Breaking Barriers in Healthcare Data with Trip Hofer, CEO of Redox

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[00:00:29] Welcome to the Chalk Talk Gym podcast, where we explore insights into healthcare that help uncover new opportunities for growth and success. I'm your host, Jim Jordan. Today, I'm excited to welcome Trip Hofer to our show. He spent over 25 years in healthcare leading innovation and shaping the industry.

[00:00:50] Trip has held executive roles in Optum, CVS Health, and Aetna, working on everything from population health to mental health services and now data interoperability. He's seen the system from every angle, and now as CEO of Redox, he's tackling one of our biggest challenges, making sure data moves seamlessly between systems to improve patient care.

[00:01:11] In our conversation, we dive into the evolution of healthcare technology, the impact of AI and machine learning, value-based care, clinical trials, and how better data sharing can drive real change. Trip has a unique perspective on where the industry is heading, and I think you're going to get a lot out of this discussion. So, Trip, tell me and the audience a little bit more about yourself. I'll share the healthcare journey portion of my career, which I realized the other day is about 25 years.

[00:01:39] I was joking with someone that one could argue that the reason the healthcare system is where it is today is because people like me just tend to regurgitate in other companies. But healthcare is very small, and it's been actually beneficial from company to company. But I started a startup in Boston, very small, in the population health arena, before population health was something that we talk about today. It was called Health Dialogue. I was there for about seven years.

[00:02:03] And what I realized at the end of my time there was that health plans, which up to that point had really been acting more like TPAs in general, had woken up to this, wait a second, we have services now that are happening outside of our domain. We should think about insourcing those services versus just finding partners to do everything. And at that time, population health was very, what was called disease management, was very popular.

[00:02:27] And I recognized that these health plans were waking up and decided to go over to Optum, which at the time was just a nurse line. And if you think about what Optum is today versus what it was back in 2000, this is 2000, dating myself, obviously, but 2007, 2008. Yeah, 2008, yeah. We used to compete against that Health Dialogue. It was like, oh, we'll go compete against this thing called Optum, which is a nurse line. It was like a no-brainer because they weren't sophisticated. And now today it's this behemoth, right? That really was brought together by a whole bunch of acquisitions that happened really with this gentleman named Larry Renfro.

[00:02:56] But anyways, so I went over to Optum for a while, did stuff in population health, eventually did health and wellness, which back then was like health risk assessments, lifestyle coaching. That was a big thing, right? If you think about Virgin Pulse and all those types of companies that were back. Then I left there, I moved to Minneapolis, had my three kids. And then my wife and I said I moved back to Boston, where we're from. And I went to work for CVS Health because I knew the chief medical officer from my times at Health Dialogue. Ran a couple companies that they had there.

[00:03:23] So that was not only population health, but also then got into specialty pharmacy. And specialty pharmacy worked in that group for about six, seven years. Then the merger of CVS Aetna came. And because I had a healthcare background, I was tapped along with a couple other people to help with the integration of CVS Aetna. And at that point in my career, I was realizing that what I liked to do is work more front-facing, more market-facing. And an integration obviously is going to pull you inward. And I'm more outward-focused, so decided to look around.

[00:03:51] And at that time, fortuitously, one of the venture capital firms from Health Dialogue, they called 406 Ventures and said, Hey, would you be interested in running a mental health company? I knew a little bit about mental health from United, but not a ton. And so that was 2017 and really got lucky because that's when mental health sort of was started to just really exponentially skyrocket in terms of importance and prominence. And if you will, the mindshare of everybody in healthcare, really. Obviously, COVID hits and then mental health skyrockets.

[00:04:20] The company, able to, was a virtual provider of mental health services. So really well-positioned for what was going on then. That company got sold to United, to Optum. That was not our original intention. It's just a series of events happened. So I found myself back at Optum for a second stint where I decided or I agreed to run the mental health group after we integrated the company. So I did that for a couple of years, but always had this intention of figuring out something else to do and was approached again by the folks at 406 who said,

[00:04:48] Hey, listen, would you be interested in coming over and be a venture partner for a small percentage of your time? Really, we'll figure out what that means. But what I think you love to do, what I figured out I love to do is really getting these companies that have had this kind of exponential growth. Somewhere to between 30 to 50 million of ARR revenue. And then they plateau, not decline, but plateau to single digit growth. And then how do you get them to phase two? To be very crass, kind of that. Like phase two is where I find my sort of my wheelhouse.

