Transcript
Speaker: Welcome to the Healthcare Theory Podcast. I'm your host, Nikhil Reddy, and every week we interview the entrepreneurs and thought leaders behind the future of healthcare care to see what's gone wrong with our system and how we can fix it.
Speaker: On today's episode of the Healthcare Theory, we're speaking with Paul Briant, the Chief Product Officer at Athena Health. And I'm really excited for this episode because Paul's entire career has been essentially working on one question.
Speaker: What does it take to get doctors to actually love their technology? He started as a teenager, writing billing software at his father's surgical practice. He spent 17 years as CEO of PatientKeeper before eventually joining Athena Health in 2019.
Speaker: Today, Athena is a $17 billion dollars company with more than 170,000 clinicians on their network, and Paul has been leading the Athena's push to build an AI-native EHR, essentially rebuilding the electronic health record from scratch with AI as a foundation. And we get into why doctors have historically fought EHRs for nearly two decades, why payers aren't the villains they arere made out to be, and what an AI-native EHR actually looks like to day.
Speaker: Paul. Welcome to The Healthcare care Theory. Thank you for coming on. ah Thank you. It's great to be here. Of course. And mean, you've had a long story throughout different areas in healthcare, but I want to start in the beginning. Your father was, from what I know, a general surgeon who left academic medicine to run an independent practice. And it's funny, I mean, as a high schooler, you helped him run it, which is uncommon to say, not only working at private practice, but as a high schooler helping on technology side. So maybe you could bring me back to that kitchen table type of moment, like what did watching your father trying to get paid as a practice center teach you? And what was your kind of involvement on that? What did you learn as a young person getting into health care? Well, it was a big risk for the family. So it was a big, big decision, right? You know, he was getting a nice salary with university and all that good stuff. And he decided to go out into private practice.
Speaker: and And so, you know, it was very much a family thing. We helped him get the furniture for the practice and set the practice up. But then, you know, and he knew how to do surgery, so he'd do some surgery, but he had no idea how to get paid for doing the surgery because in the VA and Shands, which are the hospitals he worked at, someone else took care of that. He never saw it.
Speaker: So I have vivid memories of sitting with the RVU CBT book on my lap, reading him the different surgeries he might have done and asking him if that's what he did so we could put the code on the HCVA 1500 claim for him. with a Selectric typewriter and and send it in. and And we did that for a while and and he got actually paid, which is kind of cool.
Speaker: um But then I had this real desire to to get a computer back when the Apple IIe was the computer of choice because I wanted to play video games because, well, teenagers still wanted to play video games back then. And so I convinced him that we needed to buy a computer so we could fill out the claim forms.
Speaker: And I took it by myself to write some software to literally just fill up the claim forms instead of using an IBM Selectric typewriter to fill the claim forms. You could put the information on the screen and it would print the claim form. And then, of course, you want to do more than that. So that morphed into an entire what we call today a practice management system.
Speaker: In fact, one of the first ones that was available on a PC because PCs just came out um and went on to actually create a business for myself, um selling a bunch of software to a bunch of doctors in North Florida, which is a lot of fun.
Speaker: And what surprised you most about selling to them? Or I guess in the same way that your dad had issue, he had a good practice, but it's hard to find a way to get that pay get payments for that and really sell and work with insurers.
Speaker: What was the difficulty when you had this technology, like actually working with doctors? Like, was it easy? Were they kind of dumbfounded and super excited? Or was there a little bit of friction when you're young kid with a software solution? did that look like getting it out there? Well, the thing that was most important about it I was selling practice management system. So we were not having to automate the physician workflow.
Speaker: We were automating their practice and their billing of their patients and the billing of claims. And I was the first vendor in the state of Florida to send in a electronic claim to Medicare in Blue Cross of Florida.
Speaker: And when you did that, you got paid almost instantly. It was amazing. And so it really, truly was a ah great sell. We'd sell based on that. Like, hey, we're going to come in The claims will go electronically. That was such an unbelievably novel concept.
Speaker: and And you're going get paid really fast. And they did. So it was a very much a a huge win for for the providers as as they went electronic. And you can, i mean, you know, the alternative was they were all literally photocopying ledger cards to send the patients as their bill. I mean, that that's kind of the era we were in. So it wasn't one computer system to another. It was literally pegboard accounting systems to a computer.
Speaker: And so it was a pretty big improvement for their practice operations. Yeah, I think it's interesting. I think people often say that like practice owners or just people in general don't want to adopt technology. There's like some friction, but I don't know if that's like the right and inherent statement. I think it's that people don't want to adopt technology that changes the way they do things. They want it to like a assist them in things that they don't want to deal with. But when you have something that changes the workflow, that's when you have to add real value and demonstrate that. and I think that like i mean you went to Princeton, you went to BCG, and worked mostly in their health tech practice. And it seems like after that, you basically rode a wave of healthcare care IT t consolidation in basically real time. i mean, I worked at HPR, HBSC, McKesson. And coming to see all of that, i mean, you built a so software at the practice level yourself and now I'd seen it at the highest level.
