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: Welcome back once again to the outcomes rocket podcast. Really appreciate you tuning in again. And I've got an amazing guest for you today. He's a health care leader that specializes in the aging population and how do we best optimize resources. His name is Joe Schneier. He's the co-founder and advisor at cognitive mission and he was also CEO for five years. Now he's off to his newest venture where he's the CEO at Trusty.care and at Trusty.care they're making it easy to sign up for Medicare Medicaid and Medigap. I'm really excited to have him on here. He was a member of the hive as well as other really up and coming hubs of medicine that really build leaders that grow companies to the next level and so I'm privileged to host Joe on the podcast and welcome him. So Joe. What I love is if you could chime in a little bit there on the introduction. Fill in the gaps that I have missed.
: Sir. So I'm a serial entrepreneur. I actually started in the education space with a focus on behavioral change in the education space and about 10 years ago I got approached by some behavioral research scientist to start building out products for the digital hot space and in the beginning we were really sort of bridging the gap between those two spaces and then I made sort of the full leap over into digital health about nine years ago and since then I had the honor of doing some incredible work with researchers which the incredible part was on their site around drug adherence and addiction and then five years ago I founded cognition with my co-founder Jonathan Dariyanani and the mission of Cognotion center was to look at how do we solve the problem of the talent shortage in healthcare for the aging population specifically. So areas in the health care market where you're seeing these massive talent shortages. I spent five years working on that and then most recently founded Trusty in January of this year said brand new,.
: Yeah, thank you, I'm very excited. It is scary but exciting time of a startup. So yes, I guess that brings us today.
: That's wonderful. And Joe, why did you decide to get into healthcare?
: So I've had a real passion for looking at how you can get people to change their story about themselves to sort of drive behavioral change started with a focus on the cognitive behavioral therapy sort of focus to see if you get someone to start to say I can do something, can they actually do it? And in the beginning I was I was really looking at just direct applications in the education market things like early childhood literacy and didn't have health care in my mind at all. And there was a coach by this one researcher at NYU and she saw what we were doing in education and she had the first vision of bridging that gap and bringing us over in the healthcare space into the first products that we started putting out with her were designed to work with really complex communities. They were real disenfranchised and to see how we could positively impact them in health care and it was just a trial run from me I had no idea it was going to work. But the results were phenomenal and really caught my eye. And one of the things that's like a real driver for me is is that the sensors can measure what are doing and to know that it's actually effective and healthcare that so much clearer than it was in education. So I really enjoyed that piece of it and that was sort of what pulled me over the on into healthcare space.
: What an interesting story Joe. And so you haven't looked back since.
: Yeah. I've I've done some work on this side where we were still modeling out different components that we then folded back into our health care products and I'll just give one example of that. So we did a couple of products in hospitality that were also around behavioral change really with the intent of looking at how do you apply some of the components of hospitality to the healthcare space. We did them directly in hospitality to test them out there and then ported them over. So we've done some things in some other arenas. But I'd say 85 percent in healthcare.
: Wow. Very interesting. And so I love that you have thought about you know what can we pull from hospitality into into healthcare because today we really don't treat patients as as consumers. But I also feel like we're heading that way. What would you say a couple of the insights that you gained through those projects were?
: So the insight of at other industries and there areas of excellence is something that I've thought a lot about throughout my entire career because there's things that are assumptions and hospitality that are just not assumptions. In healthcare like if you smile at a customer in a hotel they're going to smile back and they'll pop and have a better experience. And so just like some basic things over there and looking at how we could for them over into healthcare. Now, some of that is really difficult in healthcare because obviously the dynamics are completely different and speed are different and the pressures are different. But there's actually more similar than people would think. There's a lot of really high pressure moments with customers. So that was one area that we really focused on was how to get people to navigate the emotional intensity of dealing with a customer. And then over on the other side with patients who were really agitated and how to sort of calm them down and move that into a different space there was one clear thing I guess that we we we worked on.
