Improving quality of care through tele-health
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Providing Cost-Effective Quality Consumer-Driven Healthcare with Henry Legere, CEO, Founder at Reliant Immune Diagnostics was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text. Our automated transcription algorithms works with many of the popular audio file formats.
Welcome to the Outcomes Rocket podcast, where we inspire collaborative thinking, improved outcomes, and business success with today’s most successful and inspiring health care leaders and influencers. And now your host, Saul Marquez.
Saul Marquez:
Welcome back to the podcast. Saul Marquez here. And today, I have the privilege of hosting Henry Legere. He’s the CEO and founder at Reliant Immune Diagnostics. He studied economics and chemistry at UC Berkeley before attending Columbia University College of Physicians and Surgeons to earn his MD. He completed medical training at Harvard Medical School, Brigham and Women’s Hospital, completing an immunology fellowship and earning a fellowship teaching award before being promoted to faculty. He used his experience to develop innovative consumer facing symptom based telehealth solutions that allow consumers patients to potentially go from testing to prescription and as little as 20 minutes from a patient’s own home. We’re so focused on the consumer side of health care today. It’s a very exciting time. And, and Henry has done such an incredible job of being focused on the patient experience that it’s going to be a really fun conversation today, very exciting momentum that he and his company have. And so without further ado, I want to welcome Dr. Legere ro the podcast. Thanks so much for joining.
Henry Legere:
Yes. Saul, thanks for having me. This is going to be a fun talk.
Saul Marquez:
It sure will. So, so what inspires your work in health care, Henry?
Henry Legere:
I mean, so there’s not just one thing, but one thing that I can say is definitely a several moment was when I was in the fourth grade, my dad had a stroke right in front of me out of the restaurant. And so over the course of, you know, from being in the fourth grade through going to college, my dad was in the military at the time. So he was considered 100 percent permanently disabled after that and had been at veteran’s benefits. But when the Reagan administration froze veterans benefits in the 80s, they hit our family pretty hard. And so trying to find access to health care when the veterans hospitals and clinics were closed and then actually be able to afford health care. You know, it’s just being a child and watching your parents struggle like that was very impactful. So when I went to college, it was halfway with a sense of purpose to, you know, one day try to practice health care and be compassionate and just be mindful of the challenges that families with health care burdens experience.
Saul Marquez:
Wow. That’s a story, man. I didn’t even know that. So at one point during the Reagan administration, the V.A. closed?
Henry Legere:
Yeah. So it was one of those things where it was one of those things where the government didn’t have a budget and they were playing hardball. And so I think that the Reagan administration and I’m not playing politics.
Saul Marquez:
No, I get it.
Henry Legere:
I think that, though I think that the Reagan administration felt that there were a lot of entitlements that needed to be cut. And when you’re trimming the belt and trying to figure out how to balance the budget and get people to come to the table. And so it was a bargaining tactic and it just went on and on and on. So it ended up being about I don’t remember it was six or nine months. You know, when you’re looking for a doctor and you’re trying to pay those medical bills. It was a long time to. And it wasn’t just, you know, the medical benefit. It was also the actual salary that my dad got as a disabled veteran. So it was even just the stipend that we lived on. Now, suddenly, we were we went from very little money to almost no money.
Saul Marquez:
Oh, yeah. That that I’m sure that was hard. I’m sure that was hard. And, you know, it’s really, really thank you for sharing that and piece of history that, you know, I feel like maybe some of us didn’t know like me or some forgot. And it’s worth remembering. But more than anything. Henry, it’s the impact that Hanna and you and how what you’re doing today to improve access and make things easy for people. It’s really inspiring. So this is a great opportunity for us to to zoom into your company and help the listeners understand what exactly it is that you guys are doing and how is it that it’s helping the health care ecosystem.