Speaker: Was there kind of a gap between how the industry thought about itself and how it actually worked on the ground? Like, what was it like when you were first building that software and now you're at the industry, at the boardroom level, strategic side? What was the kind of disconnect there and what would what surprised you most?
Speaker: Well, it's a very interesting industry um in that with the the ARA Act, back in the, don't know what recession it was ago, two or three recessions ago, um the Stimulus Act included a mandate for providers to adopt EHRs.
Speaker: And you mentioned, hey, there's a lot of friction. People perceive friction for for doctors adopting EHRs in particular. And there's two ways to look at that. You could blame the doctor or you could blame the EHR.
Speaker: um And there was a reason why doctors adopted practice management systems like crazy, adopted robotic surgery like crazy, and did not adopt EHRs. And it has a lot to to do with what we made the doctors do when they use the EHRs.
Speaker: And I spent a lot of time at a company called Patient Keeper, which I i joined in its pre-revenue phase and kind of turned it around and turned it into basically focused around how do we give doctors in the hospital technology that they would actually love to use.
Speaker: And we did. And we had 70,000 doctors loving to use our software. um And then RO was passed actually and said, hey, you have to do a bunch of things that doctors do not love to do, like enter orders, like do electronic documentation,
Speaker: um And that's where the friction came in. Right. we Because we we basically turned doctors into pharmacists and unit secretaries. And in any other industry, you would have gone, do we want to take the highest paid people in the room and make them do the job of the lowest paid people in the room?
Speaker: No. So yeah you go you go to a hospital and there aren't unit secretaries. In fact, um if you look at the pit, they had a downtime in their in their EMR and they had to bring in a unit secretary. This woman who retired when computers replaced her. It's like, that's what we eliminated. When we went to the HR, we eliminated unit secretaries in the hospital.
Speaker: And it's like, I don't think that was the intention, but that's kind of what happened. And we made, and and guess who we made the unit secretaries? We made the doctor's unit secretary. So um we're working through all that. and And obviously, AI is going to make it so much better.
Speaker: um But that's kind of where the historical friction has been. and you know, at Athena, we spent a whole bunch of time trying to make it so that we can allow the doctors to do the things that they have to do in the HR because people said they you have to do them in the most delightful manner possible.
Speaker: um And then with AI, i think we can make it just all go away for them, which will be great. But why do you think the burden fell on doctors? It almost doesn't sound like it makes... It's so funny when you say it because it doesn't really make that much sense. You have a doctor, you're paying $100 for every marginal hour, and then you have secretary should pay much less than that, and they'd be specialized at doing that. A doctor wants to focus on medicine. So I imagine people weren't in a boardroom saying doctors should be secretaries, but somehow that ended up being the result. What really resulted in that from your perspective? Was it an accident? Was it just...
Speaker: a few bad policy decisions? Like where did that really come from? That's a great question. And yeah I have a variety of theories, one of which is that doctors aren't necessarily well represented in the regulatory bodies.
Speaker: And there are other parties that are and they have opinions. um You know, there was a big focus on patient safety, which is like patient safety. We'll take more of that. Like who who want who doesn't want more patient safety?
Speaker: and um And a lot of people got very focused on medication errors and ah decided that you know having a doctor scribble a medication down on a sheet of paper and then having a unit secretary try to read it and send it to a pharmacist probably wasn't that safe. And I don't disagree with that.
Speaker: But what they came up with was putting an incredible burden on the doctors. um you know Hey, doctors, you have to put a fully qualified SIG in all this information. We're going to pop up every alert known to man that the pharmacist used to deal with. But you should see that. And, you know, it was all very well intentioned and it was in the name of patient safety, which you just can't argue against. Like, i'm not going argue against patient safety and I'm not trying to do that now.
Speaker: But the result was system that was essentially unusable in its form. remember one of the first EHRs that I spent time with, I was at Boston Children's looking an EHR, not Athena, inpatient EHR their NICU, and in their niew um And then and and I was sat with a doctor and and I said, well, if there's one thing you could change, what would it be? And she's like, well, it takes a couple of seconds every time i press escape to ignore all these messages that come up, which are all the clinical decision support messages. You know, she would just sit there and and just press the escape key as fast as she could because there are so many of them and they are mostly irrelevant for the situation.
Speaker: i mean, yet someone, you know, spent a lot of time designing those thinking it's going to save babies. And it didn't. It just annoyed the doctors. um So it's the kind of theory versus reality problem that ah that that crept in. And you know and then you know having the government say, thou shalt do this thing is never helpful or rarely helpful. mean, and got everyone to do it, but the the systems weren't ready, right? If the systems were ready, people would have used them already. I mean, again, I always use the example of before r was passed, doctors would walk out of robotic robotic surgery and very happily write their orders on a piece of paper.
Speaker: Right. And they did not want to put them in the computer, even though they had a computer to put them into. Why? Because it was less convenient for them. And they were maximizing their time and their care with patients. And then we made them do that.
