's what we call family offices which are typically high net worth individuals looking for other places to put some of their billions of dollars or whatever that may be. And what I found is some of those family offices also have a passion for certain areas. Perhaps they've been afflicted in their family with cancer or heart disease or diabetes or whatever. And it may not be necessarily the financial return that drives them as much although that's certainly important as the cause itself and then the other thing I've been doing is I've been tapping into the companies that we in the past would not talk to until we were fully vetted with the technology and all of the all of the issues were dealt and we were selling a lot of product which is the strategic acquirers because I think they're starting to recognize the same problem that we have in financing innovation is going to dry up their pool of innovation which is what differentiates their products and allows them to maintain fairly high pricing in a market because they're delivering unique technologies that have unique benefits. And so most of them have established venture type financing opportunities. So working with the the entrepreneur to cast the broader net and finding other sources of money other than the traditional venture capitalists is one way to deal with this.

Rick I think you're doing something very unique and you're you're approaching things in a refreshing way. And rather than say hey you know what the well is dry you're looking beyond the well and you're helping entrepreneurs really dr]rive wide and deep into other areas. You listed a couple here. During our conversation so can you give us some examples of maybe some businesses you've helped out in maybe a surprise that happen in the process?

Yeah I've. There's a company in particular that I'm working with that I'm very excited about. It's a company by the name of RadiaDyne and it's a Houston based company that's focused on the oncology radiation oncology space. It's a company and I give all the credit in the world to the founder John Isham. John was a sales rep himself. He came up through the same the same pathway I did and John had an idea and he felt that radiation oncologist could benefit from balloon type catheters that could be placed in tissue structures to separate them and space those structures away from areas that are being radiated a good example would be for a patient a male patient undergoing prostate cancer radiation that he would have a catheter that would go into the urethra and separate the urethra and the bladder junction and space it by inflating the balloons space it away from the prostate so that as a radiation passes into the body it's mostly hitting only the cancerous tumor and not causing severe side effects and burning to these other viable tissues that are very very important. Well John didn't stop there. He built a nice business. It has made a living for John and other employees. Along the way, he hired a person I worked with at a TranS1, Bret Boudousquie to be the president of the company. But he's developed spent eight years of his life and a lot of his net worth developing a new technology. The Ortrack system which is now just being released to market that enables it's a device that has a capability of loading up the four sensors and the sensors are on these little micro catheters. And so the sensors can be placed in various spots around the area that's going to be treated as both within the tumor or next to the tumor itself and probably more importantly in the surrounding tissues that you want to preserve and you don't want to radiate. And what these sensors do is they measure the radiation real time and they take this reading out into the control room so that the technician and the physician both can be looking at the accumulation of the radiation inforced spots in the body and determining whether they're giving their target dose and not giving too much of a dose to areas they do not want to radiate. So once they're getting these measurements real time, they can adjust the radiation to make sure they're doing what they want to do and they're not doing what they don't want to do and that enables them to be more aggressive with the radiation perhaps reduce the amount of treatments and turn the power up and a whole level of safety to patients who undergo these terrible radiation treatments where they have these burns that could affect them. So what's exciting is that company has been privately funded and now it's time to take advantage of this new technology and publicly funded or funded through other sources. Yes. So rather than just going to venture capitalists which we are doing I I've been working with the company and we are going to some of these other outlets and including potential strategic investors. I've introduced these from the firm to banks. They knew a couple of banks to lone. We've created quite a buzz and I think we're not done yet but I think the financing prospects are going to be very good for the founders and the shareholders who let's face it they took all the risk on this.

Right.

And I think it's going to be beneficial to them. And it's going to allow us to get this technology out to the major cancer centers in the United States in a much quicker weaker if it's in a quicker fashion. So there's an example of something how we're putting it to practice.

Absolutely. And this is now an FDA approved device being used in hospitals today?

It's an FDA approved device and it also to my other point that I made earlier it also has reimbursement codes embedded in the system. It is now available in one center, Sloan Kettering in New York. And I think they just shipped another unit to another center in Ohio. And there is a stack of hospitals around the country pretty sizable number of very renowned cancer centers that are aware and they're waiting for the technology. So throughout 2018 we're going to see more and more centers have this technology available to them spread out in the United States.

That's excellent. So Rick appreciate you sharing that very granular and exciting response so listeners Here's an invite to you, if you like what you hear whether it be from a practitioner standpoint, if you're a healthcare executive wanting to differentiate yourself in a way that you are oncologists treat cancer. If you're somebody that has investment capital, I invite you to reach out to Rick and we'll be sharing his his contact information here at the end. But the purpose of the Outcomes Rocket is to do some silo crushing so that the discussions that need to be had are had and that's why we got Rick here on the podcast today to bring this exciting information to you. And so Rick you've learned a lot through the things that you're doing and now you're working on some exciting ventures, the one you just mentioned to us as well as others. Can you share a time when you made a mistake or failed and what you learned from that lesson?