: Yeah. It's really interesting. We definitely need to start seeing more of this as we transition into a more value based healthcare system is definitely important for us to start thinking about the people that we take care of as more than just patients. So it's super encouraging to see that you guys have worked on products in that realm. So tell us a little bit more about your current venture and the vision and sort of where you see this going.
: So one of the things that happened in Cognotion as we were working on this talent shortage was I got to see sort of what it was like for the workers so we were not just focused on improving the patient but we also really wanted to improve the worker experience and one of the complexities in that company was that we didn't have as much control over what happened to them once they got hired. So my initial vision for Trusty was to look at who we create a system that would enable us to upscale people to work in the healthcare space to provide a value to consumers that was valuable enough that they would purchase it. And that's a tall order. And I think I think we've hit on something but we're still working out some of the pieces. But essentially what we're doing is creating this system that is a streamlined version of applying for all the kinds of government services you need in healthcare starting with Medicare and then Medigap and Medicaid. And the reason for that is sort of known to anybody who's ever tried to sign up for any of these things. But for those of you who haven't it's extremely complex and it's catastrophic if you do it wrong then the penalties and the things that can go wrong if you do it wrong can last for the rest of your life. We knew that people some percentage were going to want to use just a pure technology platform that sort of like similar to what kind of a Turbo Tax kind of thing. But we got the news people were going to want to talk to live people. And so we said why don't we create a new wall like a new health care roll that is like a Medicaid Medicare expert, a person who knows the ins and outs of that and create a new space. And can we look at other places in the market where there's a market need and develop worker groups that have value where the salaries could potentially be higher than they would be in other spaces. So that's sort of evolution has going in that direction of again providing a real benefit to our customer but then also looking at how we can get more people into the space because it's really necessary.
: You're asking some really great questions Joe and you know it's interesting how you've approached this, it's kind of taking a look at the market need. I mean give you an example I recently had a colleague retire and she was just trying to figure out what to do with her Medicare Medicaid and it was confusing and she didn't know what to do. And it was a very opaque process. And like you said there is always if you do it wrong could be detrimental for a very long time. And so I think you're definitely on to something here Joe and the other thing that I really liked about the way you're approaching this is searching for a market of underutilized workers and so very cool approach that you've taken here for I think a segment of the population that's going to be needing more and more of these services.
: Yes. And there's one thing that we know after working in the states is that the aging market will really need some smart minds to be focused on it. I don't think that we know how much it's going to impact the economy over the course of the next 15 years but the numbers are staggering and we're already sort of behind the ball on it a little bit. So we're trying to get out in front of that a little bit. I think there's a lot of room for innovation in this space and people are looking at the space from different angles.
: Yeah and you're definitely taking a really great crack at it. Just so can you describe and I know you guys are early on with this one but maybe share a story from Cognotion of a time when you guys created results or improved outcomes by doing things differently?
: Sure. So I'll give one example when we early on in the company got hired by the Ministry of Health of Saudi Arabia and they had an RFP that they basically put in front of us because nobody else would take it. About four years ago I guess it was the height of the Ebola issue, right. And this was four weeks before the HOZ where millions of people were going to descend on Saudi Arabia from Africa. And they had done no preparation with the country to prepare for what could have been an outbreak in Saudi Arabia. So they asked us to build out a complete training program for all of their medical professionals and staff a call center for the ..that had to be aligned to the CDC standard of which we're changing every single day at that time. So we had to create this whole system like very quickly that had to embed in it the information had to be presented to the doctors and the nurses and orderlies in a way where it would really stick because the consequences of us getting it wrong could be just terrible, right? So we can't say for certain you know this is all attributed to us obviously but there was no Ebola outbreak and the use this did function exactly as it was supposed to do. That was one thing where we felt like, hey that was what was good. So that was sort of a larger one but then we've had a lot of other really interesting successes so in part of our program was training people to become certified nursing assistants. And one of the first things that we observed was that there's a real problem with retention which is a known thing but people haven't really looked into in detail why that was happening. And so we spent a bunch of time just following and CNN's around and realized that a big reason why they were leaving the job was for things like dealing with racism or dealing with families like screaming at them or time management and some things we can control or preparing them emotionally to be able to deal with those things. I was told that in a much higher retention rate with the people that we've trained. And it's surprising. It's like all you're doing is showing people that they are capable of doing this thing. And then when they show up if they've already gone through it and some of that we've had the theory that we based on a lot of work that was done in the military. They've really pioneered a lot of this type of training which is kind of odd. But yeah but it's effective.