Speaker: So it wasn't that they were adverse to technology. Right. They're willing to use a computer to operate. it takes Yeah. But they were unwilling to use technology that slowed them down, which so is everyone else, by the way. Like everyone on the planet, if I said, hey, here's some technology. Use it. It's going to slow you down by a factor of two. You're like, no. Like, it's just that we equate technology with speeding people up.
Speaker: and And so you say, well, use technology, it must be good, it must be productive, and productivity enhancing. And in the case of medicine and yeah EHRs, initially it was not. Yeah, I mean doctors use phones, doctor use doctors use computers, they use chat GPT with their own stuff. It's just like they want to use it in a productive way that actually helps them. And i think it's interesting. And almost every industry, the person who builds the product and uses it it is different.
Speaker: But in healthcare, care the person who builds it, the person who pays for it and the person who uses it are all different. And I think that's the main issue is that the doctor isn't the one who's in the procurement team at MassGen or one of these larger hospitals or even at a small practice. Maybe it's a little bit different there, but I think that friction might be an issue. i mean, how do you see that playing out? I think maybe you guys work at the practice level where doctors do have more control, but...
Speaker: Do you think if doctors are more involved in the decision process, it change? Or is it just a structural technology thing that we need to build better technology? That's a very insightful question. And and I actually used to have to coach my sales team at PatientKeeper. So we we sold to doctors in hospitals who did not buy.
Speaker: yeah And they would go give demos to doctors and doctors would be like, I want this tomorrow. And they'd come back and they'd be like, hey, I got this deal. I'm like, no, you do not have the deal. You've not talked to anybody who can buy. um And in the hospital setting, it's a real problem, right? Because doctors don't buy. Now, fortunately, with Athena, we sell the practices where actually go sell to the doctor. and And that works out really well. And that's why we're a successful company because weve got a good product that doctors like. And they they and they buy it. But the hospital sell really tough because you're selling to the hospital CIO who is almost always not a doctor. Now, since then... the notion of a CMIO, a chief medical information officer, has come into vogue to help solve this.
Speaker: So, you know, organizations are responding. But back in the URGE-LARA days, in the patient-keeper days, there were no CMIOs, right? It was just a CIO. And and their idea was, know, the answer was no, what's the question kind of thing, right? um And so ah the the notion that we could have a um a medical influence in the IT world was a pretty novel concept in the two thousand tens two thousand and fifteens um and and and help some, but they often had no power.
Speaker: They'd be like, hi, I'm the CMIO. I have no budget. I have no people reporting to me, but I'm the CMIO, right? I advise the CIO on what they might do. And in some, you know there's some institutions and actually a lot of the patient-keeper clients were ones where the CMIO actually had the power and and a portion of the budget, and then they would use it to buy our software, which is great. um But it is a is is's very complex. And and i think we've you know I think we've gotten to a good place I would imagine if we had a parallel universe where we didn't pass the Meaningful Use Act, we'd probably be in about the same place. we might And we might have better technology, honestly, but we don't have a parallel universe and we are where we are. So we got to go with it.
Speaker: Yeah, it's it's difficult. I can also imagine, yeah, it's just so much more different from where you are at Athena versus PatientKeeper. I think that the size of the organization label plays a huge difference in that.
Speaker: um And maybe like a question on PatientKeeper before we get to Athena. I mean, it seems like what you did there was, i mean, you had the original PalmPilot and then you worked on top of that existing workflow. But I think honestly, you can describe this better than I can. mean, what was your role like at a Palm, sorry, PatientKeeper? Like what product were you building?
Speaker: How would you describe that? And especially like where that fit into the time, like why was that product so necessary? And so thinking about how we can improve doctors workflow every day. um It really was about that. And this was before Meaningful Use. So this is like 2002 era. two eras yeah um and the the thesis was, hey, what what you kind of started us with, which is doctors weren't using technology. Like there was technology all over the place. Hospitals were getting automated and doctors are like, please do not make me do that stuff. And they didn't. Like the use of computerized physician or entry was like 2%.
Speaker: And I used to joke was it CROE, Chief ah Computerized Resident Order Entry, because doctors didn't do it, just residents did and in academics. And no one else did. And so PatientKeeper really, what I brought to PatientKeeper but what wasn't the founding thesis, but what I brought to PatientKeeper was, we're going to go build technology that doctors love and want to use.
Speaker: They'll voluntarily use, because there's no mandate at the time, um and adopt. And we did. And we used some handheld stuff. So we we know we started out in the Palm Pilot. That turned out to be not exactly the right technology, but you know iPhones came and BlackBerrys came and all those things came. So we used mobile devices because one in the in the hospital, doctors are running around all the time and a desktop metaphor isn't ideal.
Speaker: But then laptops showed up, good laptops and tablets showed up. and we we we supported those as well. ah But still a lot of ah lot of people think about patient keep or think about using it on their iPhone ah because we brought basically the entire medical record to your iPhone.
Speaker: And if you're a doctor rounding or you're covering for patients or you're, you you know some doctors go between hospitals and you're blind to what's going on, right? Someone calls you, Mrs. Smith's got a problem. you know You may not even remember who Mrs. Smith is, and with Page Gapery, you whip open your phone, open the app, you get the full medical record right there. It's great. you know um And so it was a really wonderful, powerful tool for physicians, and they loved it.
