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It Ain’t Dog Food If The Dog Don’t Eat It!
Episode

Neal Sofian, CEO at tuzag, inc.

It Ain’t Dog Food If The Dog Don’t Eat It!

In this episode, we are privileged to host Neal Sofian, the CEO of Tuzag, a conversational AI Omnichannel health concierge company. Their platform delivers one to one ongoing computer-mediated conversations, content, and service offerings across any communication channel, driving exponentially greater consumer behavior change. 

Neal talks about the need for true consumer-centrism in health. He also discusses how his company leverages technology to learn about individuals and create tailored interactions that can create relationships leading to behavior change. He shares about gender-fluid “Jamie”, successes his company has seen, and the big challenges we are facing in health care. 

Neal’s company is redefining the concept of consumer-focused healthcare, and his insights are truly fascinating. Please tune in and enjoy my interview with Neal Sofian.

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It Ain’t Dog Food If The Dog Don’t Eat It!

About Neal Sofian

Neal is the CEO of Tuzag. He’s recognized nationally for almost 40 years of innovation and population-based and corporate and payer health management and engagement. 

Neil commercialized the first and largest telephonic smoke cessation coaching program in the United States, Free and Clear, and many of the early health-related social networking platforms, including the American Cancer Societies Cancer Survivors Network. Neal holds a Master’s Degree in Public Health from the University of Missouri School of Medicine. And Neil is also a working potter and sculptor and has done standup comedy in a Vaudeville show.

It Ain’t Dog Food If The Dog Don’t Eat It! with Neal Sofian, CEO at tuzag, inc. transcript powered by Sonix—easily convert your audio to text with Sonix.

It Ain’t Dog Food If The Dog Don’t Eat It! with Neal Sofian, CEO at tuzag, inc. was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best audio automated transcription service in 2021. Our automated transcription algorithms works with many of the popular audio file formats.

Saul Marquez:
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Saul Marquez:
Welcome back to the Outcomes Rocket, Saul Marquez here. Today I have the privilege of hosting Neal Sofian. He’s recognized nationally for almost 40 years of innovation and population-based and corporate and payer health management and engagement. Neil is the CEO of Tuzag. And what they are is a conversational AI Omnichannel health concierge company. Their platform delivers one to one ongoing computer-mediated conversations, content, and service offerings across any communication channel, driving exponentially greater consumer behavior change. Neil commercialized the first and largest telephonic smoke cessation coaching program in the United States, Free and Clear, and many of the early health-related social networking platforms, including the American Cancer Societies Cancer Survivors Network. Neal holds a Master’s Degree in Public Health from the University of Missouri School of Medicine. And Neil is also a working potter and sculptor and has done standup comedy in a Vaudeville show. My goodness, Neal, I mean, you are just cool and interesting and making a difference in health care. I’m glad you’re here with us.

Neal Sofian:
My pleasure to be here.

Saul Marquez:
Wait a minute. I want to park on the sculpting thing. So what do you sculpt?

Neal Sofian:
I do sculptures of anything. I’m really hot on big, big whale sculptures right now. The other is a, I’ve got a little archaeological sculpture set up. I’m going that says there are people from if you look at God concepts from around the world, it’s like, what might they look like if they were all if there was one underlying thing called a guy named Himi who was actually the great God of them all. So it’s kind of it’s meant as a humorous series of sculptures that that mainly occupy different parts of our house right now. But much to my wife’s chagrin.

Saul Marquez:
That’s so funny. So are you like how do you actually do it? Like, do you just chisel it or.

Neal Sofian:
Oh, no, this is all it is all ceramic sculpture. So I work at a place called Pottery NW. In fact, until last year I was the president of the Board of Pottery Northwest. We are a community ceramic studio and educational center. We’re probably the largest ceramic educational facility on the West Coast. We’ve been here for fifty-four years, I think fifty-five years at this point. And I’ve been working there for the last thirty-eight.