Oh yes. Unfortunately when you do what I have been doing as long as I've been doing it, those unfortunately do tend to pop up from time to time. So let me take a deep breath here and recollect that experience and in a way where I can painfully share with you. The experience that I'm thinking of is a company by the name of TranS1 which ended up being a it was a we thought was going to be a huge success. It's a great technology, it's a company that I joined as CEO in 2002 and I also happened to be the first employee of the company way back in 2002. At the time I joined, it was a concept it was founded by an interventional radiologist and a business partner and they had the idea of a minimally invasive approach to the lumbar spine and the lower spine to enable surgeons to do a lumbar fusion which is a very common surgery in that part of the anatomy and a fusion that would enable patients to heal very quickly as a matter of fact the ultimate goal was to be able to do something that people just laughed at when we first broached it with them. Outpatient Fusion's. So I joined in 2002 and it moved along very very quickly. I was able to the RMV executive who was working with the company as a consultant at the time and developed some interesting prototypes and I quickly decided I got to hire this guy. And Bob also who I'm still working with today on anotherproject and we hired Bob and we were in the clinic in Brazil with this technology by as I recall by early 2003. I joined the company in June of 2002 and we quickly developed this into a surgery that was working took that data from our own US experience and took the data to the FDA and lo and behold we were able to get a 5 10k clearance for the procedure in the implants and the tools. And we were then starting to commercialize as early as the third quarter I believe in 2005. So it was about as good as it gets. Maybe that should have been a foretelling. And I'm a little bit superstitious about this and I knew it was going so well that I was I was really worried what's going to happen I truly was eventually did it. You'll you'll see in 2005 we commercialize the product in 2006 and 2007 we were seeing rapid growth. There was a kind of a movement taking place with us and around us in the world of spine surgery to move these maximally invasive procedures to a minimally invasive format. So we got caught in that draft. We contributed to that draft and then the IPO market opened up in 2007. So we took advantage of it and we did a initial public offering of stock and went public with the company in October of 2007. And of course it was a very well subscribed very successful IPO. We came in at above the price on the cover all the things that you dream of. Yes. So concept in 2002 public offering in 2005, almost unheard of. And.

Yeah, that's incredible.

And then there's the rest of the story. So within six months in early 2008 we learn that the North American Spine Society which was the Surgeon Society of Spine Surgeons that basically were made up our customer base and then some. They had approached CMS and recommended that this approach had its own surgeon payment code. One of the things we vetted early on was can we get paid for this and there happened to be several existing codes covering lumbar spine surgery and we fit the technical vignette of one of those codes. So the advice we got was, you never know what's going to happen and people could come along and say I think you ought to do something differently or it should be looked at differently. But we did fit it, fit the code so we were billing under that code through our commercialization stage. Well, this new code which was granted over time by CMS caused us basically to be put into a Category 3 which is an experimental category. And since most of our patients were covered by private health insurance not Medicare,.

Yes.

The adverse effect it had on TranS1 was that our surgeon payments went away. They weren't being reimbursed. I don't know if you could just imagine being the CEO of a publicly traded company and now you find out your surgeons aren't going to be paid for your operation.

Rick just to level set here you're in a situation where the surgeons are actually trying to make it more defined right? You fitting under an existing code, lumbar fusion of some sort. And now their intent to help actually hindered.

Well I later learned they weren't really trying to help TranS1. What I what I later learned. And there were hints around this earlier on. What we didn't know behind the curtain was that CMS had already approached the nest coding group and indicated to them that they were growingly concerned that the surgeons being performed under the existing codes the time it took to do the surgeries were not matched up properly with the time that was used in the algorithm that creates the reimbursement dollars.

Okay.

In the sense they felt that the surgeons were being overpaid for the amount of work that they were putting into their operations.

Got you.

Makes sense because those values and those assessments took place a decade earlier and all surgeries get better the equipment gets better things get faster. So we contributed to this unknowingly because our operation was taking a good surgeon only about an hour. The surgeries were valued at four hours,.

Got you.

So roughly put, the powers to be at nest we're concerned that's a little upstart TranS1 was going because if this was widespread we had adopted in a widespread way was going to cause a 75 percent pay cut to their membership. So that was the reason behind them giving us an experimental code so that we could work this through and eventually work through the white. I think they want this to go away. But I'm also very cynical at this. So that was what was behind it.