[00:05:17] And we talked about, listen, this will take a couple months maybe to find something. And I tell the story that was a Friday of the last week of October of 23. And Liam Donahue, who runs 406, called me on Sunday and said, Hey, congratulations, you're the CEO of Redox. And I was like, that was 48 hours. And that, by the way, shouldn't count because it was a Saturday, Sunday. And I'm like, what's Redox? And he's, oh, it's a great company in data and operability. I'm like, what the hell is that? He picked something that doesn't put me to sleep when you say the two words.

[00:05:44] Little did I know that data and operability has become incredibly, it's always been important. But with the advent of machine learning and AI and value-based contracting and this need to share data, the company is in a really interesting spot. Again, in that sort of 30, 50 of revenue, pretty intense growth had plateaued off a little bit. And now the question is, what does it look like in its second evolution? So that brings me to the conversation today. Sorry, a long background.

[00:06:10] Actually, I think what a brilliant thought by the venture capitalist because there's this concept that got a little bastardized after COVID. But this whole concept of real-time healthcare system, which is a recognition that we have all these devices and all these things and all this information is outside of the healthcare system, which is really the population health journey that you took. And the CBS, you're a Boston kid, I'm a Boston kid. The CBS today is not the CBS you and I grew up with, right? It's now a behemoth and it's all connected.

[00:06:41] And it's important to recognize that if you think about what this is all about, it's really about applying precision medicine or precision health techniques to populations that need it. But how do you know that until you connect the information? And so I think between our latest ICD-11 initiatives where we're trying to digitize and standardize,

[00:07:03] Snowbed integrating, FUR and all these other connections that have been made, a company like Redox has been absolutely critical enabling not only the healthcare systems to connection, but if we think about innovation cycles, it seems to me that a lot of small companies who wouldn't have the capability, the funding to connect, right? Yeah. Yeah. Yeah. It's funny, two immediate thoughts. The first is Mark Halverson.

[00:07:27] You probably know Mark, but I was at a conference and he was speaking and I wrote down a quote that he doesn't even know I attributed to him, but he said it, which is, if I meet another small company that says they're going to change healthcare, but isn't connected to the healthcare ecosystem, I'm going to pull out the little bit of hair I have remaining on my head. And it's a real, first of all, I thought it was funny, but also it's telling, right? Because there are some really amazing, innovative things that are happening with small organizations, but if they're not connected into the larger ecosystem, then what happens, right?

[00:07:56] How do you really impact care if you're not? And by the way, connection into a healthcare ecosystem can mean a lot of things, right? And this is part of the problem. It can mean, oh, I connected, I sent a PDF back to a third-party website. Nah, you literally have to be connected into the workflow of the provider, right? And that is difficult because workflow in healthcare is tough. But that connection back in is exactly what the founders, to your point, the founders of Redox who came from Epic, three guys,

[00:08:25] saw these really small, innovative companies that their lifeblood depended on ability to read and write, read from and write to an EMR. And if you're a small startup and you're like, okay, I want to connect to Epic, what do you do? Call like 1-800-EPIC? No. You're not going to get their time of day, which is understandable. And so how do you help these organizations connect, not only into Epic, but into Soros, Cerner, Oracle, and Athena, and all the other ones that are out there, especially ones like PCC, MedMod, you name them, right?

[00:08:53] All the way down, there's a long tail of EMRs. But how do you connect into those EMRs so you can collaborate with the system in a way that really connects care, right, to your point earlier? Now, Redox has changed in the past decade also in terms of what it does. Can you share how that has morphed and how it fits in today's healthcare system? Yeah, there was really two things. So the founders, of course, as I noted before, said, hey, listen, we want to help these small organizations. So what they started to do is build connections between small,

[00:09:20] innovative healthcare organizations and what we call, sorry, small, innovative healthcare providers and healthcare organizations. So they get a healthcare organization as a hospital system, for example. And so they started doing this and they kept doing it. And every time they built one, they took the configuration, put it into a library. So when they built the second one, it got easier. And then the third one got easier. And then the fourth one got right, because you start to have, now we have over 5,000 configurations in a library where if someone was to come to us and say, I need to connect from me to, from A to B,

[00:09:51] we've either already made that connection because we're connected now to almost 8,000 healthcare organizations across the country. Or we already know some pretty high percentage of how to do it because we can quote unquote copy it or use it from another configuration we've done in the past. But what that infrastructure did is it allowed them to imagine like you've built all these connections. My marketing people want to say highways, whatever you want to call it, right? Pipes from small vendors to healthcare organizations. And by the way, when I say 8,000, you name one.