Speaker: um And ah you know there there wasn't like NPS and things like that, but if we if we had NPS back then, yeah know we would have had an NPS for probably 70 or 80. um and And then Meaningful Use passed and it almost literally almost killed the company. I was like, I had to go a board meeting and say, yeah, now this is weird. And the government just said, we must use technology in hospitals now.
Speaker: And it in our company sells technology to hospitals for doctors. So it seems like it's a good idea, but it's actually an existential threat and we might need to shut the company down. Yeah. And so we we did we did so recover that. That's probably a topic for another another podcast. But we did manage to make it through um and and do okay. But it was it was definitely one of the most difficult board meetings I've ever been in.
Speaker: Yeah, and and um actually before we get into a team health, maybe a question on that too, because you think about what drives technology adoption, one is having good technology, and that can do a lot. But I think an important accelerant in the past, I guess since meaningful use the past 15 or 20 years has been regulations too. And I'd say meaningful use was unique in the way that it drove adoption just certain areas and and certain companies too. i mean How did you guys navigate that shift when you saw this regulation that should be a tailwind and end up being a headwind or even like a, I guess, a structural threat?
Speaker: What was the interactions at your management level on the boardroom to kind of navigate this? And how did you pivot the technology to make it make sense? before Especially since you guys got acquired by HTA, which is obviously a large company now.
Speaker: What did that look like from your perspective? Yeah. the i mean the The basic problem was it mandated computerization order entry and and computerized documentation. None of what doctors wanted to do. So we had the love problem and they didn't love to do that.
Speaker: And we didn't do it. And it's really hard. um And the long story short is that I spent, and and many of us in our company, spent a year and a half in Cedar Rapids at Mercy ah Medical Center working with their unbelievable clinical staff to figure out how to build computerized order entry and documentation in a way that physicians would at least like, if not love a little bit. And we did.
Speaker: And it was a restart the company thing. we had to get take new funding, do all that stuff to go do it. And we did, and we came out the other side and then we built it. It was so good that HCA bought us to be their physician platform. So that's pretty cool. Yeah.
Speaker: That's great. I mean, HTA obviously is a huge platform, it's a technology and so many more people. And almost like and speaking of restarting, it seems like, i mean, of course, PatientKeeper got acquired, I think in 2014. And not long, it's a few years after that, you made the jump to Athena Health.
Speaker: um And it seems like that era where Jonathan Bush had ended and the company had... a Originally, you went into EHRs where Epic Health, of course, kind of dominates, but now you have the core ambulatory product, which is now the real focus again. And you're sort of walking to a company that's been pivoting and still has a core product, but something you might need to refocus on. But it'd be helpful to think about what pulled you to Athena Health and how would you describe in plain terms the kind of the core problem that Athena Health exists to solve. I think it's very much on point with what we discussed today, but I think the angle in which you guys do it is quite interesting. Yeah, I looked at, you know,
Speaker: I sold my company to HCA. They actually adopted me in such a wonderful way. i was planning to stay there for a very long time and learn how to a hospital and do all those things like that. So there weren't many phone calls that I would take that would suggest me that I should go somewhere else. Athena was one. And the reason why Athena was one is because of its incredible heritage. Jonathan Bush built a great company with an incredible culture, really focused on on on on the problem that I think is even more important than the inpatient problem, which is how do you keep independent practices independent?
Speaker: And fundamentally, that's what we do. And so when I got the phone call and I got the opportunity to be a ah ah chief product officer, i thought that is the best job ever. Now, the company was in some not good straights. It wasn't like you know going out of business kind of thing. but I think people had gotten a little bit mis misguided and misfocused and we're trying to get into the ambulatory, into the acute care space and yeah lost focus on what was important. We lost focus on that mission, even though that's why I joined. And so it was really, really exciting to come in to turn the company and turn around. Is it not the right term, but to to refocus the company on its original mission and remind everyone what we're here for.
Speaker: and then go do it. And we've been able to do that. And and the company is growing great. We got tons and tons of new customers that are that we're keeping independent. like that that is That is our ethos is how do we help ambulatory providers be providers and, you know, take all the administrative stuff away, allow them to focus on on patient care, which is what they want. You you go to med school to focus on patient care and not to fill out a 1,500 claim form and really optimize their practice because it's it's ah it's a tough world out there, right? Ambulatory um fee schedules have been flat to negative.
Speaker: you know, we got a little boost this year, but it's been a long road of of basically nominal flat to negative, which is in a real basis with inflation, you know strongly negative. And these practices are struggling.
Speaker: And we come in and we optimize the heck out of their payments. We know how to get paid with insurance companies. We know how to make sure they get paid for everything they do. And we make it delightful by doing most of the work for them. um And I love that. And so that that's why I'm here. That's why I've been here for the last, I'm coming on seven years now, which is pretty crazy.