Henry Legere:
Yeah, great. So telemedicine in general has so much potential and it’s had this potential since it was conceived of more than 15 years ago. And the biggest challenges earlier in telemedicine, at telehealth where technology and regulatory. So early on, even if you could get a patient to connect on their phone to perform some sort of medical consultation, in many states, it wasn’t legal. You had to have a prior physician patient Face-To-Face relationship.And so there weren’t there were legal and regulatory barriers in place. And then how you actually conducted the visit, whether it was overall a landline or a computer, was different in different states who could actually conduct the visit, whether had to be a board certified physician, or if it could be one of the mid-levels like a nurse practitioner or a P.A. working under the direction of the physician. That also is different state by state. And so with those hurdles in place, it made it very challenging to utilize what has the potential to be something very much more affordable. And also something that can almost immediately increase access. And so one of the positive developments over the past couple of years is that technology has caught up. So with Bluetooth connected triage devices, so everything from blood pressure cuffs to blood glucose monitors to pulse oximeters, to devices that can allow you to image the eardrum, the back of the throat, medical stethoscopes that have Bluetooth connected, all of those can be integrated onto a software platform that can then give live accurate information to providers that could be sitting remotely. And state by state, those laws have caught up so that now you can actually establish a patient provider relationship through a telemedicine visit. So the promise of telemedicine is just on the verge of being realized. Even the federal government in HHS has relaxed regulations on conducting telehealth visits because they realize that our current health care models are not sustainable. And in order to really be able to cut costs, you have to take advantage of these cost saving technologies without compromising the quality of care. And so at the end of the day, everything still has to come back to the quality of the care that’s been delivered. For simple visits, for things like cold and flu differentiation, strep throat, ear infections, initiating birth control, science pressure, pain, rash analogy, pink eye. There are so many types of visits that you can tackle using the tools that you already have in front of you. And so we’ve tried to do is go even a step further and create an entire network nationwide of physical locations where what we can do what we call enhanced telemedicine visits. So instead of it just being a simple visit, that’s limited to the information that you can convey, you know, with a phone call or with a video call, we want to make sure that we have all the tools on site so that we don’t compromise any aspect of the patient visit so that we can actually get really high quality lung sounds, capture a heart rhythm, perform EKG is on site, get pictures in an ear drum. And so we’ve set up these pods that we call our M.V. Box pro version. And really what they are, they just enhance telemedicine, doesn’t it? And it works through a partnership with either doctors’ offices that don’t have access to specialists or with other non-traditional locations, like a pharmacy where a pharmacist or a member of this team can be trained by our practice to be a telemedicine extender. And so they go through a credentialing process and a training process, and we basically show them how to be a medical assistant in our medical practice and then we maintain their certification on our administrative platform and then it becomes a true partnership. So when people are on site in any of these pharmacies, they can initiate a doctor’s visit or visit with one of our other practitioners, like a nurse practitioner or a physician’s assistant. So it’s exciting times.
Saul Marquez:
It really is. And, you know, as you think about that moment when your dad didn’t have access to care, what you’re doing today is just like incredible. And it kind of reminds me of Howard Schultz and his experience with his dad. Not sure if you know that experience.
Henry Legere:
I don’t know his story, no.
Saul Marquez:
Yes. So Howard Schultz, the CEO of Starbucks, his his dad got hurt at work and it was real, is really bad. And they let him go and they didn’t cover any of his bills. And it was really bad. And it really affected the family in a severe way that because of that, he made a decision that every employee, even part time at Starbucks would have insurance.
Henry Legere:
Oh, yeah. They’ve got great benefits. Yes. Yes. And that’s. I told my sister and she’s going to law school, go work at Starbucks, you could get health insurance.
Saul Marquez:
Exactly. And you know what? It’s these experiences that that really make the entrepreneur and strengthen the mission. And Henry, your story is awesome.And what you’re doing today will help people, whether it be pharmacies or physician practices that don’t have specialists. I think it’s a it’s a great thing in areas like rural areas. I mean, there’s there’s huge need. And even urban areas where transportation or social determinants health could be an issue.