Interesting. Thanks. I didn't mean to derail the conversation but it definitely important detail there that I was curious about.

Sure. And so what did we do about it. Well we had to downsize the company and sales were shrinking. We obviously worked very hard with our surgeon base are fortunately, we had 10,000 operations that had been performed at this particular time. We are able and there were publications in the works so we were able to kind of gather our clinical data, create more clinical data and work within the system to try to turn a Category 3 code into a category 1 code which we eventually did. But we also learned that with the private payers it's very difficult even if you reestablish a new code in a world where they really don't like spine surgery anyway and.

Right.

Paying for expensive science spine surgery. It's very difficult to take a non-pay status and move it to a pay status and the company still exists today it's now private and they have been able to establish a code and bring other payers on board. But they're still fighting insurance company by insurance company to do that. So it was a very difficult time in my career. We had a rocket ship to this day. The procedure worked incredibly well. It's one of the best operations out there. If I had to have an L5 S1 fusion, there is only one solution I'm going to see that operation. The company is alive today because there's still surgeons who had great results and they're using it but unfortunately for all the wrong reasons the opportunity really went away and our employee shareholders, surgeons were hurt because of it.

And so Rick really appreciate that story. A tough one. An exciting one, a tough one. So if you had to share one thing that you learned from that what the listeners. What is that one thing?

Well there's a few things that if I broke it down to one thing I would say this my first board meeting at the company I didn't know the lumbar spine from the rotator cuff and I had just joined the company and we had a board meeting but I did have an important subject based on my prior experiences with the board. And I wanted it to term you use I want the level set with the board what our expectations were. And at the time I was a growing believer that the public markets are not a good match with single technology companies. There's all the risk is in that single technology and TranS1 was a great example of that. So what we discussed was, Do we really have a exciting product or do we have an exciting company? And we realized we had an exciting product but that's pretty much what it was and that product could be hugely valuable to a larger company that is broader base. So our intent from the very beginning the first board meeting we managed was that we would build the value and look to sell it. Now look to take it public because I had done that before I didn't need that poster on my wall anymore. I just felt that that was the wisest thing to do. We almost did that. The day we closed on our clothes. We accepted term sheets on our last private financing. I think it was 2006.

Yes.

The day that then I had promised venture capital we make a decision that day. Out of the blue we got a call from a company that had looked at the company and they made a hundred million dollar offer which the bank who we were working with felt could be easily moved to 125. We declined that because we had put these venture capitalists through this whole process and due diligence to get to where we were that day to make that decision. If I had that win back that would be the easiest decision in the world nonstop. I'm helping the process and I'm allowing the merger and acquisition conversation to take place. If we had stuck to our initial position that we made and took in 2002 at that board meeting, we would have returned a wonderful return to the shareholders at the time for the amount of money put in, for the employees. So that's the lesson learned I believe is we I guess a better way to capsulize that is you really need to be pragmatic about your value proposition at all times. And even though you're in the thick of it and you love what you're doing you think it's the greatest thing in the world, have a sensible balance to the risks that you're also taking by moving forward.

What a great lesson shared Rick and listeners keep that one with you. And if you're working toward building your company your practice accountable care organization whatever it be. Be very clear about what your outcome is from the beginning and stay true to your true north because that's ultimately what gets you through the thick and help you be successful in adding value to the healthcare system. Rick thanks so much for sharing that.

You're welcome. Still hurts.

It's those pains that help us be better right?

That's right.

And now you're able to offer these lessons to our listeners but also the people that you work with and in your practice.

Everyday.

What would you say So you took us through that dark moment. Why don't you take us to the lighter moments one of your proudest leadership experiences in medical device that you've had?

Oh sure that's that's a fun one. That would be Target Therapeutics it was my first CEO job in 1989. I was a 37 year old guy who had but you had it I had it all figured out I think until that first day I sat in the big seat. And then said What am I going to do. But it was it was a great experience from that point on. And I was with Target from basically from 1989 to 1997. The last I had a personal reason eventually to move back to the east coast. This was based in Fremont California. And so I was CEO through I believe 1993 and then I stayed on the board through 96 and the acquisition in 97. Target was a company that had developed a very novel, patented micro catheter that was capable of navigating through very small torturous blood vessels. The initial plan for the company was not to develop a catheter but was to develop a new way of treating hepatic cell carcinoma, a form of liver cancer in a way where the interventional radiologist could take a catheter through these torturous vessels into the tumor itself and also go through the venous system into the back door into the tumor and then deploy clotting agents and devices that would basically shut the front and back door. So there was no blood supply coming into the tumor. And what this effectively did was with no blood supply, this growing tumor would then start to shrink.