[00:10:21] So up here, Mass General is one, just to give you a sense, right? And so when you build those, you can start to use those connections for other things. And the first thing that the founders appreciated was that, or at least their hypothesis was that the future of interoperability was not going to sit just in the EMR. It was going to be in the clouds. So they went out and they got partnerships with Azure, with AWS, with Google, with Snowflake and Databricks to be a partner in moving data from A to B through an engine that does normalization and enrichment.

[00:10:50] And then what they also then appreciated was, yeah, it's great working with these small vendors, but we should also be working with really pair providers and enterprise clients. So that's been the big shift. And I wouldn't really call it a shift. I'd call it a compliment. And I can talk about why it's so important to work with those small vendors, but we should be able to help, you name it, large provider systems moving data from A to B. Because when you're moving a lot of data, as we do very rapidly through a platform and

[00:11:16] rapidly, we're talking milliseconds, because coming from Epic, that world is real time, right? It's all about making sure the information you get from A to B moves very fast and is very secure and is accurate, because patient safety at Epic is paramount. And so that's ingrained when you come out of that environment. So the technology you build has those same characteristics, right? A lot of data, very fast and a secure method from A to B.

[00:11:41] It just passes through a platform that can translate it, because unfortunately, we all wish we had one language in healthcare. We don't. So we need to translate it. Then you need to potentially normalize it, because how I'm represented as a male, that's how I identify, is a male in one connection is going to be different than another, which could be a number one or an asterisk or whatever. And then you might need to enrich it, because you have to add other data elements to it in order for it to be ingested and then used. But that's really what we do.

[00:12:09] We move a lot of data through a platform and then move it to a destination at a very quick rate. And then we move it back if need be. We write back, which is I'm finding is a unique differentiator for the company. I also think there's other, as I talk to different people, it seems to me there's other business models and improvements that you're making. I was telling you beforehand, I was a former VP of marketing, and I always look at create new categories, improve the category, collapse the value chain.

[00:12:34] And one of the things that I've heard people talk about with your systems is a large IDN saying, why am I going through a CRO for a clinical trial when I'm like one of the top 20 in the country? I can deal directly. I can keep the profits and plow it back into my organization, right? Because hospitals are running at less than 4% margin. So any dollars they can keep inside while servicing their populations. And drug companies are saying, I think I did an analysis when I was at CMU that there was

[00:13:02] something like $3 billion of checks that drug companies were happy to write on an annual basis that were clinical trials that failed, not because the drug at all, they couldn't find the patient. So they couldn't get the recruitment going and they just gave up, right? And so there's a lot of pieces of information I think you're providing to provide connectivity and models that are outside of the traditional healthcare system that the EHR and the hospital systems would even think of. Yeah, it's a really, it's a great point.

[00:13:32] By the way, it was fast. I was just at JPMorgan last week and I've been at JPMorgan now for many years, but with different hats on, right? The last time I was there was a mental health company. You target your meetings around mental health, obviously. In this organization, I could take a meeting with Redox. I can take a meeting with really anybody who's in healthcare because the question is, you want to move data from A to B? What's A, what's B? And what's the use case? And then how can we help you? So it was fascinating because even if let's say I was talking to a VC firm or a private equity

[00:13:58] firm, there was always a company in their portfolio that did something that we could potentially partner with. The other thing that's just fascinating about this space and specifically to your point is that there are a lot of players, but it's very fragmented. So there's really no true one-to-one head-to-head competition. At CBS, we would wake up, what's ESI doing today? And they'd say the same thing to us. At United, it was like, what's Cigna or Aetna? Username, what are they doing? And here, it's what are one of the hundred and something companies doing? Depends on the use case, industry and vertical.

[00:14:26] And so there's a lot of potential to partner together and really to, because no one owns the ecosystem. There's just, it's too long, too vast, too wide. So how do you think about partnering with other organizations? And so it's just a really fascinating time for the space because there's so many use cases, to your point, that could be used to make things more efficient, more effective. And so really, it's important just to think what you're good at and really stay focused on that.

[00:14:52] It strikes me, too, that as we start thinking of how do we start with AI, we're not going to, everyone talks about making decisions for doctors. That's not where we're going to start. Where we're going to start is just basic efficiency and being able to pull stuff together. Are there other people that are starting to come to you to partner on those things? Or do these get hubbed out by the electronic health record folks? No, it is absolutely that. Is you have a lot of people that have a lot of energy that get into healthcare because they want to solve a problem, right?

