421. Why Healthcare is Broken and How to Fix it, A Future Path Forward Where Doctors are Architects not Providers, and How the Employer-Sponsored Healthcare System is Designed to Fail Us (Adrian Aoun)

421. Why Healthcare is Broken and How to Fix it, A Future Path Forward Where Doctors are Architects not Providers, and How the Employer-Sponsored Healthcare System is Designed to Fail Us (Adrian Aoun)


Adrian Aoun of Forward joins Nick to discuss Why Healthcare is Broken and How to Fix it, A Future Path Forward Where Doctors are Architects not Providers, and How the Employer-Sponsored Healthcare System is Designed to Fail Us. In this episode we cover:

  • AI, Startups, and Entrepreneurship With Google Executives Larry Page and Sergey Brin
  • Democratizing Healthcare Through AI-Powered Pods
  • Healthcare Innovation and Technology Adoption
  • Assessing Talent and Building Teams in Person Vs. Remote
  • Healthcare System Flaws and Potential Solutions
  • Improving Healthcare with AI and Remote Monitoring

Guest Links:

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Transcribed with AI:

Adrian Aoun joins us today from San Francisco. Heโ€™s the CEO and Founder of Forward, an AI-based healthcare unicorn that is โ€œbuilding the World’s First AI Doctor’s Office.โ€ Prior to Forward, he was the head of Special Projects for the CEO of Google/Alphabet, where he founded Sidewalk Labs. Adrian, welcome to the show!
0:41
It’s a pleasure. So tell us a bit about your backstory in your path to becoming a founder.
0:45
Yeah, well, I probably all you know everything starts back if you’re if you’re Freud, everything starts back to when you were a little kid. Well, you know, I wasn’t born here in the US. I was born in Paris in Europe, which is awesome. Love France. But you know what, let me tell you when I moved to the US I had this just like super thick French accent I couldn’t say or even hear the difference between three free and tree. They all came out FW II, like flee. What you know, so literally, if you came up to me, and you were like, count to 10 I was like, 12345 And you’re like, No, no, three. And I’m like, I know. That’s what I said. So like, it’s up ways. Okay, this is cute. This is awesome, right? Any little kid sounding like a little Fred. She’s great. But it turns out that when you’re growing up in LA, the whole like sounding like a Frenchie. Not so hot, right? You’re not exactly the most popular kid in school. So frankly, I had I had what was you know, in essence, like a pretty tough time like making friends getting to know people I didn’t I certainly did not look at my at my first years of schooling is like the good years of my life. And to some extent, maybe that’s a little like kind of what turned me towards my my life of crime, except we’ll turn it we’ll call it my my life of sounding things. Because think about what being a founder is, right? It’s like being able to kind of go against the grain stand on your own, like, you have an idea, and the whole world is usually telling you. Now that’s a stupid idea. I just totally disagree with you. And you’re like, Yeah, I think I’m gonna try it anyway. Like, think of how crazy that is. Right? Well, that’s kind of a little what my what my experience was, as a kid, I would, you know, I had all these views on the world, frankly, a lot of them were wrong, but whatever. And everybody else is like, No, you’re wrong. And like, they were my friends. We didn’t get along. So. So a little I kind of just learned to be to be a little more of kind of the lone the loner or the lone wolf depends on what spin you want to put on it. Right. And, and then when I got a little older, you know, I started to discover these things called computers. And computers are awesome, because, frankly, when you’re growing up, and like, you know, not everybody’s that nice to you at school, the cool thing about computers is they’re kind of nice to you, right? Like they don’t, they don’t insult you. They’re not mean, they kind of just do what they say they’re gonna do. And I was like, Okay, well, this is pretty cool. And I really, I really kind of, you know, I don’t know, clicked with computers, I got along with them. And so you know, I’m like a nerd, kind of, you know, playing on his computer all day. God knows what you’re even doing. This is like pre internet. So I don’t know. But But then what happened was the internet started to come out. And people started to make websites. And so I was like, Okay, well, this seems pretty cool. I just enjoy building things. So I started building websites. And then honestly, when I was about 13, I ended up starting a company that build websites. So when you’re 13, and you start something, it’s a joke, right? Nobody takes you seriously. They’re like, whatever this kit, but it turns out that this company turned into something real, like I actually ended up selling it when I was 22. I did it all through college. And we ended up being like a fairly real company. We started as building website, but then we got to mature then we did online software and just sold kind of software online, then we did, you know, frankly, website hosting, and God knows how many, how many, you know, 1000s upon 1000s of websites we hosted, et cetera, et cetera. And over time, I just got to this world where like, I guess I kind of fell into having my own company, you know what I mean? And then after college, I after I sold this thing, I was like, Ah, well, what do I do with my life? I don’t know. So I went and I worked at Microsoft had a family friend