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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: And welcome back to the podcast. Saul Marquez here today have a special treat for you. His name is Dr. David Lenihan. He’s the Co-founder and CEO of Tiber Health. He’s driven by a relentless commitment to make medical education more accessible for students of all backgrounds and income levels. And experience educator and medical practitioner, he was witnessed firsthand the limitations of the traditional medical school model and resolved to create a better more inclusive and effective one. It’s fascinating what Dave and his team are up to it really inspiring when you when you think of the soaring cost of tuition, the debt that students come out into their practice as physicians. It’s incredible what he’s doing and thinking outside the box to make health care better through education. So it’s a privilege to have you on the show Dave thanks for joining us.
Dr. David Lenihan: No Saul thank you for having me. I’m really happy to be here and looking for the great discussion.
Saul Marquez: Likewise. So what is it that got you into the health care sector to begin with? I mean you’re a physician by training right.
Dr. David Lenihan: Right yeah. So I wish I could say that it was some great path or vision that I had early on but I think really the vision for the medical field was my mom. She wanted her son to be a doctor and…
Saul Marquez: Cool.
Dr. David Lenihan: Had drove me down that path at the beginning and I think a lot of a lot of parents do that. But as I as I kinda got involved and got into practice and I love the practice I love seeing patients. I also realized I really liked teaching and I know the way you described me as a CEO at Tiber Health and that’s great but when I look in the mirror and my kids are running around, I’m dad and I’m also a teacher. But that’s what I see in myself and I really started to explore that and develop my career as a teacher. I think it was that process that got me involved in that kind of trying to disrupt medical education. And yeah so that kind of it was a long path. I wouldn’t say it was just one particular event with a whole series of a career that led me here.
Saul Marquez: Yeah for sure and by the way I got goosebumps bumps when you said that because it’s genuine, it’s real, and I love it. And so maybe what we could do here Dave is chat with the folks a little bit more about Tiber Health, what you guys do, and why.
Dr. David Lenihan: Yeah. So Tiber Health was as a company it’s actually named after the river in Italy where the god escalate Jesus was born. So actually has there’s a meaning behind the name of Tiber Health. And the idea is how do we help employ the really smart on employed kids and students in America. And health healthcare is really probably the most important thing humanity is trying to solve. And I know that Eli Moss wants to send somebody to Mars and an exploration has been a great human endeavor but that doesn’t affect anybody right now.
Saul Marquez: Right.
Dr. David Lenihan: Trying to resolve and repair our health care system globally affects all of us, all your listeners. Everyone we know gets affected by us improving health care. And one of the things I will, I started to see early in my academic career was I thought we were starting to select the wrong types of doctors. We weren’t looking at the outcomes from the metrics and how to drive analytics to select doctors that are going to go back into communities that need physicians. So Tiber health is a company that focuses on trying to get more diversity into the health care sector at a cheaper cost so these kids aren’t stroud but that like I was for 20 years. And by doing that help improve the outcome measures for our parents, our grandparents, and our kids as they go through their life. And so we really have this mission of making a difference today not tomorrow or tomorrow too but making that different happen today right away.
Saul Marquez: Of course. No that’s definitely resonates and a time when it is a problem and you’ve got some institutions will really one in the US kind of going toward that way with NYU. It’s definitely a need. And so what would you say is the call to action for folks and trying to make a difference within the space?
Dr. David Lenihan: Outcomes. End of the story. Quality and outcomes. If you’re in medical education, this is different than every other field there is in my opinion, in education that quality has to drive everything and you have to use your outcome metrics to improve that. So the question I think really comes down is how do you improve those outcomes. And what I believe and what Tiber believes is we need to have more diversity in our workforce. And I’m not talking about race. I hate it when we talk about race and people talk about you know you’ve got to have this race and we treat these patients. That’s nonsense. What we need to be doing is how do we get more diversity in socioeconomic class. And what I found when we looked at this is when we look at rich areas like Evanston and Garden City and Long Island they have enough doctors. How do we get doctors that are going to go into Cabrini Green in Chicago or East Detroit or Harlem in New York. How do we get people to go in there and to do that, we have to get doctors there are we have to train doctors of that similar socioeconomic class and to get them in there. And the reason why this is important is because a lot of those patients understand that communication, the diet they have, the ability to communicate with that patient becomes paramount in getting the patient to follow directions to comply with the doctor’s wishes so speak they help the patient get better. And that’s how we drive outcomes and so outcomes and quality are the two big things that we need to do.