Saul Marquez:
Amazing. Yeah. Well I mean I find that some of the coolest leaders in health care and the most are also the most interesting ones. And you know, like your personal life, you got some really neat stuff going on. But in the health care space, you have some fascinating work where you’re really helping improve outcomes. You’re leveraging technology, conversational AI, et cetera, to do that. So I’m excited to dive into Tuzag, your company. But before we do, talk to us a little bit about what has driven your why the last 40 years in health care,

Neal Sofian:
Fundamentally the problem I see in health care, besides the fact that we are we have bizarrely strange incentives in the United States. Rube Goldberg could not have invented the US health care system. It’s such a mess. But we tend to look at health care as really medical care. And even worse, we tend to think of people as nothing but molecules and diseases and risks. And I’d say we shouldn’t be thinking about people as molecules, but rather their motivations. We are people. And if your people were way more complicated than a disease, you’re somebody with diabetes, you’re not a diabetic. And if that’s the case, if we expect it to cause people to change their behavior probably best if we treated them as people and understood how complex we are as humans. And so my goal is to say, how do you do that? And then use technology to leverage the leverage, the reach so that you can actually talk to millions of people to do that because ultimately, it’s great to be effective in helping one person at a time, which we have to do. But bottom line is, there are 350 million people in the United States and we have to find really cost-effective ways to have that kind of personal, intimate relationship in a way that can actually help people make the changes they need to make.

Saul Marquez:
And I think that’s a really great call out, Neal. And so that’s where Tuzag comes in. So talk to us a little bit about the company and what you guys are doing there to improve on and help the health care ecosystem.

Neal Sofian:
Cool. So I’ve spent years building health interventions, whether it was Free and CLear, which you mentioned in the intro, which is was once upon a time, the idea of actually doing phone coaching, which now seems extraordinarily old hat. But in 1986, it required a randomized clinical trial to actually prove that it worked. And we did that working with Group Health Cooperative here in Seattle, the University of North Carolina. Well, all of a sudden we didn’t have to have you in a room to do phone to do smoking cessation and talk to ten people. All of a sudden I could have staff and talk to thousands of people via the phone. Well, that was a big breakthrough in eighty-six. But that’s now how do you how can you use that same. That same thinking, but new technology to reach not thousands but tens of thousands, hundreds of thousands or millions. And so we started looking over time at whether that was looking at social platforms, whether that was tailoring content so that it actually every single person got their own unique message or even push messaging. And in the course of doing that, we started looking at what was consistent, that in all these cases, whether it was building a social platform or tailoring, it was how could I make content relevant just to you? How could I create a context that would say for Saul there’s something different and needs to talk to Sal differently than if I’m talking to Mary or if I’m talking to Belinda. That’s going to be all very, very different, because not only is my disease is different, but my circumstances are different. My interests are different. My values are different. And so whatever I do, whatever technology I’m using, I need to be able to scope out and find out not only how do I be relevant with you, but how do I be resonant with you. And that means I have to ask a lot of different questions like Saul you’re in Chicago. I say you know, so if you’re in greater Chicago and, you know, I need to find out, do you have kids? Are you in a relationship? What do you value? Is a career versus family versus spirituality most important to you? Are you a Bears fan? If you.

Neal Sofian:
unfortunately.

Saul Marquez:
Well, hey, they’re five and one. That’s the first year you can be proud of the bears in the time. But all those things are the little things that say this is who saw is and oh, by the way, saw also has and I’m making this up clearly Saul has diabetes.

Saul Marquez:
Right.

Neal Sofian:
That means I could talk to somebody else with the exact same disease. But how I talk to them is going to be totally different, both in terms of what medium do I choose, how do I talk to them, what’s important to them, the metaphors I use to get them to make a change. All are totally different. And that’s what Tuzag is about, is how can we build contextually relevant conversations that are unique to each individual and cross any medium of communication. So whether it’s your smart speaker through the computer like we’re doing today, for that matter, or if you like something that’s tailored print because you want something in 14 print, 14 type print and it gets mailed to you, which some seniors might want, or for that matter, I think in the near future, through your television, how can we communicate and not just that, but have them cross from medium to medium to medium. So a conversation might start one and move to another and then ultimately may it to a live person and that that live person knows all the things that we’re having in that computer-mediated conversation. And in turn, what you say is the right person gets reflected back to the computer-mediated conversation, knows what you did with the live person.

Neal Sofian:
And, oh, by the way, make sure your family knows what’s going on in that process, too. That’s it’s complex. But then again, aren’t people? Why shouldn’t we understand the complexity of human behavior? And we understand I mean, we understand the complexity of the human genome. We understand the complexity of dealing with cancer in terms of having to come up with unique medical procedures to do things. Why would we think human behavior is any less? In fact, I would tell you, most people understand it’s way more complex. So they would actually say, hey, it’s easier just to change your genome than it is to try and actually get you to take a walk or change your behavior. So let’s just do the medical thing. It’s like..well. One, because it’s three-point six trillion dollars of the economy, half of it tied to our behavior. Maybe we ought to look at the behavior side, not just the the the surgical side or the genetic side or the pharmaceutical side, and have actually more impact for far less money.