: That's fascinating. And there's been a theme here Joe and you know in our conversation but also in conversations that we've been having with other health leaders that are having success. And that theme is that in healthcare, true innovation is actually amazing implementation. So if you could implement things well then you're the innovator. And there's no doubt in my mind that you're a master implementer. What's your secret?
: I again don't give up, my secret. I think I think I joke but not completely. I think that a big mistake that younger entrepreneurs make especially in seeing this in digital health is thinking that they've come up with an idea and that they have a brilliant idea maybe they work in healthcare even they have a brilliant idea, they see a problem a build something to solve that problem and then they try and push that solution onto the system and it doesn't really work that way. It's a lot of like a feedback loop of iterating and iterating and iterating both on the product itself but also on the business model and sort of looking at how you can have the entry points that are actually going to stick. And I think that if I could say anything to myself from 20 years ago that would be the thing. Don't think you're so smart from the beginning. Look around it okay to take in new information and phase shift accordingly. And even with Trusty we started out with we we were very clear we're like we have a very clear idea of what we're going to do. We tested it for two months and realized that out of the 40 things we thought we were going to do 39 of them had about 600 a hits. And one of them had 15000.
: So even in this short period of time we had to come. We said OK I guess the market is speaking to us. So I think that that kind of thing as not not being afraid to go where the market is leading you.
: What a great message. Listeners, if you didn't catch that, I would recommend that you hit that rewind button. Look one with 15 seconds and hit it about three times and relisten to that because I was gold right there. Joe appreciate you sharing your wisdom there. There's no doubt that it's it is a pathway to make these ideas work because these things are not going to work on the first run. And so did you just put your ideas out there through like Google Ad Words or how did you get the hits.
: So with Trusty we're we're looking at two different models of selling either to end enterprise with partnerships which is a long road and we knew that because Cognotions sells to skilled nursing facilities and those are very long sales cycles. We also wanted to see if we could do direct to consumer and our initial concept was really much broader than what we're doing now. Initially we had thought well all get people connected with the entire ecosystem of people that can help them as they're aging from eldercare lawyers to financial advisers and caregivers. Sort of a one stop shop which would have involved a lot of build up of a two sided marketplace where you're getting in workers and consumers which is very difficult. But we were like, Lets put this out there. We tested using Google Ad Words, Facebook, LinkedIn we also went to different message boards where users were located and did some advertising there and then did some advertising in person saying you know what kind of word of mouth effect we could have.
: Could be generated.
: Yeah. And so it was really it was really interesting. There were a lot of reasons why I said data makes sense to me now is that out of all of the different services almost everybody was asking about how do we navigate Medicare which we had put in almost as an aside because you know an interesting thing I was like I was like oh let's put that in a friend of mine said that that's a problem for her. I'm very grateful for her.
: That is amazing. Great thanks for sharing that. Yeah, and listeners, you got to listen to the market right, and be persistent and much to Joe's great example and walking us through his process. I mean it's so key that you don't just put it out there if you build it, doesn't mean they're gonna come. And so, Joe thanks for walking us through that. That is a very helpful lesson.
: So share with us a time when you had a setback or a failure and what you learned from it?
: There are so many. So I will give one particular failure which is sort of built on the last thing that I was saying know so about six years ago we've built out a product and it was in the foreign language space. And so again this is one of the side projects. We raised a significant amount of capital for it. We saw that there was a clear problem and the problem that we were trying to solve was that Americans don't believe that they can learn a foreign language. So we said OK we're going to create a system that is going to be really effective mechanism to learn a foreign language spent a ton of money on it spent a whole year building out this program. At the end of the program, we won all these awards for it because the people in the industry thought it was great. Nobody bought it and it was one of those things where like it's beautiful. It's in an ideal world. Now people would use it. It's really great but are they going to buy it. Probably not because it's not it's not essential. And I think that that lesson is sort of what has you know whether it was a real moment of understanding that you, like it doesn't matter how many times you've done it I've already had to exit that at that point. It's easy to forget the humility of like you don't know anything until you see stuff actually happening. And that was a big one.