Saul Marquez: That’s a really unique approach. You know I think most people’s minds like you called out Dave go to race when you think of adding diversity they think of race. I feel like that’s something that is a thing that automatically pops up. You simplify and say it’s not race it’s socioeconomic. And by having these socioeconomic factors you could more clearly speak to the people that they’re telling me…
Dr. David Lenihan: Give you an example of this out and so I was with a bunch of deans. I won’t say what school they were what we were talking about how we’re going to get more diversity into our medical schools because the reality is most of the doctors in medical school look like me. I’m a white male, Midwestern kind of guy. And most of my patients, 30% of my patients are. And so I’m talking to them and I’m like we’re supposed to be smart people we’re supposed to be some of the smartest people on the planet and we’ve been talking about this problem for a century by gosh we got to be able to solve it. And so what we did at Tiber or one of the things that I started to develop was by using outcomes and analytics we’re able to start seeing what type of student actually does well in medical school. And I found that when we look at the entrance and the entrance in the medical school I saw that the verbal score really had no bearing on how a student does in medical school. However black and Hispanic students or students from lower socioeconomic classes tend to do worse on that verbal score. So I’m like well why are we using this score as a predictor to who gets into medical school. So we became the first institution to remove that from our application process. When I did that, all of a sudden the number of minority students that were eligible to create to cross our threshold to come into school increased. And the reason why this has become important because for medical school we get thousands and thousands and thousands and thousands of applicants for a small number of slots so it’s easy to just draw some a logarithm to say will only take students from this kind of group. Right.
Saul Marquez: Right.
Dr. David Lenihan: If you take a verbal score out then you can really solve that problem and get more diversity into your workforce and so Tiber and our schools became the first school to do that. And again that’s how you use analytics to start the training process to get more diversity into the health care workforce.
Saul Marquez: Fascinating. And so you Dave have a university as well is that correct?
Dr. David Lenihan: Right. So we became the first group to acquire a U.S. medical school. Lots of people have tried.
Saul Marquez: Which is I mean a lot of the big and huge kudos to you because when you think of the two industries that really are highly complicated bureaucratic and really tough to crack it’s education and healthcare so congrats for picking the most difficult area to work in.
Dr. David Lenihan: I really think the reason why we’re able to do it and it’s not me is the team that we have to do it. But the reason why we would do it is because our focus on outcomes not just everyone talks about quality. Everyone says “Oh we have a high quality product or we have. We focus on quality.” You shouldn’t say that but you have to have the outcomes and you have to have the analytics metrics behind you to prove it. And I think we were able to do that because we had that gap and that data underlies the whole engine.
Saul Marquez: Fascinating. So now you guys have the university and you’re working with what you guys believe is going to make a difference. Give us an example of what you’ve done already to improve outcomes.
Saul Marquez: So we’ve we’ve expanded so we’re in St. Lewis and we’ll be in a four or five different other places in the United States next year. And we’ve created what we call this master’s program and the master’s program is kind of for the students who didn’t get into medical school. And what I believe is that a lot of these students who don’t get into medical school will become very good doctor but it’s tough to figure out who can be successful in the academic side of things. So what we do is say “All right let’s say you got a C in calculus biology and chemistry of your freshman year, you’re probably not going to get into medical school because your grades just aren’t sufficient.” And this tends to be a lot of the minority students because here’s what happened. My son went to a private school his whole life. He’s had all the opportunities. Dad’s done well so I get him tutors, I get him what he need. He gets a fifteen hundred on the S.A.T. Another student gets a thirteen hundred on the S.A.T. but he went to an inner city school and go to Harvard. Let’s say my son gets an A in calculus biology chemistry because he has these classes before, this inner city students get C’s. It’s not that my son is smarter it’s that my son had more opportunity. That inner city student doesn’t get in medical school because of those great. So what happens is we say “All right we think you’re going to be a really good doc, so we’re gonna bring you into our master’s program and run you through our program.” It’s the very first year of medical school. So we run him through that and then we’re able to devise our analytics so as they’re going through we built this predictive model whereby looking at their exam scores and how they do I can predict how they would do on their board exam which is what they’re going to need. If they do well and we bring them into medical school. So I’m taking it up once. This is where it gets real exciting so I’m taking a bunch of students that never got into medical school. They were never ever gonna get it. We trained them to use analytics and then we bring them into med school. Here’s the exciting part. These students do better on the national board exams than the national average across the United States.