Henry Legere:
That’s exactly right. I mean, even in urban environments where you may have very long bus waits, or if you have to walk several miles to catch the bus, and even if there’s an appropriate density of primary care doctors, there may not be access to specialists. And so there’s a need inside the most heavily populated areas. But then, especially as you get across rural America and you know, part of our mission is to increase access to health to the United States. But we also have a global mission. And so we’ve also been in preliminary talks with folks in India, with folks in sub-Saharan Africa and parts of Central and South America, because even in the most those traveling in Africa over the winter. And what struck me is that even in some of the most remote villages, there were folks that had cell phones and had cell signal. And if they have that, at a minimum, they could be connected to a provider. I mean, obviously, you still have access issues when it comes to delivering the diagnostic tests and the medications. But it just makes it that much easier when you’ve got the provider part of the equation solved.
Saul Marquez:
Yeah. Now, that’s such a great point. Interesting that you’re gone global with this. Now, I’m a firm believer that contrast is the mother of appreciation. So let’s contrast what you guys offer to what’s available today. Help us better understand how what you do is different than the status quo.
Henry Legere:
Yeah. And so and I don’t mean. To besmirch the status quo of telehealth because it set the stage for what we’re doing. You know, the statute of medicine is something that just has to change. The current economics are upside down on our health care system and we just have limited access to specialists and in some areas, limited access to primary care physicians. In telemedicine, the biggest limiting factor to it being able to be the utilized is the concern that maybe you don’t have the same quality of care being delivered through a telemedicine visit. And that’s a concern that we have to take seriously, and that’s why we’ve put together these enhanced platforms. And so if you’re doing a strep visit and you’re doing it simply by talking to somebody, you can use CDC criteria for empirically diagnosing somebody with strep. But you don’t want to over prescribe antibiotics when they’re not needed. We don’t want to encourage the development of superbugs and people do have allergies to medications, and they do have certain toxicities. So we want to be very mindful of only prescribing appropriately. So if you can actually augment that and that’s what we call enhancing the visit, it can augment that telemedicine visit for strep throat with an actual point of care diagnostic and actually have medical grade imaging available where we can really look at the throat and see, are there X-rays on the tonsils? Do we see palatal patissier and really get a heart and lung exam as well? It’s just a step further. It may not be as good as what you would get, you know, with having the most skilled specialist or a practitioner place their hands on it. But it’s something that can genuinely approach that level of that quality of care. And in some cases, you actually cancer past it because a lot of these sites don’t have access to the same tests or the same devices that we’re putting in these telehealth pods. And so many times your little doctor and they can do some of the bread and butter of primary care, but they won’t be able to do allergy testing. They’re not going to be able to do PFTs that a pulmonologist would do. They’re not gonna be able to do exhaled nitric oxide. We’re not gonna be able to follow some very complicated COPD patients. And we’re putting together a suite of tools where we can do that at these sites.
Saul Marquez:
Yeah, that’s that makes a big difference to be able to do that and reach people that typically couldn’t be reached there. It’s too inconvenient and it doesn’t happen. It can make an inference.
Henry Legere:
And the last thing that we haven’t really talked about is this is all great to increase access, but sometimes there’s still cost prohibiting these visit. And another big distinguishing feature is we have the absolute price transparency. And so we are not trying to make money on a per visit basis where it’s very much a volume play. And what we’re trying to do is really get people to adopt this technology and do it in a way that can be affordable. And this is, you know, again, just coming from where I came from, I want to make sure that people have access to healthcare. I don’t think anybody should be denied access to healthcare. And so right now, and some of our pilot market, especially south Texas, where along the border are all land costs for somebody’s visits are cheaper than many people’s insurance co-pays.
Saul Marquez:
Yeah. I mean, that’s that’s a huge differentiator, Henry. Hey, you know, and there’s seems like that where we’re heading in that direction and Amazon is working on telehealth play. Who knows? I know that you guys make enough traction. You guys get purchased. It becomes a real big thing.