Saul Marquez:
Neal, some great, great ideas and insights you’ve just shared. And the one question that comes up is around this personal conversation right now. And so, I mean, just at first feel, you know, at first thought, I think it could be impactful. You put it in the right context and have that relevant conversation so that it becomes something that people want to do. And then it gets put into the context of what analogies they would understand. I mean, that seems to me very effective. How do you scale that, though, you know, like that? That’s the question, right? Because it’s personalized, but we’re talking about scaling it.

Neal Sofian:
Yeah. So you do that through a mixture of technology, methodology, and great content. And then you have to think about content much more as a kind of a Cubic version of Mad Libs so that every conversation you can structure it so that as I learned more about you, I can insert more pieces into that conversation that are pertinent to just you so that the word within the sentence might change. A sentence within a paragraph, might change the paragraph within a conversation, might change in what conversation I should even have, might change, and that it grows and changes based upon the previous conversation and that that. Conversation can happen through your thumbs, through chat or through text or through voice or through a smart speaker and Amazon or Google device or even through your Web browser or through print, and then back and forth through the mail, it doesn’t matter. Any of those can work, but it’s all about thinking about this is a two-way conversation and that the technology now let you do that. In fact, I would tell you that’s the most exciting thing, is that to do this 10 years ago, you would have said, well, the technology just won’t support it. And the answer is that’s no longer the issue. The issue is our imagination. It’s the ability to understand that. What do you wish what kind of conversations do you wish you could be having with an individual that could help move them along their personal journey and their path? And now you should start with just that.

Neal Sofian:
Don’t even think about the technology. The technology will follow, whether it’s the tailoring and inference engines we’re building or other technology that will come along, we will get pushed. We think we have pretty cool technology. But I would tell you, technology is not the delimiter, it’s not the important part. It’s the ability to take all that technology that’s out there and apply it to a very different way of thinking, which is understanding that people are really complicated. And if you can’t tell their stories and have them feel like it, like even when I said to you, Oh, the Bears. And you said, yeah, unfortunately. But I got an emotional response out of you, which is I could clue into that. On the other hand, if you’re not a Bears fan at all or a sports fan at all, then I probably need a whole different way of talking to you.

Saul Marquez:
Totally.

Neal Sofian:
If I can learn those things and I can and I can put that all in in a cloud-based database and then use it to have that ongoing conversation, the sky’s the limit.

Saul Marquez:
Yeah, it’s very powerful. And so we think about ways to tackle this. I’m imagining you’re mostly working if you’re working with populations, right? Providers and payers as they’re concerned. What would you say is the thing that makes you guys different than what’s available today?

Neal Sofian:
Most of the world is still focused on either. So I guess they’re focused on molecules or they’re focused on telling you what to do. And it’s like if I can tell you. Now we’re doing, the zoom and video know when you do this to people, when you point your finger at them, your index finger, they provide a finger back, but it’s usually their middle finger that’s like, you know, it’s the finger for finger approach. And we say, well, it’s consumer-centric because we’re telling you what you need to do. It’s about you. Because we know. We know Saul has diabetes. So we’re going to talk to him about his diabetes and therefore it’s personalized. Well, that’s what we think you should talk about. That’s not consumer-centric. Amazon finds out what books you like and then says, well, based upon what you like and what we know other people like you like, here’s some things that you might find interesting in terms of buying these books and you end up buying books you’ve never even heard of. That’s way different than saying you should care about your diabetes. So we’re going to teach you about it. If I actually took the time to get to know you and I knew your life circumstance and I knew that, for example, that yes, you do have diabetes and I can get that from a medical claims record, but that you also have three kids, you’re working two jobs, you’re stressed out and that you live in a food desert. Well, and I know all those things about you. Well, and that what you really need is respite care for your family and you need a good night’s sleep. And that’s really what you like. You’re having trouble sleeping. Well, I could either talk to you about diabetes, or I could help you with where you are right now by helping you, where you are right now, perhaps helping you with your sleep issues, perhaps finally helping you find respite care, which might be even available through an employer or not, or through government support. Then I can build a relationship with you. And out of that relationship, I build trust and will slowly but surely get you to see what are some of the underlying issues tied to that diabetes? But I do it through having that ongoing relationship with you. That is almost unheard of in health care. Almost everything you see in health care today is either push, most of it is SMS text messaging. Don’t forget to take your pill. Take do this, do that, do this. It’s push, push, push or it’s a phone call, push, push, push. And they’ll say they’re doing something with motivational interviewing, but it’s usually around, for example, with a payer. It’s around what we perceive as the payer. You’re costing us money this way. So we’re going to fix that problem for you, which is that’s not consumer-centric. That’s payer centric. Provider centric. It’s not. If Amazon uses that kind of approach to its services, they wouldn’t be slowly dominating the world.