: And Joe thank you for sharing that you know I mean I've been in that in those shoes before as well and what was the miss on that one?
: A couple things. So the first one was our channel partner that we had a distribution deal signed before we started building. So we thought it was a sure win, a large distributor. One of the largest publishers in the country. What we didn't realize was that for them there was really no incentive to push it because it wasn't going to drive their sales, the individual sales people would get such a small incremental increase. There was no benefit to them. So first of all our sales channel was not incentivized. Secondly, people were not purchasing foreign language products in the school system as much as they said that they would wanted to. So a lot of times people say that they want to purchase something but if you don't test to see are they going to actually do it then it's not really worth it. I think that with the second and the third piece and I think that this isn't really applicable to digital health is that there are a lot of things that seem nice on paper but if they add time to teacher's in this case as day or doctor's day it doesn't matter how good it is, they're just not going to do it. And I think those are the three components and the time factor is I think a thing that gets really overlooked especially in healthcare.
: What a great call out. Some great lessons there. Joe, how about the other side you took us to the darkness. Take us to the light and tell us about one of your proudest leadership experiences that you've experienced to date.
: About two years ago. We brought in a man named Dennis and we're in New York based company, Gary, LGBT friendly very diverse. And Dennis is from Kentucky he lives in Kentucky, is salt of the earth. But very sort of from Kentucky person, one is like best people I've ever met in my life. And so if we say ironically that he was our diversity.
: That's funny.
: He hadn't been the sales person. He had run some nursing home himself but he had just this really great touch. And we had this idea of what if we hired people from the region they were selling into and see if that would work more effectively. And watching him grow into his leadership role and seeing him close our biggest deals, I mean it's just beautiful when you have that happening. It's like if you have kids and you see them surpass you it's just a great feeling to see that somebody brought on who didn't even know if they could do something steps into their strength and it's resulted in the biggest sales for the company. So the both of those things. It's more that I'm proud not to visualize that but I'm proud of actually doing something. But I but for sure.
: That's great. You know Joe that speaks to the leader that you are. I ask for one of your proudest moments and you go to in a moment that you know was obviously good for your company but it was seeing this person grow and listeners if you catch anything from that. You know you've got to be very focused on both your business but your people because if your people are doing well so is your business and and Joe you identified an unlikely person as it related to your firm but you did it in a very very eloquent way and you've found a way to make it work for you guys.
: Yeah I mean he's just one of the best people I've ever met him.
: That's awesome man. So tell us a little bit more about an exciting project or focus that you could tell us about within your current venture?
: Yes. As we started mapping out what it is that we're working on it became clear that the problem that we're trying to address is something that will benefit anybody in the country will benefit from and that the deeper that we sort of dove into it the more that we realize that this is a pretty green field and that is pretty exciting. So it's pretty rare as an entrepreneur to approach a space and to see that innovation could really be applied to a large market and that there aren't a lot of people already doing that. So I would say that's pretty exciting and part of the reason why that is the case is there's still a lot of the holes around the data have changed and have gone into effect in the past couple of years. And then there's a lot of interesting things happening related to Medicare because of the tax code and the new tax bill and how that's going to change everybody's plans. So I get really excited when you see a big problem that is a crazy complex puzzle but then you start to sort of see how you can map out pulling together different fragmented pieces to create a simplified solution. That's my that's the thing that really gets me going and is motivating to me and the other thing that I'm really I guess I'll say just a quick brief personal story about why this is meaningful. So about a year and a half ago my brother a year younger than me got into a severe car accident and he is fine now.
: Oh,Thank you. Thank God, that's glad to hear.