who was very senior at Microsoft. So he kind of brought me in, I went over there. And let me tell you, Microsoft is both the most amazing company you’ll ever work at. And dear God, the most boring fucking company you’ll ever worry, I lost it. I promised myself I’d be there a year I lasted 11 months, literally, I couldn’t make it. I was like, No, this last month will literally be the end of me. And it’s awesome. Like it was cool to see like, I mean, at the time that this was like, you know, Windows and Office were like the two largest software products you’ve ever seen, right? This was insane. But also it was a big ass company, right? And they weren’t really doing innovative things back then they had just done their kind of consent decree with the DOJ and they were, you know, they were kind of Toothless. And honestly, I didn’t like it. So I left. And then I was like, well, now what do I do with my life? You know, and frankly, I ended up starting a company not because I was like, I need to start a company and I did it. because I was like, Well, I obviously don’t fit in anywhere else. So if nobody else will take me God knows, maybe I’ll take B and L. And so So I started coming, I have always had like millions and millions of ideas. So you know how people like, I want to start a company what I do, I’m like, that’s insane. Like the world is your oyster. For me. It’s like, it’s an embarrassment of riches of how many ideas there are, that are kind of out there. So I decided I want to start a company working on AI. And the reason is because I grew up in a family, my dad’s a linguist, and I’ve always been interested in language I grew up around, you know, the Chomsky is of the world, etc. And I was like, I feel like computers could figure this thing out. And so the
5:40
timeframe, Adrienne, but what was the timeframe
5:42
on terrible dates? Like? Oh, 809 was probably what I started this thing. Wow. Okay. Yeah. Oh, yeah. No, we were early. I like to tell people if I was five years later, I’d be a billionaire. But you know, it’s all good. We all make the iPhone. Yeah. Well, was it pre iPhone? Yeah. Yeah, somewhere on Oh, 809. I started. So what we were doing is deep learning applied to natural language, right? So just can you teach computers to read and understand language, which is absolutely awesome. It turns out a really hard problem. But if you think about what we were doing, it’s literally exactly what we were doing, or what we’re seeing today, which had GBD, right? It’s just the predecessor thereof, right? If you take our tech and you add more compute, you add kind of slightly better math and more data, you you in essence, chat GPT. And that was really awesome. Like, we were starting to see, like real real effects of what we were doing. We were trying to read the Internet and build what we call the Knowledge Graph. Like, could you literally just read the Internet and become the smartest person in the world, like, have a database of everything, right? And honestly, it was working pretty well. It was working well enough that Google came knocking and they were like, Hey, we’ve got this awesome AI division. You should totally join us. And we’re like, man, leave me alone. Leave me alone. But honestly, they kept pestering. So eventually, we were like, Okay, fine. We’ll give it like you can, you can go ahead and acquire the company. So we acquired, so they acquired the company
7:04
from Google. One of the few.
7:08
Yeah, well, actually, I’ll give you a better story. It is, which is, when I was about to go to Microsoft. I was like, Well, really, I should go interview at Google. They’re the, you know, upstarts, I interviewed at Google and they rejected me. And then a few years later bought my company and I was like, Haha, I get the last laugh, you know? But yes, I still have a chip on my shoulder about that. Don’t Don’t worry. So and by the way, they rejected because my GPA and I was like, Dude, I know how to do shit. I was building a company and they’re like, I don’t care. Show me your transcript. Anyway. So for the kids listening, pay attention in school to habits No, but don’t really just go to shit. But okay, so So Google acquires my company, I show up on day one, I walk up to my boss, the guy who runs engineering of like, all of Google, and I’m like, Okay, you sold me on this huge AI division you have and all these awesome people now, okay, like, introduce me to these AI guys. And he’s straight up goes, No, I was just, you know, fucking with you. We don’t have, we don’t have an AI division. And I was like, Excuse me? And he goes, Yeah, but you know what, it’s about time we build right? So Google had these like pockets of AI around the company, there was no like, central kind of real division working on this stuff. So me and a couple other guys, we ended up kind of creating it. And honestly, this was awesome. We took it from like, not existing to, I don’t know, order of about maybe 800 700 people over the course of a year we bought DeepMind out of London. I mean, we kind of put AI back on the map, right? Like, like we created the insurgency you see today. Now my mom’s calling me, are the robots taking over next week? I’m like, Yeah, Mom, you got it next week, you know, but like, honestly, like that, that was kind of my path. That’s the story of like, you know, how I started my last company, and maybe what created the the addiction that I have today. You know what I mean?
8:49
I’d love to hear if you have any great lessons that you learn from Larry or Sergey, while you’re at Google?