Saul Marquez:
Totally. Yeah, no, it’s a great call out, Neal. And, you know, it’s hard to do. And I think what you’re offering here is that it’s not impossible. It’s about your imagination and your philosophy. You know, the fundamental philosophy of what you guys are doing is the paradigm shift. Now, how would you summarize your philosophy?

Neal Sofian:
A couple of things. Start with the premise that it ain’t dog food of the dog don’t eat it.It doesn’t matter how cool a product you have if people aren’t using it. There is no such thing as a single best solution to anyone. In many cases, I need to connect you to other services, just like there’s no one best book. Amazon understands there’s neither a billion books nor one book. There’s the book that’s right for you. And so I think we have to have that same thing by getting to know you. It’s almost like an eHarmony. I’m dating you. I’m getting to know you. And of course, the core part of that philosophy, if you want a second date with somebody, is probably you let them talk. You ask them what they’re interested in as opposed to just tell them how well you are if you want, at least if you want a second date. Then apply kind of that kind of principle of dating and getting to know you tied to that Amazon kind of choice architecture of helping you connect to the right services, you put those together for health and I think you have a guiding philosophy. And then understand that it has to cross any channel as you do it. And that’s how you get more dogs to eat because the goal is to get lots of people to do stuff, not just to say I have the best single program, but I have the best single solution that can help you at this moment in time, which will be different than tomorrow’s moment in time.

Saul Marquez:
Yeah, that’s very interesting. And so maybe you have an example or two of how the platform is currently being used. Neal, I would love to learn more about that and how it’s improving outcomes.

Neal Sofian:
So a couple of places. One, we we did some work with the health delivery system in the south, I guess on price. And I don’t have permission to name names, so I won’t it’s a really large one. And there’s a winning football team in the same town, so you might figure that out. But they don’t have a baseball team in that town help you even more. But they said, gee, we’d like to help people new to our city use our health care system instead of the competitor. Well, the traditional way would be so they buy up email lists and they simply just start pushing out informational ads for our delivery system. Instead, we said, let’s take a different approach. That said, you’re new to town and we set up an Amazon Voice skill. I don’t want to say her name because she’ll start making noises in the back.

Saul Marquez:
Right. I got one right behind me, too. Yeah.

Neal Sofian:
And so we say hi, you dial into it and you’d say you’re new to you’re new to town. And you’d get hit with an email saying, hey, here’s a new service for you. Welcome to town. And then she would say, hey, welcome. How long have you been here? What part of town do you live in? What have you liked most about town? What has surprised you about being here? And you and the answer’s become, oh, I lived down in the south part of the city. I’m really surprised by the food here, you know. Oh, what kind of food do you like? A hot chicken. Another hint to where we’re going and you know. Oh, that’s great. What have you found problematic since you’ve been here? The traffic really sucks. Oh, OK. Can I help you with finding you some? Let me let me find you some great hot chicken places down in the south part of town. And what do you need any help with schools. Yeah, I’ve got two kids. Oh, you do? Great. I now know what your interests are. I know you have two kids. I know what part of town you’re doing. All of a sudden I can now say, hey, have you picked a provider yet? But I’ve built a conversation where I’ve already sent you some recommendations for restaurants. I’ve helped you with your traffic problems. And this can be over more than one conversation. That doesn’t happen at once. And then I can say, oh, by the way, did you know that I have a great pediatrician available for you and they only are five blocks from you or oh, if you need something more urgent, we have a relationship with Walgreens and there’s a Walgreens really close to you. You need an appointment, but I can set you up and schedule you for a doc today. OK, that’s building a relationship by first learning about them, asking, finding out. Can I help you with some recommendations, whether it’s around food or other sorts of things? Or if you said, hey, what’s your biggest problem? Oh, I’m having a problem with the allergies here. Great. Now, I can always, um, divert probably straight to health care because you told me. But so something like that or designing. How do I onboard of health, my health plan in Wisconsin, we’re looking at how do you do this from the moment somebody joins? How can I get to know you? And then based upon that, provide every single member their own personal care path.