Speaker: Time goes by quick. Yeah. It's interesting because, i mean, America is kind of founded on this idea, like kind of the American dream and entrepreneurship. And I think you see that in many other areas. Like you can just start your own restaurant or start your own store, but making out your own practice is hard for so many different reasons. You could be the most qualified doctor in the world and still struggle to have a well-performing practice because of so many externalities you're dealing with. And from my understanding as chief product officer, one of the big mandates, yes, as you mentioned, was refocusing. So taking Athena One, which had really become like a one size fits all product and now making it more, i guess, tailorable, less complex, probably better for those physicians in ambulatory care. So when you're looking at the platform, you're coming in at 2019 or 2020, what were the first priorities you had? like what was actually beyond the culture point? What was it actually broken or getting in the way of physicians wanting to use it? How did you refocus that? the technology suck to make it work better for ambulatory care? um I mean, the the the first challenge we had is we we had a little bit a say-do problem. So the company wasn't that focused. They would go out and promise a bunch of things to customers and then not deliver them.
Speaker: So we fixed that in a very, very demonstrable way, probably over-rotated on it as you tend to do. so we we got that sorted out, restored trust with our customers. Then we began to specialize the software. So Athena was built very purposely as a one size fits all piece of software. Like here it is, like or leave it. It's great. It's the best, you know SaaS platform on on the planet. We get you paid. That's great. But you're a podiatrist and you do things differently than the orthopedist and, you know, use as a deal.
Speaker: And so we've really worked on tailoring the workflows so that if you're a podiatrist or you're a primary care doctor or you're a pediatrician or you're an orthopedist or you're in urgent care or you're in behavioral health, the system is going to be different for you a little bit.
Speaker: Same system, same great SaaS platform, um but it knows that you're an orthopedist and it knows that like looking at images is really important. So it's really easy to do. Whereas if you're a pediatrician, you're not looking in a lot of images. You don't care. You know, they're there, but they're buried you know away. um And so that's been a big big unlock for us.
Speaker: um And then you know the other thing that you know we've always been, we talk about it as a tech-enabled services company, we've always done the service work for our customers. And we call it YouDoWeDo. So we do a bunch of work and you do some work in the in the practice. Like you know you collect the insurance cards and patients and you you know talk to the patients and and we you know make sure the claim goes and we follow up with the insurance company if they don't send it and all that stuff.
Speaker: um and and And we've always done that. And and the cool thing is, you know this AI is starting to evolve. Everyone's like, hey, you need to be, you know, this notion of a services as a software company. You know, and it's like, well, that's kind of what we've always done. We just call it tech enabled services. So we have a new term for what we've always done, ah which is, you know, we deliver all these services in the context of software. It's like it's like magic behind the scenes.
Speaker: And now, of course, with AI, we can do a lot more of it. So we're doing more of it for our customers. But but it's been a really cool evolution of those seven years. And um I think we kind of touched on this a few things times. We never actually gotten into this too much. But I think not only is that very interesting terms of how you've realigned, but almost like the layer underneath is like the whole point of Athena Health is getting doctors paid. and when you think about like software services, you think about making things more productive or doing work for someone else or helping them do their work better.
Speaker: But I mean, in the first place, like doctors' primary job shouldn't have been getting themselves paid. So like, I guess to get a reframe, ever since you started working for your dad, helping him get paid, it's still been an issue. And could you kind of speak to me why getting a doctor paid is so important. i mean, it's inherently tied to your revenue model. You guys aren't just a SaaS platform clipping a fee every every month or year. You get paid when doctors get paid. And I think that alignment of incentives is relatively uncommon in software and also and especially unique in healthcare. Can you speak more to them? I mean, why is getting doctors paid so hard? I mean, it seems like an obvious answer, but we'd love to hear your perspective on what's that friction really comes from. the US healthcare care system is is a complex place.
Speaker: Right. There are, yeah you know, thousand plus payers. Many of those payers have employer sponsored health plans and employers have their own view about what benefits they should offer. So it's not just like Aetna, it's Aetna with every single employer that comes in and and has a custom benefit plan.
Speaker: And there are all these rules and the rules are different across payers and different across states. And it's really hard to know how to ask for the money to for the care you provided. And in some cases, it's hard to know which care you can provide, whether that's allowed by the by the plan or not.
Speaker: um And you've got to get preauthorization for it. There are just so many complexities to it um because there are so many payers and so many permutations of benefits.
Speaker: um you know All very well intended. And then you had value-based care in there. And like, okay, we just sort of kind of figured out fee-for-service. and And value-based care is not one thing, of course. There are a gazillion different value-based care-like programs out there. i think Medicare has like 35 of them or something alone. um Plus, you know, bunch of commercial ones and and Medicaid ones. And so it's like navigating that's really hard. and And, you know, as a doctor, what you really want to do is practice medicine like the same way. You don't want to say, oh, this patient's got, you know a Medicare Advantage program from Humana. I needed to practice medicine differently on them than a, you Aetna pharmacist.
Speaker: commercial a commercial patient or a Medicaid patient. Like, like you don't want to do that, right You don't have to think about it. But in some cases there are things you have to document or do differently because of those plans. And, and one of the coolest thing is we take all that away.