Interesting.

It wasn't a final therapy and it was a palliative treatment but it did become over time very widespread in Asia particularly Japan where it's more prominent as a disease state. And those patients can live another five years of a very good quality of life. And I think they can at that time I believe they could receive up to 2 or 3 treatments each giving them with an additional 4 to 5 years so it was a good thing.

Amazing.

But in the United States the market was that large and the clinical pathway was not well-defined. And the company was really struggling. It turned out to be a huge science project and it was gobbling up quite a bit of capital. And the company it was owned by College Incorporation which was one of the materials that was being used to analyze the tumor. So there was limited resources to fund this but at the same time that this research project was ongoing, neuroradiologists working in the same area as the interventional radiologists were picking up these little catheters. They learned about and threading them into the brain and that was creating a nice little revenue stream. By the time I got to the company that was about as I recall about four million dollars in revenue mostly are almost all derived from this Neurovascular application. I joined the company and it was clear to me the strategy going forward was to focus on stroke. I had early in my career earlier in my career I should say I was on the team that developed and marketed the coronary angioplasty catheter which as you know changed the way heart disease is now treated and has become a multibillion dollar industry. So my vision at the time was why can't we do the same thing in the brain?

Yes.

And no one was doing it because the heart catheters could not sneak their way up past the Circle of Willis next to your ear into the brain and puncture the brain. Well we had a catheter that would do that. So we kind of jettison the cancer treatment, unfortunately had to let some people go and focused our efforts on the neural application that turned out to be a great thing. Once I got to the company and assessed our opportunity, it became clear to me if we were really going to survive and win, we had to move on beyond these venous malformations that were being treated with our technology that was a small market and a large market, all the customers told me was the cerebral aneurysm. It was a ticking time bomb if it ruptured. The death rate was very high, mortality rate was very high and the only way to treat it was wide open brain surgery which was morbid and not wholly effective. So we gathered the troops and told all the engineers we've got to find a way to fix the Cerebral Aneurysm. Within a few months after that meeting one of our engineers who is working with a neurosurgeon down at UCLA came to me and showed me on my desk working prototype of something he had come up with that I saw firsthand. You know it worked at least in a with an aquarium pump and blue dye going through the tube leaking on my desk and filling a glass blown aneurysm, he was able to block the aneurysm and block the flow of the water into the aneurysm and animal studies had shown that if you do that you could effectively cause the aneurysm to shrink and scar over. So we took that concept to a human outside of the United States at the time. And it worked. And.

Nice.

Yeah it's very nice. We were able to take the company public in 1992 even though we did not yet have clearance to market the device in the United States. Around that time there was also a large trial because the neurosurgeons did not give up easily on their technique and demanded a clinical trial where they compared the two methods. And that trial is I think one of the early interim analysis points was halted because the data the outcomes data. This is an outcomes podcast's the outcomes data showed definitively that it was unethical to apply to many of these patients neurosurgery when when this coil did the job and the results were much better.

Nice. So you're able to just nip it in the bud earlier.

We nip it in the bud in more ways than one. And we took that as I mentioned the company was public and once we got the clearance in the United States and we brought I had to move to east I became chairman initially and then Gary Bank came in as CEO and we commercialized under Gary's leadership and the stock went crazy and then Boston Scientific ended up buying the company for a little over a billion dollars.

Amazing.

The company still now resides with Stryker.

Stryker right, yeah.

Corporation. And more importantly aneurysm coiling is the de facto standard of care.

That's awsome.

It's also not only did the shareholders do well. Employees did well. We had a great time, that was great bodily experience but there's countless patients lives we saved, outcomes that were much better. A lot of dollars, euros, whatever denomination says because of the technology.

That's awesome. What a great story Rick got. You're great storyteller by the way. Anybody ever tell you that?

Yeah. Lot of employees who felt I just probably told them too many repetitive story.

I love it. Listen what a great story is shared by Rick, a technology that is now being used on patients worldwide. Currently residing within Stryker. It started with a technology that wasn't taking off in our market and a good hard look by Rick and his team to pivot and reapply where it was being used rather than dying on the vine. They found a way and a lot to be learned from that story. I would recommend that you rewind this and listen to it again because it's a really good one. Rick thank you for sharing that one.

Alan Walker Hey one last anecdotal point today those micro catheters are used globally on a variety of cancers. The original thing that the company was designed to to attack it. The good news is we didn't necessarily pioneer it at the time but it did survive as a as a viable methodology. Now it's universally applied. So it's all good.

That's awesome. That is awesome. What a great contribution to humankind Rick. Thank you for the work and the tenacity that you applied in that endeavor.