: I remember telling people that he's on the road to recovery. He's OK but he broke his neck, shattered his pelvis, broken his jaw. It was just he was a disaster, it was horrible and he lives in Nashville and I flew out visit him the next day the next morning since I could get the next flight and the surgeon comes in that morning and he looked at me and he said well it looks like we're going to have to release your brother because he doesn't have insurance and he still needed more surgeries. So we were of course like yeah no that's not going to happen.
: Those two things happened in us, we had to go through all of the headache of getting somebody signed up for Medicaid retroactively. You're out all the system try to figure out how he could get the care that he needed. Meanwhile like is he going to make it and going through that experience of realizing like how the complexity of bureaucracy intersects with people's lives. My brother was lucky he had me, he had my parents there advocating for him but a lot of people don't have that. And so when they go to face signing up for these different offerings that their government has for them it's just daunting and overwhelming. And in that case if he hadn't have that. Who know what would have that would have happened to him. So for me the idea of being able to address something that is a real technical problem really. It's like a system problem. Yes but that it will have that kind of impact on families lives. It's a rare opportunity and I'm pretty excited about it.
: That is super exciting Joe and I'm glad your brother's doing well. And it's sort of the silver lining in this whole thing is that this hardship that you experienced that your family experienced in your brother is now going to be the beacon that helps others make it easier for them. So supercool.
: Yeah we're pretty excited.
: And that's awesome. I mean I'm so thrilled for you and your team definitely looking forward to following you guys. Getting close to the end of the interview here. I always wish that I had more time. But all good things must come to an end as well. Close this interviewing. So this is the part of the interview where we do a lightning round. I've got four questions for you and we're going to follow that with a book that you recommend to the listeners. So this is the little mini course that we're putting together for our listeners it's the 10 of Joe Schneier and so on how to be the best in medicine. So here we go. What's the best way to improve health care outcomes?
: Transparency. I think that that's the biggest thing that needs the best in the market and with companies and the whole system.
: What's the biggest mistake or pitfall to avoid?
: Thinking you can sell easily into hospital systems.
: I love that.
: You can but it's possible. I've been there..
: What was that?
: It's possible.
: It's possible, that's right, good distinction, good distinction. How do you stay relevant as an organization despite constant change?
: I think that .. this shift between big data to rich data which is kind of just you know jargon that people are throwing around but really looking at how do we use all of this data in a way that keeps it relevant. And there are lots of ways to do that. Now there hasn't been a time before in the past where technology has it where it hasn't been easier than it is today. So I think that's the biggest thing.
: What's one area of focus should drive everything in an organization?
: That's an interesting one. I think for us and this is just for me on my surface will be relevant for others. But I always try to remember the humanity of the people I work with and the people that we're serving and not forget that there are real people on both sides of that. And I think through that you can really develop great products that keeps you closer in touch with your customers. It gives you a better feel for what they are going to want. But it also is just a better way to live I guess.
: Totally. What a great share. And Joe what book would you recommend as part of the syllabus to the listeners?
: I really enjoyed reading the book, An American Sickness so I highly recommend that. I am not good with names and don't remember the name of the author, I'm sorry.
: No problem.
: It gives a really good overview for people who are not professionals in this space about how the healthcare system in the U.S. got to this point. And it's quite good.
: An American sickness and I just like that up listeners it is Elizabeth Rosenthal. So there you have it some amazing recommendations from our friend Joe. Don't worry about writing any of them down. Just go to outcomesrocket.health/trusty and you're going to find all of the show notes, a transcript as well as the best places to get in touch with Joe. So Joe what I'll do is leave it to you to give us a closing thought. And then the best place where the listeners could get in touch with you.
: So my my closing thought is just that there is definitely desperately in need of great minds that are willing to look at how do we solve real problems that both sides of the equation need both the doctors as well as the patients and especially in the aging space. It's not a space that seems sexy but it is one of the largest fastest growing areas of the industry. And I am looking for smarter people to come alongside us and join up with this. And I can be reached at. We've got a Facebook page. That's your trusty care or feel free to reach out to us. My email is firstname.lastname@example.org.
: Outstanding. Joe this has been awesome. This has been insightful and we really appreciate your time here on the podcast.
: Well thank you. It's great being here.
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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