[00:15:20] And AI is at top of the list to say, hey, listen, I'm going to do X with AI because I think AI can help. But they need that data in order to do X. And what? And so they're like, okay, so I'll get data, no big deal. And then what they realize is that the workflow of how that data gets is so complicated and so wrought with error that what in another industry would be all just buy a piece of software off the shelf and run it through that if I even need to. It's just not doable in healthcare.

[00:15:50] It's very difficult. I was meeting with someone who just came over from NHS and he was in fintech before. And now he's coming over, he's working for a large pharma company and he's, and I will not do the English accent because I would be, it would be miserable and miserable experience for your listeners. But I pretend this is English accent. He's basically saying, listen, if I was, if you were to put a piece of paper in front of me, given my background, again, I'm English and I'm from fintech and said, I want you

[00:16:15] to draw the most ridiculous, messed up, inefficient healthcare system you can on papers. I couldn't have drawn what the United States healthcare system is. It's, it just doesn't make any sense. And okay, fine. Take it for what he's saying. Right now try and flow data through that. That's the interesting part, right? It's just, and again, find me an industry. I was talking to a hospital system the other day, one department within this large hospital system is going to take in 50 million faxes with images on it. So when people say to me, oh, AI is going to solve the world. I'm like, we're still using fax machines, folks.

[00:16:45] And there is no standard language. And the way the workflow is, is so I am a huge proponent of it, that it will start to solve problems and make things more efficient and effective. But my God, we've got this industry so far behind where everybody else is that to your point, let's get to basic blocking and tackling before we start to get into. And I think for the audience, it's the history. So I had interviewed someone about a year ago from Europe. And whether you're private or payer, you go through one system.

[00:17:12] I interviewed another doctor in New Jersey who had 32 databases to be able to get his billing with an average of 90 to 180 days before he gets his dollars. Yeah. And I had a durable medical equipment business at one time in my career. And at the end of the quarter, all of a sudden our billings would get rejected and it had everything to do with the intermediary was running out of cash and waiting for the next. So then what happens is they're promoting my coders, right? Cause they're panicking.

[00:17:38] They're trying to pick codes and it promotes a lot of inefficiency. But I think the history of it is that when I, my grandmother lived with us when we were a kid and Dr. Wally came to the house to take care of her. Yeah. Now that's not, I'm not a hundred years old for our audience. You can't see it. This is not terribly long ago. And the physicians were the sales reps for the hospital. That's where people went when they couldn't be taken care of by their family. And then it's connected from there. But the reality is 2010 is when we really started being serious about this.

[00:18:08] And 24 years is not enough. Yeah. Yeah. You're in the way that it's been stitched together and various systems that are being used. This is one of the hardest for my engineers. Like I'm constantly like, I'm going back to using technology from like 2000 here. I'm like, I know just there with it because they're like, I got to apply those skills. I learned 20 years ago. Cause that's, they're still running that type of tech. And it's, I get it. I get it. And, but listen, it's, it is what it is. And your point about the workflow efficiency of providers.

[00:18:36] I know a bunch of companies, AI companies, a friend of mine who I used to work with, or I should say a peer of mine. He's just starting a company that does exactly that, right? Goes into these position offices and just helps them with basic workflow using AI. So there's some great applicability there. It's just when I hear things like, to your point, oh, AI is going to replace doctors. Yeah. Huh? Sure. Make, but not overly simplistic to say that one of your basic value propositions, if I

[00:19:00] were to take a look at just software we all know about, if I looked at Zapier or make you connect things. Yeah. And then innovation, it starts an innovation cycle when things get connected. It's overly simplistic because healthcare is way more complicated, but is that sort of? Yeah. I think, listen, I tend to say to my team jokingly, like we should change our tagline to we dig ditches, right? Like we just, we're an enablement company, right? We enable things. So when people say, oh, you join a company like in healthcare, which wants to do because

[00:19:30] the passion of it, you have to have a passion for us to enable solutions that are actually going to solve healthcare problems. Cause that's what we are. I was funny. I said to my, so my team has been trying to figure out this image, right? Cause connections, like again, highway is good because it's fast and it's two ways and there's off ramps and on ramps and all this kind of stuff. And I was like, yeah, that makes, I like that. I was like, but I like treatment sewage plant. And they're like, that's terrible idea trip. And I'm like, yeah, but think about it. Like you're taking in data, which is very filthy and dirty.