8:57
Oh, my God, so many lessons. And I’m going to be honest, as many lessons in what not to do as what to do so. So look, I can tell you, I mostly worked with Larry not Sergey. At the time, there was a bit there was a bit of a rift between them too. And in some ways, I was caught in middle. But but rather than getting into that sort of drama, let’s just kind of focus on Larry. So I think one of the things that kind of sat with me the most that stuck with me, the most that that Larry taught me was, it’s just as easy to work on a huge problem as a small problem. Right? So it’s like, let’s say you wake up tomorrow, and you’re like, you know, I’m gonna create the best company in the entire world at making towels, like literally just bathhouse. Okay, so what are you gonna do? You’re gonna raise a couple million bucks, get, you know, five or 10 people in a room, come out with your first year, your v1 A year later, right? But let’s pretend you also are like, hey, instead, I want to create a company that is I don’t know solving all of healthcare. Well, you’re gonna raise a couple million bucks, get some people in a room and come out with your view once a year later. So it’s like look If you’re like startups are fucking grind, if you’re gonna go do like the entire brain damage of like, I got to build a company, I got to work late hours I got to have shitty pay, and let’s be real, I gotta have more stress, like, I have not slept a good night’s sleep and God knows how many if you’re gonna do all this, like, dear God work on something that fucking matters, you know what I mean? It’s like, I often you know, I’m an investor in and a bunch of startups and probably about 350 startups these days. So I get pitched all the time. And sometimes people come up to me, and they’re pitching me this idea. And I’m like, man, you’re about to embark on a fucking grind. And if you win, who cares? Like it’s a shitty app. It’s just a it’s like SAS software to help you keep track of your hours for billing. I’m like, I don’t care about that. And you probably don’t either. So it’s like, Look, if you’re really gonna go after building a company, like choose something that matters to humanity to somebody that like gets you out of bed in the morning, you know what I mean? Not to knock the billing software of course, we need hourly billings I, you know, I’m sure somebody’s listening being like, suck you wager. But like, if you’re passionate about it, power to you. But my point is choose something that’s big to something that matters, like, because that way, even if you fail, like I mean, think about it, you look at Google, and you say, OK, Google is a pretty damn successful company, right? They’re like one of the largest companies on the planet, period. Really well think about their mission. Their mission is to organise and understand the world’s information and make it freely accessible. does Google know where I don’t know where this little thing is? Is Google nor my pen? Is my shirt? Is today’s Google know where I am? No, no, it’s fucking nothing. Like what you realise is like Google knows point oh, 1% of all information that humanity has. So actually, Google has failed in their mission. But this is kind of the point. If you go after something that’s enormous and you fail. Well, you know, that old phrase of you know, you reach for this, you reach for the star, I don’t know, the phrase is you read ours and you hit the moon or something. Okay. Yeah. Okay, there. See, I didn’t grow up in the US. I never learned our idioms properly. But But my point is, right. Like, like, if I go after something that’s really big, then okay, I’ve got a real chance of making a difference. And if I go after something that’s really small, even in my best case, I’m not going to make a difference. So since then,
12:11
I’m going to put you to the test. Yeah, yeah. Submission of forward. And is it? Yeah,
12:19
okay. Really, really, really easy. We want to deliver it to, I’ll actually set up the problem for you. There’s 8 billion people on the planet, less than 2 billion of them have access to anything you and I would call like, a real form of healthcare. Like, How insane is that in the year 2024. When we can get like smartphones to the whole fucking planet, we can’t get basic health care. They’re like, why? Well, you peel back layers, the onion, you quickly realise, like healthcare is based on doctors and nurses. Now, I love doctors and nurses. They’re awesome humans, but you’re never going to scale them to the whole planet. There’s not enough of them. They’re too expensive. So we had Ford said, Well, hold on what would happen. If instead of building healthcare as a service, we rebuilt healthcare as a product? In other words, can we take every single little thing that doctors and nurses are doing and just migrated over to hardware and software? Because if you can, like holy shit, you can scale it to the whole planet. You can apply all the AI you want, it’s going to be super awesome. So our mission is to be the first healthcare system to deliver health care to literally the entire planet planet scale healthcare truly democratise health care. If you want to go even further. It’s really simple. I want everybody to live to 1000 I know that sounds absurd. I know that sounds crazy, but I’m not so sure it is crazy. And so we’re going to see what we can do to get us along that path. Now. Is this one of those? Well, hold on Adrian, this sounds absurd. This sounds crazy. Why are you even going after it? Maybe but you know what? So did organise the world’s information and you know what, we put a dent in that one, maybe we can put a dent in this one. Okay,
13:47
so one instantiation of this mission is the care pod. And there was an article in TechCrunch last year titled forward health launches care pods, a self contained AI powered doctor’s office, get a blood test, check blood pressure and swab for ailments all without a doctor or nurse. So this connects with the problem that you outlined. Make it tangible for us. How does a pod without any human intervention? Take a blood sample? Yeah, okay. Well, for nurses that can’t hit.