Speaker: And if we need something from you, we ask you, you know, Hey, I need this piece of information for this particular patient in this circumstance, but you don't have to remember, you don't have to think about it. You think about providing the care. And if there is something that you, you know, unfortunately that we need from you we'll ask because we know,
Speaker: And hopefully we won't have to ask. um and And with AI and and and and and and especially the ambient dictation where we're getting literally a transcript of the entire visit, like you don't have to remember to document it. Like we will go find it. Now you talk about it, um then we'll ask you to talk about it as part of our AI native yeah EHR. So we'll be like, hey, um you know, you're doing the the visit and, you know let's say for example, you're working some up for a a total ah hip replacement.
Speaker: in order to get a pre-off, you need to have put the patient on physical therapy in most cases, right? Try physical therapy, physical therapy failed. But if you don't talk about that in your and in in in your encounter, i mean, maybe you know it because you know Susie and you know she got physical therapy and you know it didn't work. But you need to talk about it because got to get documented so we can go get the pre-off.
Speaker: So if you don't talk about it, proselytics will say, hey, don't forget to talk about whether physical therapy was successful or not. And the doctors will say, hey, Susie, remember you you did six weeks of physical therapy and it didn't work, right? Right, didn't work. Okay, move on.
Speaker: It's totally seamless, totally delightful. And and and we've we've just taken the complexity away. Like we we have this theme for for us that we cure complexity. And that's the way we cure complexity is like, make it simple, make it about the encounter. And that's it. And that's that's what we're doing now with our AI native EHR.
Speaker: That makes sense. um and I think the whole AI native thing is really interesting because what's ended up happening is a lot of, I think in healthcare, care is something that's both good for the companies that are incumbents, but also hard for new innovators, that there's a deep entrenchment once you have an EHR or some medical record, it's very hard to remove that, which is um good, but it also means that the innovation needs to come from the top or through acquisitions. And I think both of which is something that's been a key priority among many of the top companies. And I think you're you're you're basically the central architect of Athena Health's AI-native strategy. i mean, the idea that we can rebuild Athena One as it was built from scratch today. um to Can you speak more to this? I mean, AI is going to transform
Speaker: many things. They can do a lot of work that doctors don't want to do. It also also can help doctors do the real doctor type of work, like real important things, um which the other companies are focusing on. But what does an AI native yeah EHR actually look like in your eyes? And what are the key steps in at getting Athena out to that point? Yeah. So so basically, we um when we built the EHRs the beginning, everybody does this, right? The only metaphor that we had was a paper chart.
Speaker: So we built EHRs around the notion of a paper chart, right? That's what we did. Like, look, we're doing it on paper. Let's do this on the computer. You know, you have a section for lab. It's your meds and vitals. and And you can flip through it. You know, you could maybe search it if you're fancy because it's a computer.
Speaker: But it was fundamentally that metaphor. And what AI Native allows us to do is to say, hey, wait a minute. If we built those EHRs when we had AI, we would not have used that metaphor.
Speaker: And the metaphor that we're using is the metaphor of a 100% informed medical assistant or resident. So in Accurate Medicine, if you're attending, you walk and there's all gaggle of residents around you. And the and the residents are there to to demonstrate that they've studied the patient and know the medicine really well because they're they're they're learning, right?
Speaker: And so it's it's delightful as a resident as an attending because you don't have to touch any HR. You've got residents to do that. They know everything about the patient. They can brief you and tell you, and you're testing them. um And so what our AI native EHR is like is that super informed other physician that knows everything about your patient, who's gonna help you get up to speed quickly.
Speaker: um There's another metaphor, um there's a in hospital work, there's an notion of a handoff. So after a shift, um and you know the new physician shows up and the existing physician does a handoff process, it's a formal process that you do to make sure there's a continuity of care.
Speaker: Here's what's important for Mr. Jones, Here's what you need to know Keep an eye on that this. You know, worried about this. um And a briefing. And so what we can do with AI and AI, EHR is make it like that.
Speaker: So they open up the chart. And instead of having the chart like a ah paper chart, got to go hunt through. it puts all the information that you need for that particular such situation on the screen. It's like, hey, I know you're an orthopedist. I know this person's here to work up for their hip replacement to keep on that one. um and um And here's what you need to know.
Speaker: And here it is. right there for you. And if it's a different situation, hey, this is you your post.followup, here's what you need to know. um And that level of intelligence just didn't, there wasn it wasn't possible without AI. Like there's no way, right?
Speaker: ah You could have, you know, you have to template the thing to death and it would, it' just it would people would try it, it just never worked. And so then you take that into the ambient encounter and you say, hey, now we can listen to you talk to your patient and we can fill out all that stuff you didn't want to fill out before, um you know, code the problems up,
Speaker: tee up all your orders. So they're already, are already there for you. Write your note for you. um you know, it's like, Oh my God, now this thing is something I love and could never live without. Um,
Speaker: Yeah, I can imagine that. I mean, you have like, i saw a stat that voice agents are placing over 20,000 prior authorization authorization calls a month. And I think that level of adoption shows that like doctors just like to use this.