Henry Legere:
We’re part of the Amazon on Health Accelerator Group, which is it’s not a typical accelerator where they give you money. And what they do is they just connect like-minded health platforms to try to get synergies evolving to advance health care. And so we know we’re on people’s radars and hopefully even more than being on those radars and acquire, we can actually hopefully establish a big footprint in United States, because that means and people are using us, taking advantage of us, then go like benefiting from what we’ve produced.
Saul Marquez:
Yeah, yeah. And, you know, you mentioned the volume play and, you know, so before folks, before we before we jumped on and started recording, Dr. Legere and I were kind of going through some of the success that they’ve had and in expansion to-date. It’s good for everybody to know the numbers. I mean, you know, you want to share kind of numbers of where you guys are, and what your doing?
Henry Legere:
Yes. So we started out very modestly with with pilots in rural Texas because that really was who we were catering to initially. It just in some primary care offices. And from that we grew to a 50 store Wal-Mart pilot in the Dallas market where we were in every supercenter in the Dallas market. It was a short pilot to deem success.It sas about four or six weeks before we got into contracting for a national agreement with them. And then we turn our attention to the dominant grocery store pharmacy here in Texas, which is HDB. And we just completed an 80 store pilot with them. And I believe March 1st, we roll out into all 274 pharmacy locations here in Texas. And in addition to just this simple telemedicine visits that we do with them. They also have asked us to do some pilots around employee health with them. And that grew. And two other contracts with dominant regional grocery store pharmacy up and down the east coast, across the West Coast, the Midwest. And so we’re right now in about twelve hundred locations or. And over 10000 locations by the end of Q2 and just with signed agreements that we could actually get our act together and put together the infrastructure to pull this off. We’ll be in 23000 locations by the end of 2020.
Saul Marquez:
That’s awesome. For those that are listening that believe healthcare is not transforming. I hope that Henry is is. And you know, the thing that they’re doing is is a wakeup call because it is transforming and it’s exciting for all of us. And it’s exciting for, for our government and the financing of health care and access and price transparency. It’s truly wonderful work that you guys are doing. Give us an example of how your business model is improving outcomes or making business better. Henry Yeah.
Henry Legere:
And so that’s one of the things I’m really excited about, is that the status quo, telemedicine, a lot of the objectors to it. It comes around. Do you have enough information to be able to make a diagnosis? And so just the fact that we can actually show medical great images of eardrums or the back of the throat and couple that to diagnostic tests.So, you know, even though there aren’t pure guidelines for prescribing, we can actually validate it with a confirmed positive test or imaging that we wouldn’t otherwise have access to. As we move forward with some of our FDA trials to kind of step away from the practice of medicine and actually have some approved direct to consumer platform products. We’re going to be tracking outcomes and making sure that nothing that we do compromise is quality of care. So that that’s just as a former academic position, something it’s very exciting to me. On the business side, we just from the point of view of what we can do to increase access to healthcare makes me feel like our business is very forward thinking in terms of simple economics. As I said, just as we have more and more adoption. And we have folks that use us genuinely like us. And so we have great average wait times right now. Average wait time when you’re on a platform is under five minutes. Over the last 30 days, it’s been about two minutes, which is almost unheard of for a telemedicine platform. And the various retail entities that we’ve partnered with when we’ve done pilots with them, every single one of them that we’ve completed, a pilot has asked us to at least pilot with their employee health. So it’s creating very exciting business opportunities for us. What we’re going lies with top Ko’s employee health, pioneer our ex employee health and soon with HUB employee health. And then there’s a whole other opportunity that we never really talked about, Saul. And this, again, is just time getting back to my core mission where CEOs like the CEO of Starbucks. They want to take care of their employees, but maybe they don’t have the business to do it or they’re too small. There’s a lot of worn out places when you go to any shopping center in suburban America. There’s nail salons. They might have three or four employees and they might be independent contractors, stylists that haircut boutiques. And so certainly those people probably can’t afford to offer those people health insurance. But what they can frequently do is they can offer a cheap subsidy off of a telemedicine does it. Especially at the price point where we’re at. And so we’ve partnered with some local restaurants in Texas. Chewy’s is a kind of famous Mexican food chain and where they actually do have enough money to offer some health benefits to their employees. But what they realize, it’s more expensive to basically send people to urgent cares than it is to encourage them to tell us the problem. So they encourage them by telling them we’ll cover the cost of it. And so we’ve integrated some codes onto our platform where employers can give these codes to their employees and they’ll get for singles visit. And so we’re working with a lot of small one off businesses just to provide access to health care for those employees as well.