Saul Marquez: Wow.
Dr. David Lenihan: So a hybrid seeking a group of students that no other med school is taking. We run them through our program get them into medical school and they do better than the other students who just go normally.Tto me and mostly students are lower socioeconomic students. To me this is the most exciting thing that we do. I’m telling all the other school deans that look at you need to change how you look at your mission process we need to kind of revamp it and another part is that students that don’t get into medical school we can tell them “you know you can go into dentistry, you can go into pharmacy. you can go into pharmacy field” so we can start moving them into the healthcare workforce getting more diversity into the healthcare workforce and filling those jobs so we’re taking people with lower socioeconomic starting point and getting them into jobs that pay a high salary. That changes the whole life just like the TV show or the movie Rudy. What are you reading with the college. Everyone else with the college. Once you kind of lift them up and give them an opportunity they shine again. That is really the exciting part of what we do that that social benefit and what we create.
Saul Marquez: Amazing what a great example and fascinating program and layout. And it finally clicked Dave, like the Tiber. And folks I don’t know if you know this but I was a classical humanities major when I was young.
Saul Marquez: Yeah. Yeah. A lot. The story…
Dr. David Lenihan: I would go back and do that if I could Saul. I loved that.
Saul Marquez: It was fun man. I enjoyed it and it clicked. So Romulus and Remus were left at the River Tiber.
Dr. David Lenihan: That’s right.
Saul Marquez: And they were discovered by a she wolf. They would have been left there to die. And they weren’t. And then that was the beginning of Rome which is you guys all know it’s noble story in this way just connecting the dots for everybody listening if you haven’t, the folks at Tiber health Dave and his team are leaving the Romulus and Remus’s of the world and picking them up and helping them develop health care you know not necessarily empire but helping contribute to health care. I love the connection. I literally just made it Dave. Took me along…
Dr. David Lenihan: I’m actually going to steal the Romulus and Remus example.
Saul Marquez: I’m glad because it’s definitely what you guys are doing. They were left there to die. You guys picked them up and you’re doing the same in healthcare so truly magnificent. So give us an example of the time when you guys made a mistake or had a setback Dave. Take us to that moment to learn from it.
Dr. David Lenihan: Yes this says the problem is as everyone sees kind of this you started here and now you’re there and they think it’s a linear path. And I guess this is you’re a young entrepreneur or you’re trying to set up it ain’t a linear path. It’s all over the place and I remember this one time I had to get medical students to go to class. It’s very hard. They’re A personalities they’re smart they’ve learned on their own. Their whole life. It’s a lot of times they think they can do that. And so we just couldn’t get many students to go to class. And so I had this brilliant idea. I go that’s it. I’ve had enough of students in the class. So I installed fingerprint scanners all over campus and I said every time you go in and out of class you have to fingerprint in and out or we’re going to march you absent and deducted from your score. I thought this was a brilliant idea Saul. It was the worst bloody idea ever, the students revolted. All the petitions they were they started to sue me so they thought I was stealing their fingerprints. Break into their bank accounts. I mean the thing that was really this everyone told me not to do it. Somebody that doesn’t. They did come out directly and say that’s not you know I wouldn’t do that but all they would say is don’t know if that’s such a good idea I should add it was a disaster and I hope by next year the following year I had stopped it and pulled everything out. I guess the moral of that story is it’s okay to make a mistake. Yeah I did it. I fix it but you have to make a decision and what it did it was a godsend notion to the student that they have to go to class. This is too important to can’t do it on their own. And there’s all types of failures from maybe calculating your analytics wrong to coding a script wrong or putting fingerprints on what the thing is you have to make a decision and move forward. And if it’s not right fix it. But a lot of times people get stuck and can’t make a decision. And then I have to tell this to my kids. It’s okay to make a mistake. You just have to keep trying and that’s that’s the lesson I think I really learned from it.
Saul Marquez: Love that, love that Dave. And it’s interesting. And you know you talk about you have a team and I think it’s so important to surround yourself with people that you know aren’t you know see the vision but it’s also good to have one or two people that see the other side. And we’ll tell you straight up hey you know what. I don’t think it’s gonna work like point blank.