Speaker: um and you can And you can kind of see why. I mean, if you're a doctor, do you really want to I mean, I guess if you're an assistant, maybe you'd love to help out. But if you're a doctor, mean, you don't want be doing this stuff, especially at a small practice, when you lack the money to pay for assistance or the ability to go back and forth and manage that friction. And I want to kind of come back to something out of your at McKesson and something you've spoken on more previously was that um When thinking about payers, i mean payers have a large role.
Speaker: i mean You're the one that you're trying that you're trying to get paid from, but also they have a role in what type of technology you can be used and adopted. and You've kind of spoke on that you believe that payers aren't evil. i mean They're just playing a different game. And everyone is in healthcare to some extent, the hospitals, the practice owners, the the payers, patients, everyone's kind of serving their interests and the ideas that you want to align them together. But um a lot of payers are developing their own AI to deny claims and and kind of, it seems like an AI versus AI arms race is what's been characterized. And whether it's true or not, I think we won't know for a couple of years, but from your perspective, how does that interaction work like with the larger payers? And are of course, on the other end, of every conversation you guys have and every API call you guys have. What does that look like and how do you guys plan to navigate that at Athena Health?
Speaker: Well, so, um, when I joined HPR, which was a company focused on, um, pairs, uh, most of the physicians that had, that were my clients or or had been my clients basically disowned me. They're like, how could you go work for the pairs? They're evil. They are the devil and carnivore enemy.
Speaker: And what I found working with pairs is they're absolutely not that they're actually are the only entity in the healthcare system that's trying to look at a population of people and keep them healthy. There's no other entity that is doing that, right?
Speaker: and hospitals, it's too late. They're already sick. We just try to get them less sick and get them out the hospital, right? And if you're a provider, you're just trying to to to to see the patients come in the door and and and and and be okay. and Maybe with value-based care, you get a little bit like payers have always, even back in the 90s, they have always been focused on, i have a set of patients. They call them members.
Speaker: And we would like to keep them healthy because frankly, that is cheaper and we get premiums. So we'd like them to be healthy. We really would. And i think it gets lost in translation because then payers do things that annoy the heck out of doctors and make them feel like they're evil, even though they're very well-intentioned, kind of little bit like our CPO discussion. um and what were And when I was running HPR and then all McKesson's payer businesses,
Speaker: I always, we always fantasize with our payer customers about imagine a world where you could actually get information real time to providers while they're providing care. Wouldn't that be cool? Cause we had all this stuff retrospectively. Like we'd send letters to pay to to doctors. You didn't do this for Susie. You should have for Susie, you know, six months later. And thank you, but that's not helpful.
Speaker: And so basically when I joined HPR or joined Athena, I jumped on a plane and went to UnitedHealthcare and said, Hey, um, You know, we we talked about this 20 years ago. Would you like to do this? Because we could do this now. We can put information. You have information we can put at the point of care that'll help doctors do a better job.
Speaker: And they're like, we don't believe you can, but sure. And so we came up with a whole thing. We call it moment of care. It's a big business for us. It's a delighter for doctors. Like doctors are very happy to see this because it allows them to get paid.
Speaker: It allows them to do the things that the payers are going to call later on in a very annoying way and ask in a very delightful way. And the payers are like, this is great. We're, you know, we're satisfying. We're checking all the boxes we have to check to get paid by the, bet by the people that, you know, underwrite our premium.
Speaker: So um it's been this incredible win of alignment. It's like, like, like, you know you figure out, know, what a payers need, what a providers need and make it a delightful experience to get those two things. And it's been ah a massive win and ah and a great business for us and a a great, great win for for all parties.
Speaker: That makes sense. Yeah, i mean, it's interesting. Like if you think about an insurance's business model, they earn money no matter what, and then they want ideally to you to cost less than that.
Speaker: So you can say that they can like deny every procedure, but the ideal outcome for them is just for you not to get sick. That's the best case scenario for them. And I think that's been where things have been trying to go.
Speaker: But what I've seen also, not kind of and a set a little similar point, is that, i mean, independent practices, it's getting, even with technology, it's getting easier, but it's still consolidation is still coming in regardless of that fact. You have private equity, health systems buying up practices, payers acquiring provider groups, like the group we just talked about. and Where do you see this fight actually going? and Do you think that there's going to be kind of a plateau point where there's going to be a set number of independent practices always existing? do you think the industry is structurally moving towards consolidation? Or do you think there's a mixed ground and he might move towards independence? Like, what do you see as the trajectory of the industry and into whether practice owners will stay independent and large? Or do you think it's going to be evolving a little bit in terms of what that structure looks like? Because I do see some consolidation, but also steady set of doctors that are going to stay independent. Yeah, you know, this is always interesting because i I've been in this industry long enough that that that I've seen this go through cycles.
Speaker: Like there was a, there have been previous cycles where things look like they were going to consolidate and everyone's going become an employee. And then that didn't work. Now, when you're in a cycle, you never know whether you're in a cycle or whether it's permanent, right? You know stock market's doing great. You think it's going to be great forever. and then it's not the stock market's doing bad. It's going be bad forever. It's not. um So I don't know whether this is a cycle or not.