Saul Marquez:
That’s interesting. Very interesting in another area where transformations are happening. You know, employers have, have a lot. And we’ve we’ve talked about this. You know, we’ve had we’ve had folks from across the health care stakeholders that are focused on employer-centric care delivery. It’s a very real thing. And it’s cool to see you guys engaged in that as well. So great to hear that example. Henry, what’s been one of the biggest setbacks you’ve experienced then and what’s been a key learning from it?
Henry Legere:
Yeah. I mean, so I mean, when you start when you start a new endeavor and especially when it’s something that potentially can be so transformative, you learn by making mistakes. And my my philosophy has always been it’s OK to make mistakes. Just don’t make the same one twice. And having made enough mistakes in business, in life, you do as much research as you can so that you minimize those mistakes and mitigate that, you know, what it would cost in terms of development time and overall dollars. And so it’s one of those things where early on we thought that, you know, just having doctors and having attorneys that were health care attorneys would be enough to be able to figure out what the regulatory complexities are to allow us to go into a new state and what we realize, you just have to bite the bullet and you have to spend big dollars. So now we have a 50 state road map where it’s one of the things that I tell. Friends and other people in health care. This is the most expensive 30 pages that I’ve ever generated. So very detailed and it gets updated know up to the month state by state road map on all of the regulatory and legal complexities of practicing medicine in each state. And that’s still going to be an ongoing hurdle. The practice in the United States, it’s not federal, state by state. So it’s so interesting because we’re all trained the same way. And you go to know, I went to Columbia University in New York City, but we sent out doctors from my graduating class to probably just about every state in the country. And then we all have different local state regulations that really are have nothing to do with the fundamental physiology and biology of the human.And so in order to cut costs, the federal government actually proposed very recently in the last six months of federalizing medical permits. And there’s a lot of pushback from states. And it was one of the things I don’t want to get into politics either. But, you know, it’s that the states really do like to the pessimist in me would say it’s a money-making opportunity to license a credential, a doctor in your state, because you charge them a dozen times. But the non pessimist in me that a pragmatist realizes there are some considerations that the politics of every area is a little bit different. And so especially when it comes to reproductive rights and the age of consent in various states, those are voted on by the people that live in those areas, state by state. And then that impacts the practice of medicine. Again, just to give you an example, if this is all you could have a whole conversation on this, you can invite some reproductive rights specialists and really get a fine debate on that. If you’re in the state of California and somebody and I don’t know what that age is right off the top of my head, if it’s 13 or 14, if a child is 13 or 14, comes in and wants to initiate birth control, you are legally required to give it to them without telling their parents. In the state of Texas, that age is about 16. So if I’ve seen 13 year old that come in, ask for birth control and I gave it to them. That’s considered felony abuse. And so that’s a criminal offense to the doctor. So it’s important to know what the laws are because we think you’re doing. You know, what what what is best for the patient and what’s legal in one state. And it can be a felony in another state. So is what it is. That would be an ongoing challenge.
Saul Marquez:
And that’s a great example. Henry. Yeah, and I’m glad you brought that up and you gave us both perspectives. It’s it’s good to to appreciate that. And good mentor of mine always told me, you know, the an expert always understands the fine distinctions.
Henry Legere:
And yeah, that’s that’s on me. You know, Emmanuel Conte said that if you want to think rationally, you have to understand a problem from the point of view of every person. And, you know, that’s one of the three steps. And so, like, you always have to do that. You’ve got to try to step into their shoes and figure out where they’re coming from. There’s a lot less conflict. You don’t have to agree with them at the end of the day. Think for yourself, but you definitely have to understand what the issue is from another point of view.