Well we had a wonderful team that we've been. Many of us have been best friends from those days as you can imagine. So it's a great experience.

That's outstanding. All right getting to the end here Rick we've got the medical leadership course and what it takes to be successful in medical devices today. The 101 of Rick Randall. So we're going to write out the syllabus with a quick lightning round. I've got four questions for you followed by your favorite book that you would add to the end of the syllabus. You ready?

OK.

All right. What's the best way to improve health care outcomes.

I'm going to focus on early stage companies. That's what's going to live and breathe. My advice there is the best way to produce outcomes is develop a therapeutic technology and a product that not only reduces procedural morbidity and fixes a problem but it also lowers the cost of of care. So patients should feel faster. Your technology should be appropriately priced and you create a value-based outcome if you do that, you have a high probability of winning.

What's the biggest mistake or pitfall to avoid.

I've never seen a company take too much capital. You typically need more capital than you think. So under-funding and I think the other thing is to employ a very comprehensive clinical plan as you're measuring your new technologies so that you both measure clinical outcomes and economic outcomes as well because you're going to need both to be able to get your commercialized and find your way into the hospitals to be successful.

How do you stay relevant as an organization despite all the change?

That's a great question, I think we typically start these things with a grand vision and then we get mired in the day to day things that you have to tackle. So my advice there is you build a functional strategic plan and you revisit that strategic plan yearly and you're honest with yourself. You're pragmatic,you employ your unaffiliated customers and you change based on the changes that are taking place environmentally.

What's one area of focus that should drive everything in an organization?

Kind of ties into the last comment. It's constantly getting customer feedback. Feedback from your employees. Making sure that what you are doing is not alignment with what they feel you should be doing. That's both the visionaries and the visionaries. Because if you only satisfy the visionaries you may not hit the bell shaped curve of humanity that is there to use your product.

Some great tips there. What book would you recommend as part of the syllabus?

Oh gosh know this is a bit of an outlier here. I don't know if you'd be part of a syllabus but I'm big on leadership. I don't think you can ever be complacent when it comes to leadership and good leaders are are very important. So a couple books come to mind that are interrelated actually I love the trilogy The Edmund Morris trilogy of Teddy Roosevelt. I thought that the century you know the 21st century was the American century and the rise of America to power. And I think Teddy in his own unique way he was a unique president at the time he came in. There has never been one like him with that kind of background that came into the presidency at least since the seventeen and early eighteen hundreds that had fit that mold. This trilogy covers kind of a rise and fall and really points to characteristics of strong leadership and it's not all good it's it's difficult tough decision making times as well. And the other thing that ties into that is I love the Malcolm Gladwell books and how he makes you think about things. Blink, to me blink, blink told me how I was unconsciously competent. When you're with a startup, you don't have any history. You don't have any clinical data to go on. So you have to make decisions based on very little evidence. Evidence is important but you can't wait for all the evidence to come in. So you have to make some gut level decisions and Blink is all about you know more than you think you know based on your experiences and to trust your gut instincts if you have the right experiences to back them up. So I think Teddy Roosevelt employed those principles. And so those are two books that I find very helpful to me and made me think a little bit differently about how I do things.

Outstanding Rick. And yeah, these are awesome recommendations. Listeners if you're driving or running or doing something else where you can't write them down don't worry about it, just come back to the episode or just remember to go to outcomesrocket.health/randall. That's Rick's last name. It's R. A.N. D. A. L. L. You will be able to find all the show notes there as well as links to the books and the things that he's up to. Rick, before we conclude, would love if you could just share a closing thought. And then the best place for the listeners could get in touch.

Sure I'd be happy to and thank you for again for having me join you on this podcast. Hopefully it's helpful to, at least interesting to some people. My closing thought is and I touched on this early so close on it. We've been in a leadership role in United States for some time in the health care segment particularly medical devices and we need to continue leading that way and we need to continue being the driver of game changing cost-reducing medical technologies and to do that we need we really need as a country to come together and devise a new fundamental funding mechanism to enable entrepreneurs to do what they do so well and create those technologies. I would suggest that we we look outside of this country, look to Israel. I've managed a company and Israel. Innovation in Israel is fundamentally critical to them. It's existential to Israel to be able to innovate. They don't have a lot of customers living around them who want to buy from them. So they've got to innovate for markets well beyond their borders and they do a good job of that and they found a way to match venture capital with government assistance and entrepreneurs to find a way to allow innovation to live and breathe and mature. And I think this country should absolutely be tapping into that kind of methodology to replace the old venture capital model that seemingly is broke. So those are my thought I'd leave you with this podcast.