Dr. David Lenihan: So I actually have two of those guys and I want to say their names because they’ll probably get embarrassed but I can come up with some crazy stuff like I had this one other one. I’ll give another example of this failure to realize it was called as I call it a DNA morphing rating system and I related it to golf. Because in golf the only people you compete against is yourself to get a better score right. So I thought same thing with Grade. I was going to morph your grading scale based on your ability so if you’re really clever and do well you might need to get a ninety six figure today but I would only need to be eighty five to get an eight to the system would change your grading scale based on your ability instead of everyone having the same grade each year. And I actually one of my friends pulled me aside they go after the debacle with the fingerprint you can not do this without all the coding and worked out everything for ads as I like. So yeah. No no no no. But you really need somebody that’s just not going to agree with you to somebody that’s going to stand up and say that’s not a good idea. Let’s really rethink this. Oh you’re right.
Saul Marquez: That is so good. And you know what. I do my career I’ve been sort of a glass half full and recently actually I had one of my people at work just have a really frank conversation with me and they said look we know that you see things the positive but it’s important that you take a look at the other side of the glass and call out the things on that side too. It’s important.
Dr. David Lenihan: Yes. I think what people like I’m seeing right now I think with us is it’s tough for us to do that. So you need somebody there that you trust that can also point that out to you.
Saul Marquez: Yeah. So interesting. Thanks for sharing those definitely took some nuggets of wisdom there I know other listeners did. What’s one of your proudest moments to date with Tiber?
Dr. David Lenihan: This actually happened is this not necessarily to date but it’s the kind of thing that happens and it happened yesterday. It’s when a student I was driving my brother had flown into town come in and visit us and we’re driving home from the airport and a student called me and he just was just want to check how he’s doing telling me what he was doing and how much he liked my course in years ago when he was a student I was describing some patients that were similar that we had we had worked in class. That’s what gets me excited. When I when a student calls up and says hey I did learn something even though I complained about you when you were teaching me the stuff we did learn something and it was important to our clinical practice. Again when I look in the mirror I see myself as a teacher. And so when someone comes back and says hey I learned something from you that to me is the most exciting thing and you know my wife can tell when a student called me because I’m be there you know during the movie again know it makes you feel great.
Saul Marquez: Yeah.
Dr. David Lenihan: And so that’s probably I and I could talk about you know starting a new business or having a success in the business but the reality is helping somebody who’s going to go help somebody else. And the whole purpose of being a teacher and that that really gets me excited.
Saul Marquez: That’s beautiful. And now you’re doing it at scale with Tiber and so I think it’s it’s a beautiful thing.
Dr. David Lenihan: Yes.
Saul Marquez: What would you say an exciting project you’re working on today is?
Dr. David Lenihan: I really think that the project on our master’s program and using the analytics so by by being able to get more students in to our medical school that normally wouldn’t get in and these students are coming from lower socioeconomic backgrounds where they don’t have all the opportunity. So by getting them into med school and using this type of platform that we created in our analytic engine predictive that’s what I do all day. And that’s something we can take globally. So not only are we looking at here in the U.S. The we can trace that across the world. So think about this for a few seconds. We have a medical school in Ethiopia and I got five Somali doctors that looked like they’re going to do very well on our analytic model. I can call up the Minneapolis St. Paul health system which has a lot of Somali immigrants and their health and their presence and say “hey look at guys. I got four docs they’re going to do great on the border you need E.R. doctors you need orthopedic surgeons. Let me place them into your community that’s going to improve the cultural competency of their workforce there. It’s going to interact with their patients better. They’re going to get better outcomes at a lower cost.” So we’re driving the cost down, improving the outcomes, and giving people opportunity globally. And the number that’s just staggering were 13 million health care workers short on this flow right now. We’re not solving this problem today. I mean we’ve got to be aggressive and active in doing this. And as far as I can see Tiber is really the leader in taking the reins and trying to solve this problem.
Saul Marquez: And man that’s awesome. And you know the question just occurred to me. So you’ve got the access part how about the financial part you know how are you guys tackling that especially when you’re getting students in that don’t have the means to necessarily pay first.
Dr. David Lenihan: That’s what you’ve got to keep these costs down and it’s great. And you can why you is giving away free tuition. Well they got lots of money in their endowment and somebody donate four hundred million dollars to make this happen. Now most of the medical schools and universities across the United States across the globe cannot do it. So what we do differently is we completely change the way the curriculum is delivered. So all of our lectures are kind of given on video. So students watch the lectures. Now this is not an online program. They still have to come to class but they take that lecture part and move it off off line. And then when they come in the class we work through clinical problem, problem after problem after problem which means we also get analytics. But by doing this I really reduce my cost. If the teacher gets sick a teacher leads I reduce my costs of delivery by about 35, 40%. So when you look at our tuition levels our tuition levels are about half of what the average in the United States is.