Saul Marquez:
That’s brilliant. Brilliant. So what what are you most excited about today?
Henry Legere:
I mean, what’s there not to be excited about?
Saul Marquez:
I find it so exciting. It’s great time.
We are right now, whether it’s us or somebody else. We are on this verge of radical transformation, health care and it’s just technology in general. You know, being a kid growing up and the 80s and 90s cartoons like The Jetsons or even this is very futuristic versions of flying around in cars. You know, I’m a little disappointed. I’m not flying around in a car, but I’m glad that there are electric cars out there. And health care is one of those things. That’s the last thing to transform. I mean, 10 years ago, we were already starting to move towards using our phones for everything, went from you had you had all these separate peripheral devices. The phone was a great aggregator of these devices so that now you don’t have that carry a Walkman, iPods and everything is on a phone. Your music, your your movies, your access to TV. You hail a taxi on your phone. And the last vestige that’s holding out is medicine. And so you ordered your dinner, had it delivered to you. But right now, you still have to go to see a doctor. And so we’re finally stepping into that realm of taking advantage of the technology and and the regulatory environment has transformed so much in the last couple of years. So it’s you know, it’s exciting on all fronts. Technology’s catching up. People’s usage of the technology is finally getting to a point where the people actually are creating it and asking for it. And the federal government recognized it and they relaxed regulations at a federal level and state by state. The same thing has been happening. There’s only a handful of states that are a little bit more challenging. But for the most part, states have had very much come around to realizing this is the solution.
Saul Marquez:
That’s awesome, man. Well, definitely an exciting time. You guys are leading the charge. And the coolest thing of it all is that you’ve got the outcomes, you got lower costs and you’ve got you’ve got all that put together. So super excited for what you guys are doing. And I’m curious, what are you reading today or what’s one of your favorite books?
Saul Marquez:
So I’m actually rereading a book that I read when I was up on a cardiology rotation in medical school. And it’s an old one. It’s a classic. It’s The Good Earth I don’t know if you Pearl Buck was nobel prize-winning book on the experiences of a Chinese family in the late eighteen hundreds, I believe. And so it’s one of those that every now and then I kind of go down the list of classics that and another book I get through. And then I kind of walk away from it. I come back to it is the Count of Monte Cristo and it that’s just for personal indulgement. As I say, I love the intrigue and just the idea that at a time of the Enlightenment thought that folks were able to write even in a time of political oppression.
Saul Marquez:
Yeah, some some classic recommendations there, Henry. And and so, folks, you know where to go, outcomesrocket.health in the search bar type in Henry or Dr. Legere, that’s L E G E R E and you’ll find the show notes with the full transcript, links to the book’s links to their websites so that you could continue the conversation and get more information on what they’re doing. That’s so exciting. Before we conclude, Henry, I’d love if you could just share a closing thought. And then the best place for the listeners to get in touch with you and learn more about the company.
Henry Legere:
Yeah. And so let me leave you with the fact that right now you should demand more in health care. You should have price transparency and you should be able to access the types of providers when and where you want to. And so to that end, we created the mdbox platform so you can download it on your smartphone. You can go to the website mdbox.com or just on your phone if you got an iPhone. Go to the app store and it’s MDbox. Or if you have an Android, then go to Google Play store.
Saul Marquez:
Love it doesn’t get easier than that. So mdbox.com or check it out on your Google or Apple device. Android, Google.There’s so many of them now. What is it? Three main platforms as well.
Henry Legere:
And so we’re pretty much just on Android and IOS. But if you go to the Google Play store on any Android, you can, you can get us.
Saul Marquez:
Got it. OK. So there you have it, folks. That’s how you get them. Learn more about them at mdbox.com. And with that, Henry, just want to give you a big thanks and we’re rooting for you.
Henry Legere:
Yep. Thanks Saul.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for those show notes, resources, inspiration and so much more.
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