Neal Sofian:
The average payer today basically welcomes you and lets you know what your benefits are and says, hope we don’t have to spend any money on you. Instead, we should engage you, not when you have a medical problem, but from the moment we meet you, the time to build a relationship is when I’m not I don’t I don’t have to have the relationship yet. It’s so that it really is mutual. And I get to know you and I learn your needs. And by doing that, I can really help you that way. Or another example, which in your neighborhood we are now fine with, with a major university and cancer center in your area about how can we use the same sort of technology to help people post-chemotherapy and the cancer diagnosis, as they have to move in that move back home and deal with their oral meds in terms of adherence and not just ask them, are you taking your pills, which you could do with a smart pill bottle and Bluetooth? You can do that without a talking point having a conversation. But how are you doing with it? How are you managing your care at home? Is that are the drugs making you sick or if you’re not taking them? How come? And what kind of support can we provide you that might help you do those sorts of things?

Neal Sofian:
And so once you start thinking about this as, rather than a technology, but it’s the same as what a coach or a companion or concierge might do, just as we’re doing it more virtually and that it’s two-way and that we call our concierge Jamie. Jamie, nice gender fluid. In that process how can Jamie be a virtual member of your care team and be your companion, your support, your concierge, the person who directs you to the life support when you need it? And at that point, you can say it applies to anything from adherence to health promotion, to an employer being able to say, how do I connect my employees to the kind of wellbeing services that help them stay well and productive, healthy and productive. It can be applied to almost anything because half of health care is all about consumer behavior and can be used. For example, we’re talking with a group on how to how to use a post-hospital discharge, those 30 days after you leave the hospital. How do we help get you back on your feet doing the right things so that you don’t end up back in the hospital unexpectedly?

Saul Marquez:
So, yeah, that’s interesting. So on the first example, are you saying I was thinking about the touchpoint where the device, the smart device, smart voice device about using the name.

Neal Sofian:
Amazon or Google device.

Saul Marquez:
Right.Amazon and Google device. So does the initial prompt just happen from the device or like you did?

Neal Sofian:
Right now, unless you’ve set it up. She can, very interestingly and decide how quickly and the research will show how quickly people will attribute humanity to them if you make them act human. They will actually deal with the issues of loneliness and connection. So yeah, so people do tend to.

Saul Marquez:
I do the same thing.

Neal Sofian:
And provide a gendering and then the gender could be male or female. You can, you can do all sorts of things. You can add personality to them if you want. We’re really thinking about those sorts of things. But you know that she will not just initiate automatically. So it starts with some sort of I’d like you to you know, in this case, the institution was sending out an email because they had those addresses to say, hey, here’s an opportunity. Would you like to sign up? So it’s not like she’s going to be just spying on you and just knocking on your virtual door without permission. All this has to be very carefully permission-based. And I guess so if you start saying, hey, I’d like to set an alarm so that she will she will wake up and say something like good morning and then kind of encourage you to then say, hey, Amazon device, lets let’s have a conversation. You can do those sorts of things, but those are more the limitations of the devices at this point, not the ability for us to set that up.

Saul Marquez:
I guess I’m not I guess and I don’t want to get hung up on this because it’s not where the value prop is, but it’s more my curiosity. Yeah.

Neal Sofian:
How do you get started?

Saul Marquez:
Yeah. Like, how does that start? Right. because I get that I could start but how does it actually get started.

Neal Sofian:
Yeah. So it gets started and a lot of different ways. So if you’re an employer setting, there’s a traditional health risk appraisal business that we’re employers say, hey, complete this health risk appraisal once a year and we’ll send you out some information. Well, we can start the same way where the employer is saying, hey, let’s do this. A second way can be your doctor saying in the case of what we’re doing with cancer, follow up and adherence, the doctor says, I’m going to send you some equipment like a smart pill bottle on budget, send you an Amazon dot and some other things. I want you to set it up and use it so the doctor can initiate it. You can even initiate this with, you know, in the I think the day will come where you’ll see in the drugstore, in the pharmacy, whether it’s in a Walgreens is in Chicago. And. Yes, but it could be CBS. It could be Rite Aid.