Saul Marquez: Wow.
Dr. David Lenihan: By keeping the tuition levels down. Also by maintaining and sustaining a business environment. Yes that’s how you solve it. And if you look at the average debt load of our students we’re about 30% of the national average. Now this is important because all of the majority of our students come from families who earn less than thirty thousand dollars a year and they’re borrowing less money than the students that are going to the other schools. That’s the exciting thing.
Saul Marquez: That is exciting.
Dr. David Lenihan: To able to teach and support them because it took me 20 years to pay off these bloody loans. I took. It takes a long time and I don’t want my kids and I don’t want it now. And it’s ridiculous right.
Saul Marquez: Yeah
Dr. David Lenihan: So my wife would say it’s incredibly ridiculous.
Saul Marquez: Hey listen man I am definitely you got to run a good business and you’ve got to give value. So it sounds like you guys are going above and beyond with the value for the price. And so kudos to your team for having been able to put that together getting to the end of the interview here. We have lightning round so I’ve got final questions for you. It’s the one on one of Dave on how to improve outcomes in health care. So you ready for the five questions?
Dr. David Lenihan: Sure. They’re short answers or are…
Saul Marquez: Short short answers short answers
Dr. David Lenihan: Right. Here we go.
Saul Marquez: So these things are like rapid fire. What’s the best way to improve health care outcomes?
Dr. David Lenihan: Quality and analytics. Measure everything you do and make decisions based on that information not your gut.
Saul Marquez: What is the biggest mistake or pitfall to avoid?
Dr. David Lenihan: Trying to do everything yourself. When I first started I thought I had to do everything and get a team around you have people you trust and let them do it. They’re probably smarter than you are anyway. And they’ll do it better just learn to trust the people that do work with.
Saul Marquez: Amen. How do you stay relevant despite constant change?
Dr. David Lenihan: I guess and do what you love. I’m president, I’m CEO. I still teach in the classroom. If you like the code, if you like to write, if you like to do arts make sure you still do that. As you move up the ladder because that’s what’s going to keep you connected with why the business is successful.
Saul Marquez: What’s one area of focus that drives everything in your company?
Dr. David Lenihan: Quality.
Saul Marquez: And what is your number one success habit?
Dr. David Lenihan: Learning to trust people. That when I say habit you have to learn to do that and make that a habit. You can’t do everything yourself as I said before so you have to kind of work on how you trust people and make that a habit.
Saul Marquez: Love that. What book would you recommend to the listeners, Dave?
Dr. David Lenihan: My wife is gonna laugh at this. I love The Hobbit. I don’t want to say how they ended a book or something but…
Saul Marquez: I love it.
Dr. David Lenihan: It was it was the very first book I read to my children when they were 4 and 5. And if you read it it’s a life lesson right. It’s the journey. It’s not necessarily about the reward at the end. It’s a journey travelling through and learning what you need to do and the option but not everything’s great. It’s going to be the ups and downs of life. And so if you look at the book from that perspective and it’s an enjoyable but if you look at it from that perspective it provides incredible valuable lessons to the change in adults. So today’s society still relevant.
Saul Marquez: Love that. What a great book to recommend listeners go to outcomesrocket.health check out – just type in Tiber health in the search bar. You’ll find all the show notes and transcripts there. Dave before we conclude I’d love if you could just share a closing thought and then the best place for the listeners could get in touch with or follow you.
Dr. David Lenihan: Yes so if you want to get in touch with us it’s tiberhealth.com and you go to our website and see what we’re doing and what we’re about. Closing thought I know in today’s environment we want to say you know everything’s going up in smoke and everything’s bad but I think this is one of the most exciting times on the planet to be alive. Healthcare is becoming a global opportunity for everybody, it’s one of the fastest growing markets. We’re now able to make strides. And as long as you internalize the idea and do the best you can at all times you’re going to be in a very successful healthcare worker and embrace it, be part of it, and make tomorrow better for our kids. And to me that’s what life’s all about. So I’m excited about it.
Saul Marquez: Love it Dave. Hey it’s truly inspiring to have you on the podcast. Keep up the amazing work and looking forward to staying in touch with you. Thanks again for spending time with us.
Dr. David Lenihan: Thanks Saul, really appreciate it.
Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.
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