Speaker: It's certainly there is, a as you say, a general trend towards more consolidation. But, you know one of the problems is, is that when you acquire a physician practice, you tend to see a pretty deep steep decrease in productivity.
Speaker: And in many cases, a decrease in patients out and things of that sort is people become employees. And and anyway, there's an entrepreneur. So, you know you know you know, where I sit on this on this philosophically. um So, you know, what you know, what would we do is stick to our knitting. Like our job is to help these independent practices stay independent. and and And the reality is I count a big private equity practice as an independent practice.
Speaker: in my mind. Now, maybe that's a little bit self-serving, but we have a bunch of very big um you know consolidators, but but many of them are consolidating in a way that still respects that productivity of the individual physician.
Speaker: um and and And the practices in some cases are even still branded what they were before. They just have access to capital and best practices and better management and things like that that they didn't have before. So that's okay. I think the thing where it the that is always dubious is in my mind is, you know, when, when big hospital systems buy up ancillary practices out in the community and that's where you see, you know, and then they're doing it to get ref referral volume.
Speaker: um And, and they kind of, it's a loss leader for them. and And, and that's where I think you get a little of the yin and yang because like, yeah, it looks good for a while when you're trying to grow. Then you're like, well, wait a minute, these people are like losing tons of money. Maybe we don't need them anymore. Maybe they can still refer to us if they were on their own. and they would do better.
Speaker: And that's where you see, I think, some of the yin and yang. But this private equity thing is an interesting game. um You know, I think that there there is some opportunity, I think, for private equity to to come in and and help rationalize, provide some capital, um be be be creative, um you know, frankly, deploy platforms like Athena, ah you know, and in cool systematic ways and and and make the practices even better. Yes.
Speaker: Yeah. Yeah. I think if you think about consolidation is like, what's so good about it, it's the fact that if you bring different practices together that are run in a small way, you can have like some synergies, you can have people sharing some of those back office important areas that can all kind of aggregate together, procurement can aggregate together.
Speaker: But I think there's some value in being independent too. this is what you want. It'd be cool. Like we saw more software like Athena health and other verticals that would allow so you can see those like synergies and getting that technology kind of, um, obviously amortized across all the different practices, but then people can still be independent, which is why I think technology is so important. It kind of enables that. But um for last question, I think that's been really cool to see how Athena Health has evolved and how technology has evolved within within healthcare. care I think it's very clear there.
Speaker: Doctors don't want to not adopt AI. They want to adopt AI and technology that works for them. And when you see the next couple of years, like what what keeps you up at night? Whether it's things that you're excited about, you're scared about, what are you looking forward to in the future of healthcare? care What's keeping you up at night for better for worse? Honestly, I feel like a kid in a candy store. I've been in this industry forever. I've been trying to figure out how is it that we get doctors to to love their technology.
Speaker: And we we scraped out it at PatientKeeper, but we didn't do the whole thing. We picked off the things that actually worked. And now with a i we can do this for doctors. We can make it make ah an intelligent partner, make the HR into an intelligent partner, and we can make technology that they absolutely love. And it allows them to focus on their patients. Like like ultimately, that's what they love, right?
Speaker: They want just all this administrative burden just to be wicked away, which is what we do. And we've always done. And now in the clinical realm, we can do the same thing. um which we couldn't do before, before the doctors still had to go through and type out all their notes and fill out all the forms and code their diagnoses and type in their scripts. And and now they don't have to do that anymore.
Speaker: And it's just so unbelievably cool. I've never been more excited about it. My team, my clinical team in particular, they're just, I mean, we're you know we're anxious because we just wanna get it out.
Speaker: And we're cautious because we're this is a like a big time innovation and you you're not gonna get it right the first time, that's the innovation is. um But we've got a lot of momentum and a lot of excitement and we're seeing a lot of great stuff out in the field. I just give ah a shout out to, we've got a whole bunch of physician partners,
Speaker: that very, very early adopters that are helping us do this. So we're not doing this in a vacuum and we could not be doing this without them. And that's a big big asset that we have and that we're're we're so excited to be ah to be partnered with our clients and in in in this in this particular quest.
Speaker: Yeah, i had we had a guest on a few months ago, Amiya Bhatt. She runs digital health for the FDA. and She basically said that the way she sees AI evolving in small practices is that AI becomes like an Ironman suit for practice owners and the way that it empowers them to do the jobs that they should be doing. and It really is that. so i makes just curious to see like how far this actually goes and what the future of EHRs look like, but I really do think it'll come on the front lines with Athena and Epic and these larger platforms and also the startups that are pushing the boundaries on what's really possible in healthcare. So thank you, Paul, for the time today. It's been great to hear your story from a young kid working on technology to now working on one largest EHR providers on the planet. It's definitely really cool. So thank you for the time and I'm looking forward to see what happens next. Awesome. Well, thank you so much. Really enjoyed talking you.
Speaker: course.
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