Some great thoughts and we really appreciate your insights Rick. I know they're going to make a big difference to the listeners. Where would they reach you or follow you if they wanted to.

Randallrick1 is my e-mail address. It's Randall, randallrick1@gmail.com is the probably the best way to reach me. And we can go from there.

Excellent. They haven't listeners. Rick Randall sharing some amazing insights and medical device. Rick, it's been a pleasure having you on the podcast and looking forward to staying in touch.

It's been my pleasure. Well thank you Saul.

Thanks for tuning in to 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 can 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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Recommended Book and Podcast:

Edmund Morris's Theodore Roosevelt Trilogy Bundle: The Rise of Theodore Roosevelt, Theodore Rex, and Colonel Roosevelt

Blink: The Power of Thinking Without Thinking

Best Way to Contact Rick:

LinkedIn:  Rick Randall

Email:  randallrick1@gmail.com

Mentioned Link/s:

RadiaDyne

TranS1

Target Therapeutics

Stryker Corporation

Episode Sponsor:

Outcomes Rocket - Rick Barnett

No More Sales Reps in Med Device? Rick Barnett, President at Rep-Lite

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing health care thinkathon. That's outcomesrocket.health/conference.

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I have an outstanding guest for you today. His name is Mr. Rick Barnett. He's the CEO at an amazing company that is doing some pretty efficiency driven processes to help operating rooms as well as med device companies be more effective and efficient in the way that they do their process. His name is Rick Barnett and he's a CEO at Rep-Lite. He's held many senior level executive positions within the medical device arena. Mr. Barnett is a performance driven sales leadership executive with expertise in building client relationships developing and executing winning sales strategies and the selection and development of top sales teams. Mr. Barnett is recognized as a leader with a reputation for advancing successful business development campaigns leveraging core strengths and capitalizing on solid client relationships. He's done a lot of things and work with partners such as Stryker Intuitive Surgical. Over the last 25 years. In a nutshell he's a visionary who commonly recognizes outside of the box opportunities while driving the current business to surpass establish goals which has allowed him to function in a consultancy capacity for the past 25 years for top industry leaders. I'm so privileged to have him on the podcast today and what I want to do is have an awesome discussion with him working through some of the things that they're doing at red lights to make health care more efficient and improve outcomes so Rick it's such a pleasure to have you on the podcast.

Saul, thank you for having me.

So anything that I missed there in your intro that you want to fill in the listeners on.

No not really. And you're gracious and kind. So thank you and your comments. I would just tell you that the reason that Rep-Lite was founded Rep-Lite was really to provide a needed solution for medical device manufacturers and providers to continue providing amazing patient care to the patients that we serve.

For sure. And you know the thing that I that I love about your mission Rick is that it is so centered on the patient. And a lot of the things that we do in health care can oftentimes take us away from that mission. So I'm excited to dive into some of the things that you guys do. But before we do that I love to learn a little bit more about what got you into the medical sector.

Well it's a great question. I've always had this passion so the little boy for helping people just in general and had an opportunity early on to know a few surgeons and a few healthcare providers and just decided that that it was a perfect space for me. You know I get the sense and the things that we tell them that we drive through all of our people that work that we need to treat every single patient like it's a family member. And that's just kind of the core of what we do. So no matter what intervention is happening with that patient we go at it as if it's our mother or father or some immediate family member. And so for the past 30 years this careers been bearing fruit for me and my family were very blessed to be a part of it.

That's awesome. Yeah and what a great story. It's you know you're surrounded by folks that are and are in the sector with a great mission you just kind of got involved with it and now fast forward you've got Rep-Lite going. What I want to do is just kind of level set the audience and give them a little glimpse about what red light does what problems they solve and yet so just kind of highlight a little bit of that.

Yes so it's fairly simple, Saul. What we recognize early on is that in the world of health care there's a lot of things that pull our attention both from the provider and the medical device manufacturers and what we wanted to do is to do a few things we wanted to make sure that the technical aspects, the service aspect, support aspect was never diminished with all the tasks that we do. So we just believe that if we can continue to provide great quality of care which equals great outcomes and then we can do that in a financially responsible way then we can continue being a leader in this country in healthcare. And so really what we do is we provide service sales and support to medical device manufacturers at a level that will allow the professional sales organization to do what they're supposed to do and sell while we service and support the devices that ultimately give patients their care.

Rick such an interesting proposition here and if you're a medical device manufacturer listening to this some to think about we're in an era of constant change. You never know what's gonna pop out of policy in Washington for healthcare that's going to change how you do business like the medical device tax or who knows. Right. You just there's so many unknowns and in an era of unknowns. Rick is providing a really interesting solution. Rick can you give us something within this realm a hot topic that you think should be on every leader's agenda listening today.