[00:19:59] And then you're trying to clean it so it can be used and they poo-pooed it. And then someone at the CDC was at a public forum and actually used the analogy. And I was like, see, someone thought it was a good idea, but like a refinement plant, whatever it might be, but it's connecting, but it's also flowing through a platform that can do something to it very fast. Cause again, if you just do A to B, arguably what you're doing, right? It's garbage and garbage out. They, that's used all the time in healthcare, right? Cause from the very first moment a provider puts a code into a system that's not right,

[00:20:27] or it doesn't have the right modifier, you name it. It's going to create chaos, right? So you've got to do stuff and that's just an example, but you've got to ensure that it's running through a normalization translation engine, or else it's just going to, it's just going to, you're going to get information. It's not as duplicates or like missing tons of information, you name it. So it's got to, so think about that way. And, but that's what it is. And we enable some amazing things to happen on the other end, but it needs that data in order for those things to, to work appropriately.

[00:20:56] As your company evolves, it seems to me that there's this moment in time where those that have embraced you might be afraid of you, meaning that electronic health record needed this sort of connectivity, but they're also fearful of Oracle coming in and saying, you know what, these are just a bunch of toggle switches, because if you go back 30 years ago with MRP and ERP, there were a million firms out there. And at the end of the day, we have a couple of big ones, right? So it's inevitable whether they like it or not. And so it ends up being a delicate moment.

[00:21:25] How far are we from that delicate moment? I don't, I think there's, we have a long way to go, to be honest. There's like just, and this is where my team, I say to them all the time, healthcare is so big. What was that? The report just came out $4.9 trillion, right? Annual spend. Think about that. That's a massive industry. And so there is so much need to move data and in various use cases for various reasons. And there's a long way to go. I think what would be interesting to see is the regulatory environment with stuff like

[00:21:55] TEFCA and QINs and how that, and the Trump administration, where that goes. Can you explain TEFCA to the audience? That's probably a term widely known to them. Yeah, sure. I apologize. Think of TEFCA as it's regulations that try to use, try to advance data and operability. Basically, through these regulations, how you're able to move data from entity to entity, really within a healthcare ecosystem. There's something called care quality today, which governs that movement of data. And it gets into things like how, for what reason is it moved, right?

[00:22:24] For clinical purposes, for example, for operational use. There's use cases that it governs and the types of languages. There's something called FHIR, which is a language that we're trying to move to as an industry to get what we talked about before, to get to a university adopted language. But obviously, there's implementation challenges there. So think of it as a governing body. TEFCA is the latest one. It's the advancement that is the future of interoperability. And these QINs, Q-H-I-N, are organizations that basically administer TEFCA.

[00:22:54] And so there are eight of them right now. There's others that are applying. And it's basically how you pass data from A to B, if you will, for certain use cases in certain situations. So anyways, it's the attempt to try and get a future of standard interoperability into our space. But even that, there's a lot to still be defined and how people are going to participate and when are they going to participate. And there's a lot to do.

[00:23:16] But it's at least, I think, a great step forward in terms of, again, trying to get some standardization in a very unstandard world of exchanging data. So are they a replacement for healthcare information exchanges or are they on top of? Yeah, no, they're not a replacement for it. They would participate in it. Yeah, they would participate. You would be connecting those. These QINs would connect into what you call the health information exchange. We refer to HIEs. This is the abbreviation. But HIEs would be part of those networks that would be connected into. Yeah, so there's still an incredibly important and vital part of that.

[00:23:46] So that would mean when they came about, we started recognizing we were passing data through these hubs, for lack of a better word, right? So we regulated the hubs. And then the next thing was between two hubs we weren't regulating. Is that what that really is about? Think about it in a way. It's about that. And again, just advancing this interoperability so that people can move to a standard, right? Which, again, the standard everyone's trying to move to is FHIR, F-H-I-R. But again, like how that's adopted, when that's adopted.

[00:24:14] And then you try and do it for use cases. So today there's the use case for clinical purposes for passing data back and forth, right? So it needs to be a clinical reason that you're requesting data and not for other reasons. So this reason, and there's going to be a lot on patient rights and when do patients have the ability to say my data can and can't be used. All that is still, in my opinion, very Wild West. And so that'll be really interesting to see how that unfolds. So there'll be opportunities there for companies to come in and support.

[00:24:41] But again, like for us, it's how do we enable those types of things and moving that data in a fast and secure way. Yeah. So as you scale, what's your biggest challenge? Yeah, it's funny. It's really interesting. It goes back to what you talked about before, which is, I think, choosing the right path. Because there's so many places. There's a massive business in what you were just talking about related to clinical trials, right?

[00:25:02] For example, one could envision, and companies do this today, but understanding what the characteristics of the right patient is for a clinical trial and making sure that information gets into an EMR. So when you're with your provider, they can say, hey, Tripp, listen, you'd be a really good candidate for X clinical trial because that just popped up in the workflow, right? That's a major industry unto itself. And working with life sciences companies, that type of stuff. So I think value-based contracting. We talk about value-based contracting, right?

[00:25:29] A lot in this, that's the quote-unquote savior of fee-for-service healthcare. I think some would disagree, but let's just presume that's the premise. Listen, you need data in order to do the simple things like establish baselines and then understand what the metrics are going to be and how you're improving and all that kind of stuff. So there's a lot of places to where you're going to head next, I think, is what gives me anxiety. Is, okay, so what is our next play and where are we going to be focused? Because you can't do everything. You just won't do anything well.

[00:25:57] So the question is, where do you focus your energies? And so that's what we debate as an organization. I also think the second thing, honestly, is there's going to be a ton of consolidation. There has to be. This industry is just massively ripe for it. And so there'll be things that are opportunistic and things that you go after. It comes to you. So things that you say, wait a second, I want to be proactive and think about putting these things together. And so how do you think about those various puzzle pieces? And what are the right ones?

[00:26:25] Because, again, there's a lot of entities that do different things, both vertically and horizontally within data interoperability. But I just, and I'm not like some massive visionary, right? This is if you just looked at like a map of all the logos, you'd be like, oh my gosh, like there's way too many here. These have to come together. And so that's also going to happen in 25. And the questions are, which ones are best fit? Are you able to-

[00:26:48] Well, I imagine at some point you have a mission of aggregation and understanding, but then you start moving towards owning categories. For example, personal healthcare record. Who pays for that, but people have information they're not getting into the record, right? Different things like that. Yeah. It's a category that's very hard for venture capitalists to invest in because it's a lot of moving parts and a lot of knowledge. Or I can't remember if you had a relationship with this company, SymmetryRx.

[00:27:18] They were doing drug analysis for people and they found that if they could get the right drug to them within the first two weeks, they create the habit of the script. And it changes outcomes, they had data dramatically. But the process flow and they needed data to be able to do that. And I think at some point they interacted with you guys. But I could imagine that you could see a bit of a VC arm or something like that with you guys because there's lots of these little places for future innovation. That's what VCs do with startups, right? They look at small places that are going to be big.

[00:27:48] The aggregate is pulling in just the pennies later on. Exactly. That's exactly right. Yeah. And so how do you keep current? The audience loves to know how much do you read a day? How do you keep current? And when you look at all the permutations and combinations of what you need to know, I find that an interesting question. Yeah. So I would say, if you ask my team, that I am constantly either on the road or on the phone.

[00:28:13] I think when I came into mental health, one of the things I did, because I didn't know, I knew about mental health, but I didn't know the industry that well. As I had the team give me a bunch of logos that we thought were competitors or potential partners. And I just called the CEOs and said, hey, what do you do? Would you meet with me? Heard their stories. And so I did the same, I ran that same script here, which was just layout and this thing we have now has over a hundred logos on it.

[00:28:37] I probably met with at least almost everybody, either in person or on the phone and really just gotten relationships going, but to just really understand what everybody does. And I think that allows you to be current and understanding what's coming next. But I just, I think for me, I'm a, what I, with my team, I say all the time I'm an outside in leader. So meaning almost everything I do is based upon what I hear in the market. I got to go to client meetings, not to, and my client teams always freak out because I'm sitting there and they're like, why are you here?

[00:29:06] I'm like, I don't really, obviously I care how you perform, but I actually want to hear from them and what they're facing. Because that informs our product development agenda. I really don't believe that I've had an original idea that hasn't come from somebody else. I was a CEO the other day and he was like, Tripp, you sit on a gold mine at Redox. And I was like, oh, yeah, I know. But what do you really think it is? You're not knowing what he was talking about. But he was kind enough to share to me, this is what I think you guys should be doing. Because you have an ability that no one else does, which is an ability to write back into the workflow of an EMR.

[00:29:36] And he's, you should take advantage of that in these ways. And so, and he was doing that because he wanted to partner with us to be able to do more end-to-end, if you will, data and operability. But I think that's how I try and stay current, is I do some reading. But a lot of it is a lot of phone, a lot of talking to different customers, prospects, other companies, just trying to always be as much as I can out in the marketplace, which can be very taxing. But it's a way to really know what's going on fast. Yeah, it really is the way to go.

[00:30:06] What is the biggest lesson you've learned in your journey so far? I think there is really, for me, over all the companies that I've run, there is no degree of humility that will ever serve you well enough. You can always be more and more humble and more and more humble and more and more humble. I think that ability to listen and say, yeah, maybe I do think I know what's going on, but someone else out there probably can do it better than me, has really served me. And I think the companies I work with very well, I try and ingrain that in the culture of just be humble.

[00:30:35] So a lot of people walk into healthcare and say, I'm going to solve – a lot of people, especially who come into healthcare from outside. I'm sure you've talked to a ton on this show and others. I'm going to solve healthcare because I'm coming out from a different approach. And I'm always – I laugh. I'm like, okay. And by the way, I love ideas and I love taking ideas from other places. But the reality is that this healthcare system is one that's very complicated and having some understanding of it. But also appreciating that, like I tell this in my group all the time, like we're not – I guarantee you someone else has tried this. I guarantee it.

[00:31:04] So let's go back and not think that we're like the smartest people in the room and learn from what they did and then – or in some other adjacent. Like in mental health, you think about – we talk about mental health, right? And I'll give you the example. It's like in mental health, we just say mental health. Wait a second. If you're having an eating disorder, that's very different than if you're – Ensternia. Or on autism. Yeah. We say mental health, right? In physical health, you never use the word physical health. You say cancer, diabetes, whatever. But in mental health, it's all grouped together.

[00:31:33] So I was like, we should as an entity start thinking about creating centers of excellence and really hone in on the specialties within mental health because they are so different. But that was a novel – and that wasn't rocket science. I just like – they did it 20 years ago on physical health, right? Like why don't we do the same thing on the mental health side and think about it that way? So I do believe a lot of this has been thought of before. But you have to have humility when you go and talk to people and just learn from them.

[00:32:00] One company I ran way long time ago was in North Carolina. And I used to listen to NPR when I would come in to the – I would drive in from the hotel because I was living in Boston. But the company was in Greensboro. And a state senator had just died and he was like 98 or something. And he said, I never really became good at my job until about 93 when I learned how to listen and have some humility. And that – like that little statement he made has always sat with me because it's hard. It's hard for me sometimes to shut up and – especially when you get passionate.

[00:32:28] But there's so much to learn and especially if you take that lens. I just think – You have a sense of details. That's – and given my analogy of you being a Zapier or a Make, there's so many details there that you can't be knowledgeable of all of them. You have a sense of them. You're probably good at – you're probably good at a majority of them. But that's really – Yeah, no, that's a really good – that's a really good observation. Yeah. Your humility is an interesting story. When I came through finance, operations, engineering, plan management, quality, then the sales rep and marketing. Yeah.

[00:32:56] So when I got into marketing, I come out from board meeting and I have a – approval to launch a new product and the head of customer service, who is sort of an older nurse, says, why don't – I know you've got approval for that. You're ready to launch it. And why don't you come out tonight with some sales reps and share it? And my – going through my head at the time was a very disrespectful, hailed lady. What do you know? And I'll say her name. She's retired. But I bring her up all the time, Marsha Shallon. And so she arranged that night to put me in a booth between a bunch of division sales managers and regional sales managers.

[00:33:25] And they beat the hell out of me for about two hours. And they probably saved me the biggest humiliation that I would have ever had in my life. And I'm always very grateful to her. And that was – that and having four daughters made you realize she got – Yeah, no, I couldn't agree with you more. And like I said, there's typically something you'll pick up on from something they say that you hadn't thought about before. And so I think that's – the other thing, because I just thought of it too, and I learned this from a former CEO of UnitedHealth Group, was it's really important in healthcare to follow the money.

[00:33:53] And even when I say that to you, honestly, I feel a little bit apprehension in talking about money in healthcare. I think this is the problem we have in healthcare in the United States is there's not a lot of industries where the vast majority of people get into healthcare because they have passion about helping people. Yet the majority of institutions in the United States are for profit. And so you have this paradox of a for-profit entity which has to make decisions that are not typically – or in some instances –

[00:34:21] I shouldn't say typically, in some instances, it collides with the people that have a lot of passion about helping people. And that's the big rub in healthcare today. And I said this publicly a lot of times. You have decisions that are made because they have to be made in order for shareholders and board of directors and all those people to be satisfied. And they really don't jive with, wait a second, you should be doing this because it's good for human beings, right? That just – it is what it is. But I was taught earlier, you have to follow the path of money.

[00:34:49] And that doesn't matter if it's profit or not-for-profit because everything has to run on some kind of monetary scale. But you have to be able to understand where the money's flowing from A to B and how does it flow? And how does the revenue – who makes what where and who loses what where? And I think that's also been – served me well is to always try and figure out that and where there are opportunities. Your point, to be more efficient, right? The concept of outcomes is really – we all can know the story of intended misinformation, right? There's always a few of those out there.

[00:35:18] But the reality is you can be sitting there in an orthopedic procedure or cardiovascular procedure, and there's definitely something that makes it more efficient and does this thing. But four years from now, there's some complication that outweighs any benefit that you're completely unaware of, right? Yeah, I understand. And so this is where these longitudinal studies are starting to be there. And this is where the connectivity that you're talking about enables a lot of that analysis, I think. Yeah, 100%. No, that's really well said. Yeah, very good.

[00:35:47] What do you see as the biggest opportunity in the next five years and the biggest threat for healthcare in general? Yeah, I think I go back to this ability for us to understand and share data through very complicated workflows. That's – I think if people take it from that angle, it'll be interesting to try and get over this idea of we can just build a whole bunch of AI tools on the front end. Because I think what's – the AI phenomenon of healthcare is always going to be there.

[00:36:15] And listen, again, I'm 100% behind it. But I think there's some realization now of, wait a second, this great idea I had, it's not going to work because I can't get this data in. I think – I think the – what I would hope is the continued push to have interoperability. That's always a question, right? So the problem in our space is that – and you hit on this really well in the beginning – is that these details matter and that next level of questions matter, right? So what does it mean to share data? And so people have different definitions of that, right?

[00:36:45] And everyone knows that Epic is a dominant player in this space, right? And Epic has said, listen, we are here to share data and participate in interoperability with the caveat that they do it as long as it's their services that are providing, right, that data and that interoperability. And by the way, they're not doing anything wrong. No one says they can't do it that way, right? Microsoft and Google certainly are, right? Yeah, listen, and we try and work with them and they're like, that's great, Redox, but you know what? We provide services that we want to promote ourselves and that's fine.

[00:37:15] But I think that ability to – there's just so much that has to be done in this space and there's so much that's going to come. So the ability to just continue as an entity to move data in a way that benefits all is going to be really important. And try and put standards around that and that type of stuff is going to be really interesting over the next coming years. And again, I think people are waiting to see what's going to happen with Trump because the last administration pushed a lot related to some of the regulatory environment. And so you just don't know.

[00:37:42] But right now it's okay, let's get it from A to B and try and enable as much as possible because there are some really cool things that can happen. And there's so much, right? There's so much territory. There's so much greenfield, if you will, I should say. Sorry, so much greenfield out there that in this one industry, there's so much that can be done. I think in those in the government, one of the things that if you put your economist hat on, you look at gross domestic product, part of it is about how much of your economy are you spending in innovation?

[00:38:10] And when the rest of the world is at 10% to 12% for healthcare and we're at 18% moving to 20%, they have a big number that they can put towards innovation. And so if they hit the right market, all of a sudden their GDP is going to grow dramatically. And I think we're so big that we haven't historically worried about it. But now if you watch China and other places, they're getting within striking range and healthcare is detracting from that. Is there anything else you'd like to share with the audience? I'm trying to think.

[00:38:40] No, it's been pretty comprehensive, I think, so far. So unless you can think of anything else, I'm trying to... I appreciate the other side, I appreciate just the forum to be able to come on and talk about this type of stuff, right? And your ability to reach in and promote more efficient and effective healthcare. So I think that's what's important. But no, that has been great. So thank you. I appreciate it. Thanks for tuning into the Chalk Talk Gym podcast.

[00:39:03] For resources, show notes, and ways to get in touch, visit us at chalktalkgym.com. This podcast is produced by Outcomes Rocket, your healthcare-exclusive digital marketing agency.

[00:39:30] Outcomes Rocket exists to help healthcare organizations like yours to maximize their impact and accelerate growth. Visit outcomesrocket.com or text us at 312-224-9945.