14:16
I hear ya, I hear ya. So it turns out there’s actually tonnes of technology for doing this. So what we’re using is and I could I got one here if you want me to demonstrate. So for all you podcast listeners that are sitting there going well, I can’t actually watch this. Well just use your imagination. So you’re familiar with things like the FreeStyle Libre continuous glucose monitor, right? That little, that little patch that everybody’s wearing these days? Well think of this as kind of the next generation thereof. So this is I’m just gonna take this off. This is just double sided sticky tape. And for those of you that are just listening while on your bike ride or whatever you’re doing, just think of this as it’s a little contraption that you just attach a double sided sticky tape. It’s just it’s sticky. I just putting it on my arm. Okay, now it’s just stuck on my arm. Now this little white chambers a little vacuum chamber. And so what that means is there’s nothing in it literally not even air, right and I’m going to puncture that vacuum chamber. I’m not puncturing my skin, there is no no knife, no needle, no Lancet, that’s puncturing me. But in essence, what it’s doing right now is it’s allowing that to have a bunch of suction. And so it’s literally going to suck the blood out of me. It’s honestly, I know that sounds ridiculous, but just think like, when you were 16, and you had your first Hickey, what’s a hickey? Well, it’s somebody like sucking blood to the surface, right. And so it’s what’s called capillary blood, it’s there, you can just kind of pull it right out. And you’ll see it a minute that this guy starts to fill up, we got I don’t know about 400 to 600 microliters of blood. It’s pretty awesome. And then what’s kind of great about it is we we then you just kind of put it back into the little tray that the care badass, it’s got a little like vending machine style tray that can give you everything from a heart sensor to a blood test to whatever you need. So you just put it back in there. And we process so you see how that bloods kind of popping out right now? No
15:59
kidding, you’re doing it real time? How sample can collect
16:04
500 to 600 microliters. So I’m not going to finish this just because I do this quite often. But you see it’s kind of filling up with blood right there. And and yeah, it’s it’s not a joke. Turns out turns out, it’s pretty real. And so it doesn’t hurt nothing. You just go you put your little bandaid and you’re done. And I hate needles, like I really hate needles. So getting something like this is pretty awesome. But that’s kind of the idea that care about the idea that care bot is just like super futuristic box, you walk into it, it talks to you. It’s like Hello, Adrian, welcome to forward, please step inside, right. And then as you do basically loads a bunch of different apps for you to play with. You choose the body scan app, it’s going to spin you in a circle, take all your readings, explain them to you and then give you any treatment you need. You know a prescription a plan, you name it, right? You choose, you choose the let’s say heart health, it opens a tray hands you a heart sensor, it shows you how to hold it against your heart again, takes the readings etc. You choose COVID test, it gives you a SWOT you, you want to measure your your thyroid, again, you can do that. Like the idea is we’re taking healthcare, and we’re putting it into users hands. And the second you do this, all of a sudden, it becomes way more scalable, right? Like pods, just a piece of hardware, we can build pieces of hardware, just think of it as a really fancy ATM. There’s ATMs on every fucking street corner in my neighbourhood. Well imagine if healthcare could turn into that. Imagine if healthcare was like the ATM. You know, all of a sudden, you’re like, Well, that seems pretty awesome. Right? That seems like a good way to go. So so that’s kind of what we’re doing. That’s what we’re working on. So that makes sense.
17:34
Well, Adrian, I gotta tell you in 10 years of hosting the show, this is the first time that literal blood has been to
17:42
me was crazy enough to have like their blood, sweat and tears. You know, when they told me that I thought they were joking. I didn’t know that they were like literal about it. But you know, what can you do? Well, we’re
17:53
still friends with the French. So Walby Yeah, right here. So Adrian is Tony Conrad from true once said to me on the show, healthcare is all about the codes. Right? So my question for you is, you know, a lot of physicians will do a procedure. And that procedure is connected to a code. And it often is also tied, tied to a time based component, you know, how much time the physician spends doing something? Have you been able to map the procedures and diagnostics done by these pods?
18:23
No, not and you’re not gonna succeed at doing that. So take a different approach. Right? So you, you, you literally have kind of nailed why health care is like so fucked up. Right. So let me give you an example. I like when we first launched for before building these care pods, we built some super high tech clinics. And I remember I brought the CEO of Kaiser in and he like, looks around, he looks at what we’re doing. And he goes literally like, oh my god, this is the most advanced healthcare system I’ve ever seen. You’ve got these body scanners scanning people’s body. I have 40,000 nurses, like how efficient how awesome, and I’m sitting there and I’m like, Kaiser, like, Why do you have 40,000 nurses when you could have had like this body scanner? And you kind of you completely iterated to it, right? Which is like, well, if you think about it, if he uses the body scanner, there’s no billing code. So he loses like $8 Every time like, that’s insane. That’s literally insane. Like healthcare is so backwards. So we took a different view. And we’re like, Okay, well, rather than fuck around with these, like billing codes, and you know, frankly, I’m not the expert and how to change those. We said, well, why don’t we instead just go direct to consumer? So our first product or clinics? Were 149 bucks a month? You go, Well, hold on, Adrian, that’s pretty expensive. How you you told me you want to get health care to billions of people, right? Well, now our care pods are 99 bucks a month. And you get it right? When you shift something from from labour to technology, you get to ride the Moore’s Law cost curve, right? We’re just decreasing logarithmically. So yeah, we’re 99 bucks now, but you know where we’re going next will be 79 that will be 59. That will be for now. And the idea is if we’re direct to consumer, we can do what’s right for you not what’s right for the healthcare system. I want you to be my customer, not some random employer sitting around somewhere just I need your help. To me that just seems fucked up. You know,
20:02
interesting. Have you thought about trying to get it to the point where it’s free or where individuals are paid to go and get some
20:09
our internal mission that we if you walk up to any foreign employee and you say, Hey, what are you guys trying to do? And they say the world’s best health care for billions for free. That’s what we’re trying to do get the payers to pay for it. I think it’s a while. But you know what, like, who cares? Like it’s worthwhile? Let’s work on it. So
20:23
a little curveball for you, Adrian. So I reached out to Brian Singerman. From founders. Wow,
20:27
not Brian. I love Brian. Brian’s one,
20:31
one question he thinks I should ask you. And he said, Adrian’s clearly found, or Adrian clearly has a grand and unique vision for the future. But medicine has been a very tough space for behaviour change. Why does he think the masses will actually adopt forward versus just thinking it’s cool. Those are very things. What’s your response?