Yeah I mean it's that's a pretty easy question. So I mean it's continuing to maintain probabilities for company while adhering to all the changes happening. So everyone's being asked to do more with less. And so one of the things that's very difficult for medical device manufacturers is they they need to see more people but at the same time they need to support the equipment that is sold and distributed and used in the field. So how do you allocate resources. It's not really financially responsible just to contain the headcount have had that headcount. So what we do is we come in behind that and again supplement the headcount we hold headcount and we provide a contracted service so that really the medical device manufacturers can do more with the resources that they've allocated from a sales perspective and we supplement that with great service and support of the product.

That's outstanding. And Rick obviously this isn't your first time around you've had success with this type of model before. Can you give us a little bit more details on some of the things that you've done to create results and improve outcomes.

Yes. So I'm a clinician by heart started out as surgical assistant.

Oh did you? That's pretty cool.

I did and ended up in a surgical services. And what I did, Saul is I created basically a Rep-Lite internally. Again it came with the same set of problems. You had to continue to increase headcount and that headcount is a pretty big strain on a PNL. So what we did is back and I'm going to date myself here but back when minimally invasive surgery was really taken off and in the mid 80s it was very disruptive to the CEO. There was a lot of resources put into it and it was fairly inefficient. So what we did when I went to Stryker's we started a program similar to what we have now Rep-Lite where we would put that support role in and we got to see a lot of tremendous benefits. We've got to see clinicians having what they needed the things working properly we enhance the ability for our sales force to do what they were supposed to do at the same time the parameters were growing because of the efficiencies that were created inside the walls there. So we did that there and then we did the same thing because we had the summer scenario an intuitive surgical where disruptive technology. So we kind of did the same thing. The thing that was all of the great results that we were getting were amazing. The only hiccup to that is that we were continuing to increase headcount rapidly in today's environment with all of us having to be punished financially responsible and and price compression everywhere. We had a bit of delay. So it's kind of the genesis for Rep-Lite. To provide that type of service without increasing company company's headcount.

Man that's so interesting Rick and today in healthcare it's not only product innovation that's going to move us forward, listeners - it's going to be process innovation, operational excellence, and the time and dedication that Rick has spent and seeing how to best make this system work has given him results has given the company that he works with results. Stryker Intuitive Surgical pretty well-known names. Rick you had a chance to catch up before this and you kind of walk me through the Rep-Lite can you tell the listeners a little bit about why the name?

Yeah yeah. So you know I think as we go through this process and all the change in healthcare, Saul, we're trying to find ways to become a patient save money. Proper allocation of resources. And so one of the things that has come up is the buzz word is Rep list and the problem with rep list is that you dump up then you take a tremendous amount of responsibility and you put it right on to a hospital employee. Well the hospital is already maxed out. So now we've got a even bigger problem because we're asking people against do probably double or triple their daily work with the same amount of time. So really it's not really rep list that I think gets us back to this. I think it's rep-lite and that's the reason that the name came about I think rep list is very difficult. I think rep-lite is much easier.

I think that's so awesome Rick and listeners you know when you think about how you improve process. Oftentimes it's incremental and rather than go all the way to the other side and just get rid of the sales rep altogether or the service rep or the clinical rep just make it light and it really this is just the tip of the iceberg. I definitely invite you to go check out Rick's Web site where you could learn a little bit more about his system. Rick you want to share your Web site.

It's simple. It's rep-lite.com.

So check that out because we're just kind of scratching the surface here with 30 minutes. We really don't have a lot of time to check that but I definitely encourage you all to check this out. https://rep-lite.com/. Rick you obviously didn't get here without making mistakes or having setbacks your system wasn't always perfect. Can you share a setback that you had and what you learned from that?

Yeah I think one of the big things from a corporate standpoint is early on I really didn't pay attention to headcount. From a budgetary standpoint if we were growing the business that we added people and would learn the set back was that that really can have a negative impact on your PNL. The other thing is is that there's a lot of times in this space that medical device manufacturers and vendors are looking to increase and they really go through a due diligence interview process but they're really kind of in line with reply. I always will allow my client if they want our people to take them on at the proper time. I encourage that as a matter of fact the beautiful thing is that you get it's almost like a baseball form team you get to have a look at this person you get to see their talent and you get to sit within your culture before you do a higher. So we get a deep rift. And again I think the tail or the missed that I had early on Saul, is that I don't know that I paid attention to resource allocation as much as I do now. Now it's critically important these companies they've got to deploy resources in the most cost effective manner. And that's why I think Rep-Lite We've been so successful we're helping a lot of small to very large medical device manufacturers really create value to the customer.