Neal Sofian:
It could be any of the players, whether there’ll be a kid who hears this stuff. And then when you get home, you open it up and there’s your code for signing up and getting into the conversational part of it. And I would tell you, in cases like that, you know, who’s going to end up buying it is not going to be. And this is going to be great for helping seniors stay at home as you’re managing chronic care or helping people age in place. It may not be the senior who’s purchasing that. It may be their adult child who’s trying to help take care of them at a distance, who says, I think I’ll buy this. And in fact, Rite Aid, I’d like you to have somebody deliver this to my mom and set it up. And that way we’ll set it up in case my mom was in St. Louis while she was still alive and I was in St. Louis and my God, my brother was in Jerusalem. So we had to. How do we manage her from a distance? I think the day will come where that will be delivered. They’ll either be home delivery for that sort of thing through any number of pharmacy delivery companies or through your retailer or through your provider or payer. So a lot of these can be set up in a lot of different ways. You’re right. That is still the biggest single issue is saying how do I really make the first interchange happen? And I would tell you that that will still involve in much the same way as Amazon. What’s the biggest bribe Amazon offers and the answer is prime. Free shipping, they find something you want, and then once they do that, once they give you free, they give you Amazon plus TV. They give you all kinds of stuff for all sorts of stuff,

Saul Marquez:
I love Amazon.

Neal Sofian:
And once they get, you go. And so that’s how they get you to go and they there’s a front-end pitch. And after that then they have to be relevant enough to you to that you want to keep using them because otherwise. So yeah, the bribe works but it won’t work forever. So you may have to move to intrinsic motivation quickly. And I would tell you, the difference between an Amazon and us is that besides the X number of hundreds of billions of dollars in revenue, is that fundamentally it’s one thing to get you to buy a book? It’s a whole nother thing to get you to go for a colonoscopy.

Saul Marquez:
Oh, without a doubt. Yeah.

Neal Sofian:
Yeah, that I have to not just simply say if you like this book, you’ll like this book, too. I actually have to be able to say, if you like, I need to understand that that health is actually not an end in itself. I need to understand what you care about, that you want to be able to bicycle. You want to be able to pick up your grandkids. You want to be able to go whatever they what, fulfill your dreams. I’d like to be able to travel, take your pick. I want to be able to get the next good job. I need to understand your motivation so that I can then create the metaphor that makes it resonant to you as well as relevant to your need. And that’s more complex than selling your book. Health is just more complicated, so we need to do more.

Saul Marquez:
Yeah, well said, Neal. Well said. And I think and by the way, thanks for indulging my curiosity.

Neal Sofian:
That’s exactly the right question.

Saul Marquez:
Yeah. I appreciate you saying that. And you know, that word that you used is resonating. And I love that for me, being in the podcast, part of things, communication like what exactly is resonating the people. We care about that. And I think that if you’re listening to this or watching it, you’re probably thinking the same thing. Right. What are we doing as an organization to not only reach out and engage with but also resonate with people so that they behave in a way that that helps them? And I think it’s a really personal touch, Neal, and I love it. Now, let’s think about this. I feel like we learn more from those challenges than the win. So talk to us a little bit about something that’s been challenging for you guys. One of your biggest setbacks. What was the key learning that came out of it that made you guys even better at what you do?

Neal Sofian:
I would tell you the biggest challenge we face and I faced it for a career is, as I say, the pioneers of the guys with the arrows in their back.

Saul Marquez:
Pioneers get spears. Yeah.

Neal Sofian:
Then come the settlers in the farmers after that. And the problem we’ve had is by thinking about this, the paradigm shift of getting a nonmedical model, understanding that this is social is probably the biggest challenge we face is that there are huge countervailing powers in health care and they all have their own you know, they all have their own way of making money, whether it’s more care for the provider, less care for the payer, though overall, the payer doesn’t mind there being more care because they’re just taking they’re really just the middleman and they’re taking a slice off the top to the pharmaceutical company who want you to do more to the to the payer, who actually is probably to the employer, who is probably the only one who’s really saying, whoa, whoa, whoa, I’m writing the check for all this amount. How can we reduce the cost here? You know, and they’re only finally figured out. But so their goal is less the provider is more the payer is whatever the pharmaceutical company is, is more the consultant is use me, not the other. They’re all pushing back and forth against each other. And so the biggest challenge in all this is two things. One is navigating that complexity as a sociological problem and the corporate problem. And then as you start pushing new things, which we’re doing, which is this is a fairly radical, different view. This is a very consumer’s view. And for all the talk in health care being consumerist, they’re really not. They are both medical and institutional. And so the biggest setbacks we’ve had, as we’ve often been too far ahead, whether it was when we using phone coaching, was viewed as like, you can’t do that.

Neal Sofian:
And oh, my God, we wouldn’t even certify diabetes nurse educators if they were on the phone rather than in-person to when we built the Cancer Survivors Network, which was essentially a prequel to what would become Facebook because when we built, we essentially built a social network for cancer survivors. It was nineteen ninety-nine. Mark Zuckerberg hadn’t had a bar mitzvah yet. So, you know, so, so there was no Facebook for another six years after we built this and getting the adoption of that kind of really different kind of social approach and human approach to care is far and away the biggest challenge, I think we are also discovering, though, because it is half the cost of health care and that we have failed so dismally at treating this as either a rational or a medical problem. And you face something like COVID, which we all face every day, and that you literally are going to have to do things virtually. I think it’s begun to be to turn the screw on that where we are beginning to truly say we have to do this in a totally different way, that we can’t just talk about the nursing homes. You need to talk about nursing at home. And instead of care being something that happens in a doctor’s office, we’re understanding that care has to happen wherever you are and that there’s still only so many minutes in a day, just like you and I are having to zoom. However minutes we use, we use, and that there are not enough minutes in the day to see all the people that need the kind of social support they need. And so that’s what’s beginning to drive technology. But I will tell you, it’s been a slow slog.

Saul Marquez:
Well, and I admire you for that. You know, it’s a challenge. And you look at history, they say it repeats itself. You’re doing it again. You had success in the past. And you’ve got my vote, man. I think you’re on to something here. And yeah. And you highlighted the health care is a fixed problem, layer in the COVID issue. We’ve got to make some choices. And so let’s make the right ones. And I say that to all of us, you and I, obviously, Neil, but everybody listening today, let’s make the right choices. Let’s do something that is impactful. Neil, you’re doing such great things. What are you most excited about today?

Neal Sofian:
I’m excited about the fact that we are and this will sound paradoxical, that it’s such a mess right now and that the bar is so low when it comes to how do you engage consumers. If you have ever and you’re probably too young to remember a guy named Dick Fosbury.

Saul Marquez:
I am too young to remember me. Enlighten me.

Neal Sofian:
He was a high jumper and he was the first guy. When you high jump, you used to throw your first front leg over. And then it was called the Western Roll. That’s what I grew up with. I’m a little older than you and I have a Medicare card. And and Dick Fosbury was the first guy who said, you know what, if you run-up to the bar on the high jump and then turn your back to it and jump headfirst and then kick your legs up as you go. And it was called the Fosbury Flop, and he could jump higher than anyone else. And that’s the only way people high jump now. Wow. And but let us say, health care has not reached its Fosbury flop moment yet. You know that in terms of thinking of things we’re talking about today, the high bar is pretty much laying on the ground.

Neal Sofian:
So if you just don’t drag your feet, you can do better. And yet the excitement is that because of things like COVID, because of the fact that employers are simply going, we can no longer afford this this kind of unsustainable approach to health care. There’s a move that says, I think we’ve got a moment where we’re unfreezing from old paradigms. And that’s truly exciting that we have to rethink the whole thing. And sadly and usually it takes a crisis for that to happen. And, man, if we got a crisis as Rahm Emanuel, the former mayor of Chicago and the White House said, you know, a crisis is a terrible thing to waste and he’s crazy and he’s correct. And we need to do that. And so and I think that is happening. And it’s and the cool part is not only can we make things better, but we can also do it for far less dollars if we do it correctly and do it with a much greater sense of personal satisfaction and warmth and joy. So it’s there’s a great opportunity here. And that’s tremendously exciting.

Saul Marquez:
Yeah. Now it really is, Neil. And you’ve got a really great way of contextualizing things. And, you know, oftentimes people say that our businesses are kind of an extension of us. And you’ve done a really great job today at kind of contextualizing the conversation. I wrote a little note, the Fosbury Flop. I mean, these kinds of things, if we’re able to do them at scale, imagine the possibilities, imagine the possibilities of what it could mean for our communities health, what it could mean for the bottom line of the employer, funding that health program. It just the incredible, incredible work.

Neal Sofian:
Or taking care of your mom at home or I think the whole the whole paradigm can switch. Absolutely.

Saul Marquez:
So this has been great. And obviously, you guys are doing phenomenal work. Folks, the address is wearetuzag.com. Tuzag is TUZAG. Wearetuzag.com, just incredible work being done by Neal and the team. Neal, leave us with the closing thought and the best place that listeners and viewers today could continue the conversation with you.

Neal Sofian:
So a great story. I heard I was speaking at a conference about a year and a half or two years ago. I was at a pharmacy specialty pharmacy conference and a doc walked up to me afterwards, he said, and I was pitching the same sort of concept of resonance and relevance. Let me tell you a story. I have a patient and this patient is a guy with diabetes. Really terrible, really bad, really on the edge of going blind and losing his feet and all that. And he completely will do nothing I tell him to do. But he always comes to his appointments every eight weeks completely on time and then absolutely does nothing I tell him to do. And he said so one day. So we got to the point where we were just kind of shooting the shit because there was just no point in irritating him anymore because it wasn’t going to be a nag. And so I said to him, you know, Hey, Joe, whatever his name was, what are you doing today? And he goes, Well, after the exam today, I’m going to Cabelas. Why are you doing that? He goes, well, my tomorrow’s my grandson’s birthday and I’m buying them a new fly-Fishing outfit so that we can go fly fishing together. Yeah. And he said Great. I hope you really enjoy it because based on your foot exam and everything else today, it’s probably the last time you’re ever going to be able to get out there in cold water and do that with them. So have a really good time. He started taking insulin that day. Oh, because what the doc had found was what this guy really cared about. He didn’t care about his health. He cared tremendously about being able to do things with his grandson. And he likes anything like fly fishing a lot. He found the Y you found the why for this guy and put it to him in a way that was that made sense. And then said, and now I can here’s a path on how to how to get to reach your why and it works. I mean, we all have those we have. And can I be perfectly successful with what we’re doing? Of course not. But can we do a lot better than we’ve been doing by pointing my finger and saying, you’re a diabetic, you’re going to lose your feet, you take your medications which your on or worse, anger, anger, anger?

Neal Sofian:
We can do that. Yeah, we can do this. I mean, so the story is it really is always about me. Whoever me is. It’s always about me and understanding what makes my trip go. And so. Yeah. So to hang with us like you go to www.wearetuzag.com. There’s a place to contact me directly. There’s also even a place you can do some testing and actually get some little demos of how this works now on the site. So or if you’re a wonk and want to go way into the how does the technology of this work, there’s a tab in there for that interesting group of people who want to go, how do they actually do this,

Saul Marquez:
Get techie right now.

Neal Sofian:
To the tech. And that that will not lead you to me, just not the techie part of the organization. Our founder, Dave Bolger, is that guy. And he’s he’s the guy who’s the brilliant guy who spent the last thirty years building this kind of tech with this deep understanding of people. So, yeah, but please, please come visit us. We are thrilled to make the connection and share what we’re doing.

Saul Marquez:
I love it, Neal. Well, I really appreciate your insights today. And folks certainly check out more info on our conversation outcomes rocket that help in the search bar, type in Tuzag and you’ll get the links to our chat today. I’ll put a little link to the Fosbury Flop. I’m sure I could find a good YouTube video on that. And overall, you know, just best ways to get in touch with Neal and his team. Neal, big, thanks to you man, this has been a great conversation

Neal Sofian:
And it’s been delightful to talk to you, Saul.

Saul Marquez:
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Things You’ll Learn

  • Don’t think of people as molecules but rather motivations. If we expect it to cause people to change their behavior probably best if we treated them as people and understood how complex we are as humans.
  • Find out what kind of conversations do you wish you could be having with an individual that could help move them along their personal journey and their path. Don’t even think about the technology. The technology will follow. 
  • It doesn’t matter how cool a product you have if people aren’t using it. There is no such thing as a single best solution for anyone.
  • We should engage individuals not when they have medical problems but the moment we meet them. 
  • Health care has not reached its Fosbury flop moment yet. The high bar is pretty much laying on the ground.
  • We can make things better. We can do it for far less dollars if we do it correctly and do it with a much greater sense of personal satisfaction and warmth and joy.

 

Resources

https://wearetuzag.com/

https://www.youtube.com/watch?v=CZsH46Ek2ao – link to the Fosberry Flop