20:51
So I actually, whereas I love Brian, I’m not sure I agree with the premise. I’m not sure that it’s actually that much behaviour change. Like think about it, right? Almost every industry that you that you work with today, basically has a screen and some maps, right? You go you check it at the airlines, there’s a screen and Sabbats VEC you’re super busy. And you’re like, ah, the screen says it won’t check you in and you got to go stand in line. There’s a person sitting there typing for like seven minutes, and you’ll get the fuck are you doing? You know, you go to McDonald’s, like these days, not that I go to McDonald’s, but if I did, a friend of mine who did told me that I love McDonald’s. Okay, so you’re going to McDonald’s and there’s literally screens you don’t even like talk to the people anymore. Like we live in a world where technology has been adapted to us. We’re used to it. It’s called the iPhones, iPads. They’re fucking everywhere. And yet, for some reason, the modern healthcare experiences you walk into a doctor’s office, you probably sit on your ass for 30 minutes while they’re running late. Then you go into a room, you tell somebody What’s wrong with you? And then they like, I don’t know, they fucking Devine, what the what like, what what, you know, diagnosis you have, and they somehow remember your treatment off the top of their head. It’s like, this isn’t saying, imagine if you took your BMW to the dealer, you’re like, it’s not working. And they just kind of sat in the corner like stroked their beard. And they’re like, Ah, it’s the carburetor. And you’re like, No, plug in some fucking technology into this thing. Read the damn numbers, like, where’s the computer that tells me what’s wrong? And so I actually don’t think it’s that different. I literally think we are. It’s not that we’re taking healthcare into the future. We’re taking healthcare out of the past, we put like, I’ll tell you, we put a screen on a wall with a model of your body and all the data overlaid on top and the whole world went holy shit, that’s awesome. And I said, Are you kidding me? How have we not had this before? Like we’re just doing for healthcare, what we’ve already done everywhere else of it. Love it.
22:41
So So Adrienne, shifting gears a bit, you’ve said that you all made some hard choices early on in the company, where you turn down folks who are excellent engineers, or physicians, but who were very obviously out for themselves. My question for you is, how do you assess for ego humility? And the degree to which talent is maybe more of an agent than a principal?
23:05
Yeah, okay. Well, let me tell you that if I had the answer to this, I’d probably be a hell of a lot more successful than I am today. I think judging talent is one of the hardest things to do. And the reason for this is because basically, people will just reverse engineer whatever you care about, and then tell you what you want to hear, right? Like, and we’ve seen this time and time and time again, in our company, but everywhere, like we’ve all seen this, right? And so what we iterated to is basically saying, show me times in your life, where you have sacrificed yourself, you’ve made decisions where you sacrifice yourself for a greater purpose. Like we didn’t start Ford because we’re sitting around going, Oh, this is a good company that IPO or oh, this is a great way to get rich or famous like that, who cares? We started Ford because we want to help as many people as possible. And so what we want are we want people who legit are going to put that first people who want the mission of helping others to be their overriding factor in life. And you know, it’s easy to say that and it’s really hard to do that you know what, and you can do this in all sorts of ways there’s no one way to kind of skin the guy like maybe it’s the person who showed up at the soup shelter every single weekend you know, I don’t know then maybe you’ve got some other way that you’ve done it but what I want to see is what motivates you what gets you out of bed in the morning? What is your your your north star when you’re making decisions and trade offs? And you know what if it’s about helping others, maybe you’re the right fit and if it’s not about helping others power to you. If you’re like look, I just want to make as money as much money as I can sounds good. Like I’ve got a bunch of portfolio companies I invested in I’ll introduce you they’d love to hire you. But that’s not why we’re at for it and so it’s just important that the right people are at the right company for that doesn’t mean doesn’t mean any one company is right or wrong. For everybody. It just means you got to find the right fit for the person. Adrian
24:48
Why is building in person versus remote the right thing for forward.
24:52
I fucking hate remote. I will tell you I hate remote. And there’s two reasons that I hate remote. The first is a Like, imagine I walked up to you. And I was like, oh, man, I’m so I’m so excited, dude. I’m Nick. Like, this is awesome. I’m about to propose to my girlfriend. We’ve been dating for six months. And I know she’s the one. And And honestly, I’m really excited because I’m gonna go meet her in person for the first time this we get, what are you gonna say? You’re gonna say, Are you fucking kidding me? Don’t propose just whatever you like, like, Stop, like, hold on a third, don’t do it. Right? Why? What do you intuitively know, you kind of intuitively know that for some weird reason. We don’t build relationships the same way over video as we do in person. Now, maybe eventually, that’ll change. I’m hoping with the VR isn’t the AR is of the world, etc, that that changes over time. But it’s certainly not the case today. In fact, this isn’t an opinion, this is fact you can literally see they’ve done studies fMRI studies, where they look at which neural pathways light up over video versus which neural pathways light up when you’re in person, it’s entirely entirely different. Okay, so that’s the first thing. At the end of the day, if we’re in the trenches with each other, we need to have real bonds, we need to know who we can trust inside our gut, we need to know that the person to your left is going to get your back, we need to know that the person to your right really does care about the same things that you do. And you’re not going to build those relationships remotely. And then the second is more idiosyncratic to us at Ford, which is we build real shit. You want to show me how you’re going to do hardware and work on a carrier board from from I don’t know, Alaska, like, like, let me know, because I haven’t figured that shit out. We’re not like FedExing these, these enormous care pods to everybody all around the country, right? Like, so at the end of the day, we got to be in person, healthcare is physical healthcare is is real, like, healthcare is not telemedicine healthcare is a true, true real notion of like drawing blood and seeing bodies. And we’re not going to do that if we’re remote. So that’s, that’s why we do it.
26:52
I mean, we’ve seen tech take over many industries. But in healthcare classically, you know, there’s this thought that tech alone is insufficient to address the problem, rather, you know, tech enabled services. So you’ve got tech, but it’s bolstered with some human touch in some services is necessary to really serve the patient and love to make these like overarching big statements. like, Ah, this
27:18
is just the way it is you need to again services, okay, sure. But unless you can give me a first principles, reason that comes to that conclusion. I’m just gonna say like, and that’s intellectually lazy, you got to do better. So So first off, let’s just go ahead, you said tech hasn’t taken over healthcare? Yeah. The fuck it has, like, what do you think’s dealing with all these billing codes? You know, like, Epic is an enormous company, like, literally enormous. The problem is they have the wrong incentive, their incentive is to, you know, take money out of your pocket. If you not notice that how the price of healthcare has gone up astronomically, you realise it’s roughly one in $5. In our economy, literally 20% of every paycheck of yours is going to the healthcare system. That’s how fucked up it is. Right? But let’s go ahead and let’s dive into your premise that well, healthcare can’t be tech. Okay, fine. You need a doctor. Sounds good. Let’s look at what a doctor is. Let’s break it down from first principles. And let’s just ask yourself, what is it really? Okay, well, the first thing is that a doctor is is I always think of that doctors three things. I think of it as their heart, their hands and their head. So what’s that mean? Let’s start with the head. They got a brain. They’ve got algorithms, right? Okay. You’re telling me that like, you want to bet on a human’s algorithms over a computer’s algorithms like that didn’t say, You know what I mean? Like, they’re doing complex statistical probabilistic math. We know computers are better at that than us. Right? Like, you know that for sure. Okay. Then there’s their hands, right? They’re just doing physical things. And like, Wait, you mean to tell me like, like, robotics isn’t good at that, like, look at what robots are doing these days? We got, we got surgical robots that appeal of fucking great. You mean? Like, we can’t do it. Like, come on, like we can do healthcare, right. And then the third thing is their heart. Like they’re just like a caring person who can help you through the rough times. Now the first thing is 98% of the time, this is not what you care about. When you have the flu. You’re not like oh, you know what I really want today I really want somebody to coach me through my tough time. Now you got the fucking flu, get over it. You know what I mean? But sometimes you know what you do get really bad news and things are really tough and you do want somebody to help you through it. But ask yourself does that need to be a doctor? Like let me use analogy? Let’s pretend all your money’s in the stock market and the stock market is totally crashes you’re you log into E trade and you’re down like 97% You’re thinking oh my god, I’m super fucking stressed. Maybe you’re like thinking about maybe I should take my life or crazy shit like that is E trade like No, no, we’re not going to show you the numbers. We’re gonna sit you down with a financial prevent No, you trade like whatever. Look at the damn numbers. And then what do you do? Well, you probably call your sister your brother, your friend, your wife, whoever it is and say, You know what, like, helped me through it. I’m having a tough time. Or let’s just go to the most the toughest moment in someone’s life. You go through a terrible fucking breakup an awful breakup. I went through an awful breakup a couple years ago, I didn’t go to a professional I went to my best friend, I went to my cousin, I went to my, my literally, like, my community was there for me, right? Why do we think healthcare has to be this thing where like, oh, the only person who could be there for you has to have gone to school for 10 years, and probably makes half a million dollars a year? I mean, it’s just insane. I rest my case. That’s what I got for you. Now tell me why tell me why at the limit, maybe not today. But at the limit, why I need, you know, all these all these fancy individuals at ask you
30:29
something related, which is often people call the health care system, a sick care system. And part of that is because you know, it’s treating ailments after the fact, you know, how is floored contributing to, you know, the prevention of health care issues and episodes, instead of just another way of dis, you know, identifying that they exist, and they need to be treated. So
30:54
I love that. Okay, before we go on to that, I want to finish what I was saying earlier, I actually do think you need doctors, I’m going to contradict myself, I just think that what you need is you need the doctors building the systems that deliver care much more than you need the doctors providing the actual care. Like, if you think about it, why is healthcare so not scalable? It’s like you’re taking these people who went to med school for 10 years are super educated, they’re high earners, and you’re putting them in a room like cobbler saying, fix the next person, fix the next person, fix the next person. And if instead you can move them to building the health care products that serve the care. Now all of a sudden, that person can fix a million people or a billion people at a time the same way engineers can write code that goes out to a billion and now you come to the maybe the most important question, which is, obviously what you need to do is you need to prevent illness, not react to illness. So ask yourself like, why is that not occurring? today? It’s so obvious like, why why haven’t we ended up there? Well, we did this really dumb thing. I’m gonna give you a little history lesson. So World War Two, World War Two was pretty brutal on the United States after World War Two, there wasn’t that much labour that came back a lot of a lot of young men who were mostly the people in the workplace, like a lot of young men died. And so you know, companies started doing after World War Two, they started basically paying more just to get talent. It was like a race it like it just super inflation of wages. And then the government saw this was like, This has to stop. This isn’t okay. So you know what they did? They said, you know, what, we’re gonna put a cap, you cannot keep raising salaries. And so all of a sudden, companies were like, hold on, we need to get talent. So what are we going to do? And they did something pretty wild. They said, Okay, we’re going to create this notion of benefits. So companies sat there, and we’re like, oh, we’ll give you health care, because we can’t give you more salary. So this is a sneaky way around it, after a bunch of companies started giving health care than the government was like, Oh, well, we like all of our citizens having health care. So let’s just go ahead, and let’s just make it required for companies of a certain size to give healthcare benefits. And now we’ve attached now we’ve, by each one of these decisions being totally reasonable decisions. We’ve now done one of the dumbest things we’ve ever done, which is we’ve attached employers to your healthcare. Why is this stuff? Well think about it? When I was at Google every year, they’d come around and be like, Adrian, time to get your flu shot time to get your flu shot time to get your flu. It’s like, literally, that was the thing they cared the most about. And I always ask myself, Is there some huge rash of flu deaths going on that I don’t like know about? Like, what the hell right? Okay, but now ask yourself, Google never came around to ask me about like my cholesterol asked me to maybe sequence my DNA to understand the heart disease or cancers that I’m going to have in 20 or 30 years? Why? like heart disease number one killer in the United States? Yeah, you got it. Right. Like, I’m only going to be a Google for two years. Why that like the average tenure of an employee with their employer in the United States is two and a quarter years. Why on earth would they focus on on long term health? So what you realise is we’ve created an entire healthcare system that’s focused on keeping you at work, not keeping you alive. But what did forward do. We said, actually, this is go direct to the consumer, wait a minute, what changes when you go direct to the consumer? Well, obviously, what changes is now all of a sudden, you have their best interests at heart because they’re your customer. So you start preventing things, you start dealing with the long term. And so the key of this industry is incentives. It’s not everybody says technology can’t do this. Technology can’t do that. No, incentives can’t do this. And incentives can’t do that. You can’t but that was the
34:20
system, you know, the genies out of the bottle. So how, how can you go to direct consumer in the US when the majority of the population receives their health care via their employer?
34:30
I don’t know, man, let’s look at how other industries did it. So you have Spotify? Do you have Netflix? Yep. Do you use Uber? Yes. Oh, interesting. Because you didn’t have to pay for Spotify. You could have just use public radio. You didn’t have to pay for Netflix. You could have just, you know, watch the watch TV with those little bunny ear antennas. You didn’t have to use Uber you could have used as public transit. So why are you paying up for something that you already get for free? You know, why? Because they are superior solution. Far, far superior. Not just a little better a hell of a lot better, right? 10x better. If I told you to ditch Netflix and watch normal broadcast TV, you’d be like, No, that’s what do you talk? Ditch Spotify use the radio? What are you talking about? Adrian? No way, right? Well, that’s the trick. The trick is to make the healthcare 10x better. If I make it 10x better, you’ll want it. So that’s our that’s the ballgame build the world’s best damn healthcare product. Oh, so
35:20
to push back a little bit, like, you know, part of the problem with the healthcare system is it’s very episodic in nature, right? I have an annual physical, you know, but it’s not continuous. You know, it’s not periodic remote patient monitoring RPM is not, you know, a fixture in the health care system in in Ford has launched this care pod, which, you know, it feels like an improvement, but it’s also episodic in nature. It’s not like, like, I think you’re wearing an aura ring. You know, it’s, it’s not something that’s monitoring on a continual basis. So how do you get there? Or is that even part
35:56
of the goal, it not only is it part of the goal, we already do it. So every single one of the apps inside of the care pod continues to run on your mobile phone. So if we put you on a heart health programme, it’s not we scanned it, and we told you what to do goodbye, it’s we continue to monitor while you’re at home, popping up on your phone and actually connecting to sensors, whether those are wearables, whether you got a blood pressure cuff, whatever that happens to be,
36:18
does it require behavioural difference from the patient? Or can they just wear a device? Or? It’s a good question? Does
36:23
it require behavioural difference? Well, it requires you to engage your healthcare, but people typically want to do that, right? Like that’s not an that’s not a novel new thing, like everybody who’s got an Apple Watch, or you know, an aura ring. They’re constantly like looking at the metrics. And now it’s not just looking at the metrics, looking at the metrics and getting some advice, you go do something different and you kind of see is it helping my metrics or not
36:47
got it. So you partner with biometric devices in order to do this continual monitoring? And absolutely, and then you can raise a flag if anything abnormal pops up. Ads,
36:56
right, you got to say why for it is a monthly membership model and not a UPS for visit, because I totally agree with you healthcare. Healthcare is not episodic, it’s not the repair shop for humans got to be an ongoing thing. We’ve been
37:09
talking around this for most of the conversation, but how do you see AI integrating in healthcare? I
37:14
think AI is the ballgame. I think you start with saying, hey, let’s let’s import existing medicine into our platform, right? Let’s take all the things people do today. And let’s deliver it in a more scalable fashion or platform. But in some ways, that’s the least interesting. What you then want is you want the AI to basically say, hey, let’s start looking at this and making suggestions. And it’s almost like Elon with a self driving car, you start really simple, right? Hey, let’s speed up slow down, change lanes, the left change leads to the right off ramp on ramp, and you’re working your way up till self drive. Well, here, it’s the same thing. Maybe you just make a suggestion to a doctor, hey, don’t use this med use that met, hey, in this circumstance, wait three more days before you try something, whatever it is, but you’re working your way up until one day, it’s coming up with medicine that like the rest of us are like, Where the hell did it come up with that? But that seems to be working. And that’s the ballgame.
38:03
What is next for forward and carry upon? Yeah, it’s really,
38:07
really simple. More care bods. More Apps, more capabilities, just think of us like we’re like the iPhone, right? The iPhone came out, it didn’t do too much. So what they do they add 3g. They add 5g, LiDAR, gyroscope, GPS, they just keep adding shit until one day it’s making you coffee, right? Well, for us, it’s the same thing. We started the care bots didn’t do blood tests. Now they do blood tests, you know, they didn’t do they didn’t do body scanning. Now they do body scanning, they didn’t do your COVID. Now they do go and they’re just continuing to add until one day they were like running out of ideas. That’s where we want to be right kind of like the iPhone is these days. And then of course, you want more apps taking advantage of those capabilities. And obviously, you want more care pods, you want them on every street corner around this whole damn planet. It’s a really simple strategy. How
38:48
many pod deployments today? And how many do you anticipate in 24?
38:51
It’s a good question. We we’ve got a handful of them out there. We don’t actually release numbers. The funny thing was TechCrunch wrote that we’re gonna launch 30 to 100 this year, and I was like, what isn’t? No, that is not the right number. I wish but we’ve got we’ve got a bunch launching, you know, every few weeks or so.
39:07
You know, Adrian, the the funding markets for startups have been broken for a while. Personally, I don’t anticipate an improvement in 24. The Middle East has been one of the few sort of bright spots, I guess you could call it that’s, you know, providing funding for startups. What kind of relationship do you think Silicon Valley should have with places like Oman or such Saudi Arabia? And you know, where are the opportunities for founders and investors there?
39:34
You know, I actually think the the more interesting opportunity is not just kind of do a trek over there, grab some money, but actually say hey, what are the what are the advantages that the Middle East has over the United States and what you realise is like, Yeah, I know that everybody looks at me and they’re like, What are you talking about? This is you know, blasphemy, but take a step back and think about it. They’ve got rulers, right. We’ve got a democracy. Well, democracy has its pros and cons, buddy, right. Like if I They say, hey, I want to go change the United States healthcare system. Well, you could be Obama and barely make a dent, as we saw, right? On the other hand, there you go. And you convince like one dude, and all of a sudden, like the whole country is changing. Startups are agents of change, when you realise is when you’ve got like one constituency like one customer to convince, all of a sudden, maybe that gives you some opportunity to try some pretty, pretty interesting things. So I think the interesting opportunity is for startups in the US, especially the startups that are trying to get like regulatory change, or you know, physical infrastructure change, to go have some of those conversations and see what they can get done. Is
40:36
your end. If we can feature anyone here on the show, who do you think we should interview and what topic would you like to hear them speak about?
40:42
Two people that I would think of one is Keith or boy. So on my board, Keith is just a fucking character. He’s, he’s entertaining in the best way and in the worst way, but he’s super damn smart. And he’s got really, really good ideas on how to operate companies. He’s just got just a litany of like, these are the principles and the frameworks, and I think that’s really helpful. And then the other guy’s Fritz LANMAN. Fritz is the CEO of ClassPass good friend of mine for many, many many years and before that, he he was pretty high up in strategy at Microsoft, and he’s incredibly good at analysing and thinking through any situation to go hand in everything from the elections to venture capital. He is just shockingly smart. Love it. Adrian
41:25
what book article or video would you recommend the listeners something in recent memory that you found informative?
41:31
Yeah, you know what I actually really so I’m gonna sound it’s gonna sound a little odd. I don’t really read that many books. I think they’re a very slow way of consuming information but I do listen to podcasts because I cycle a lot and I love to listen while the cycle the required podcasts are really long piece on visa that I thought was fantastic. Love it. Love that show. Adrian, do
41:52
you have any habits tactics or techniques that are a secret weapon? Yeah,
41:56
I work out every day. For me it’s huge because if I don’t work out, I don’t have my time to just clear my like mental inbox. And I just I sit there stressed if I’m yelling at people at work, I knew I didn’t work out that morning. So every day I get on my bike for a couple hours and it’s like my version of meditation. Oh out there. Yeah. Oh yeah. I love to sleep at all. Not enough my aura ring says I’m half dead apparently. You know, whatever. sleep when you’re dead. Two hours
42:25
on the blank. That’s incredible. And then Adrian finally here what’s the best way for listeners to connect with you and follow along with forward?
42:31
You can follow my twitter you might be the second follower behind my mom. I don’t tweet very much. Honestly go to our website or you know what, if you want to get in touch message me on LinkedIn, shoot me an email idea. Those work. Very
42:43
good. He is Adrian, a goon and the company is forward. Adrian, thanks so much for the time. This was enlightening.
42:49
I really enjoyed thanks for having me.
42:57
All right, that’ll wrap up today’s interview. If you enjoyed the episode or a previous one, let the guests know about it. Share your thoughts on social or shoot them an email. Let them know what particularly resonated with you. I can’t tell you how much I appreciate that some of the smartest folks in venture are willing to take the time and share their insights with us. If you feel the same, a compliment goes a long way. Okay, that’s a wrap for today. Until next time, remember to over prepare, choose carefully and invest confidently thanks so much for listening