Man, that's such a great share and definitely something that we all have to be cautious of when we're running our companies. And we really got to keep that cash flow going. And it's it's a balancing act like Rick said if you're wanting to grow double digits or continue to grow at a good pace and you're adding on headcount how do you keep this balancing act of growth and profitability. And Rick what a great lesson that you shared and I think one that we can all definitely be reminded of and stay profitable and stay consistent with the way we approach it. What would you say one of the most amazing leadership experiences that you've had in healthcare to date?

I have two, Saul. I mean one of the things that hold very dear to my heart is we will take a genuine professional and we will allow them to launch into this great industry. And so that's one thing that from our standpoint is it's our ministry it's what we do. We take younger folks and train them and have them to where they can work in this amazing space taking care of our patients. This is a little dated but in 2007 I was awarded Stryker's corporate. Most impactful point.

Nice. Congratulations.

You know but. Thank you. Well I think that's a secondary. Other than that what we're doing for our folks to have a company of that scale recognize us as having the most impact in the businesses is pretty overwhelming. And it was a total surprise. So very blessed and very grateful for that award.

Definitely something to be proud of. And you know Stryker's an excellent company as you guys build this client base and you continue to serve even more people. What would you say one of the most exciting project that you're working on at rep-litet today is?

What's kind of interesting is that we've been pulled into many different verticals. Anything from orthopedics to laparoscopy to home health to dialysis. So what's really exciting to me is that the Rep-Lite model really can provide value across the spectrum of care and not only for the providers and our healthcare providers but the vendors and the manufacturers and the innovative companies that are that are bringing innovation to this space. What's exciting is that this model we never have one cookie cutter answer for anyone. We always modify what our process would be so that it benefits our client. So it's pretty exciting to be pulled into many different spaces at the same time because you get a great look at just the overall healthcare space.

Yeah, that's so true Rick and one of the things that we've been talking about a lot here on the podcast is that the end of the day innovation in healthcare is implementation. And so if you're going to have a successful program,the importance of implementation is so key and it sounds like you've had this impact across several different verticals and that's definitely something to be excited about.

Yeah we're we're we're really excited about it. We kind of started in one vertical and it just seems to continue to expand out of the CRM just I can't even name all of them, Saul where they are contacting us now to provide the services. It's pretty exciting.

Well there's a huge need and I'm super happy for you guys that that things are going well. Getting close to the end here. And this has been a ton of fun. I love to put together a medical leadership course with you. It's the 101 of Rick Barnett on medical efficiency. And so we're going to write out a syllabus for questions lightning round style followed by a book that you recommend to the listeners. You ready.

Yes sir.

All right. What's the best way to improve healthcare outcomes?

Lower the cost and reduce infection rates.

What's the biggest mistake or pitfall to avoid?

I don't think we should ever sacrifice quality over cost. You should always strive for the best healthcare possible.

How do you stay relevant despite constant change?

We are a change agent so change is kind of in our nature. So for us we welcome the change because it plays right into our business model.

Love it. What's one area of focus should drive everything in a health organization?

It's very simple. You have to provide either of those that you serve period.

Love it. What would you say your all time favorite book is?

My all time favorite book is probably a book called point man. By Steve Farrar and it's a book on how a man should lead his family.

Very cool. Very cool. Love that point man. Well listeners we've got the syllabus for you as well as a link to this book. Rick's Web site. Everything's available if you go to outcomesrocket.health/rep-lite. You're going to be able to find that as well as a transcript to all of the things that we discussed. Rick this has been so much fun. I love if you could just share a closing thought and then the best place where the listeners can get in touch with you.

So first off thank you Saul for having me. It's always a pleasure speaking with you and really appreciate what you're doing in health care and getting this information out. What I would tell you is that I hate to be cliche but have any of your listeners historically have used a taxi cab service. But now they're using either Uber or Lyft. That's really what we're doing in the space. So and again not to be cliche but we've done things the same for a long time and now we're kind of being asked to change so we consider ourselves the Uber for medical sales and support. You can get in touch with us by the way and that includes on-demand efficient and less expensive. You can find all the information and all contact information. Like we said again. rep-lite.com.

Outstanding Rick. This has been a true pleasure. And folks, again take the invitation from Rick to connect. Find out more about what they're doing at rep-lite.com. And Rick I just want to say thank you so much for spending time with us and sharing these operational efficiency words of wisdom with us.

So again thank you for having me. And I appreciate you as well.

Thanks 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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Recommended Book:

Point Man: How a Man Can Lead His Family

Best Way to Contact Rick:

https://rep-lite.com/

Episode Sponsor: