Harnessing Data Analytics to Revolutionize Healthcare Strategy with Hal Andrews, President and CEO of Trilliant Health

[00:00:02] Hey everybody, welcome back to the Outcomes Rocket. So excited that you all decided to join us again today because I have a treat and our guest's name is Hal Andrews. He is a president and chief executive officer at Trilliant Health.

[00:00:19] He's a business leader with over 25 years experience as an entrepreneur, executive and investor. Today we have a large problem in healthcare and a lot of that is related to the data he happens to be responsible for a very cool platform that takes a

[00:00:37] look at data analytics and helps with insights to make a difference across the continuum of care, whether it be value-based care or helping you all with some of the biggest problems you're faced with. So Hal excited to unpack what you guys do and want to give you

[00:00:51] a warm welcome to the podcast. Thanks Saul, glad to be a part of this. It's a pleasure to have you here. And so before we dive into Trilliant and the really cool things that you guys are up to.

[00:00:59] I love to better understand what got you into the business of healthcare. Well, it's an interesting story as I guess a lot of them are. I'm in healthcare cause I failed at the music business. Okay.

[00:01:11] And when I hit the biggest failure and the music business, which was when the client that I had pushed all the chips in on the table on got a record deal. He fired me to hire Garth Brooks as lawyer.

[00:01:24] And I didn't really know what to do with that. But the next week, one of my clients on the healthcare side called and said that he'd like to take me to lunch and we went to lunch and he asked me if I'd ever thought about being in healthcare.

[00:01:37] And I said, nope, never occurred to me. But a year later I got an offer to join a startup firm in Nashville. There were a lot of those and I left the practice of law. I never looked back. That is a heck of a story Hal.

[00:01:51] And I mean, Nashville, you got music's a big game there and you're at the sort of like you hit this rock bottom and the transition happened. So really cool story. Really appreciate you sharing that by the way.

[00:02:04] It takes courage to, to share those tough times and the transformation. So we're here now. You did the startup and how many years has it been? Like since that. That was 1996. That startup went bankrupt two years later.

[00:02:18] So I went to another startup, which at this point I was starting to get good at identifying things that might go bankrupt. So I left that one just before it got in trouble. And so I did things in the services industry from 1996 until 2007 with a

[00:02:37] little side gig in England for a few months, helping Humana launch a program and then I got to the tech and data side in 2007 and that ever since. Love it. And what a cool history. And you mentioned the bankruptcies, there's a lot of froth in the market.

[00:02:55] And we're one of the things we do as well, Hal, is we're a marketing agency and the numbers, right? It's 97% of businesses fail within 10 years. And the number one reason is lack of product demand. Do you know? Yes. I've been at one of those too.

[00:03:14] I've somehow I've ended up being at least in this town, the guy who helps to fix other people's messes. And so this is the fourth time that the crew has gotten together to fix a mess. And so we've been there.

[00:03:30] We've been places where you did great work and nobody cared, like literally nobody cared. One example, we couldn't get anybody to pay attention to us until the application had a little hiccup and was down for a week. And then everybody called and realized they missed us.

[00:03:49] And then once we came back, they, nobody fired us. I've seen just about everything that you can in an early stage. Oh man, we're going to have more conversations, Hal. I think we'll definitely enjoy those conversations with you more on the

[00:04:02] entrepreneurial side and things that our listeners could learn. Let's dive into your company today. So talk to us about what you're up to at Trilliant Health and what exactly you guys are doing for the healthcare ecosystem.

[00:04:15] You mentioned at the outset that data is a problem in healthcare, and I think data is a problem in a number of different parts of healthcare, certainly clinical operations, certainly financial operations, we focus on strategy.

[00:04:31] And so the team, some of the team have been together since 2007 and we've had a stint in clinical benchmarking. We've had a stint in revenue cycle. We've had a stint in building a really cool thing for HCA using NLP to cancer.

[00:04:49] And this time we ended up in the strategy space. And so we use a number of different data sources, claims data, public data, consumer data to try to help our clients make better strategic decisions. What we call evidence-based strategy. I like that a lot.

[00:05:07] And evidence-based strategy, great term for healthcare for sure. I didn't think of it. I have to give credit to Dr. Robert Groves at Banner Retina who when I was talking to him said, oh, you do evidence-based strategy. And I said, that's brilliant. Can I trademark that?

[00:05:23] And he said, yeah, sure. So we did. Oh, you did trademark it? Oh yeah. Awesome man. But I've asked for permission because right, my music business background, I'm big on intellectual property. He graciously let me do that. And that's our timeline. I love it. That is fantastic.

[00:05:39] And actually we've had Dr. Groves on the podcast a couple of years ago, actually. So had a good chat with him and yeah, he's an awesome, he's an awesome brilliant mind. For sure. For sure. And look, I love this approach and let's talk about practicality

[00:05:53] and how this comes to life. Hal, help us understand how I imagine payers and health systems mainly are leveraging your platform. That's right. And life science. And life sciences. So I think if you break it down to the atomic level, everything that happens

[00:06:09] in the health economy happens between a physician and a patient. And there are a series of decisions that are made every day in the room. I actually went to see my internist yesterday and there were a number of decisions that we made together that some people will eventually

[00:06:27] find out about and some people won't. There'll be orders that are made or not. There are scripts that are written or not. The referrals that are made or not. And I think if you break it down to the very atomic level, every stakeholder

[00:06:42] in the health economy cares about at least some of those physician patient interactions, now how they interpret those, whether that's good for their business or bad for their business depends on what their business is. But we're in the business of aggregating those individual physician patient

[00:06:58] interactions, watching the patient journeys longitudinally, and then helping people understand how consumers make decisions and how physicians make decisions so they can make better strategic investments and strategic decisions based upon the evidence of what happens in the market as opposed

[00:07:18] to anecdote or theory or what happened five years ago, we're looking at a 30 day lag of interactions to help people understand what might be coming around the corner next. Cool. And very useful. And let's, let's zoom in on that.

[00:07:33] How, if we can, I'd love to, I'd love to maybe explore a use case in particular that to help our listeners understand, Hey, how can we use this stuff? I think the, there are a lot of ways.

[00:07:46] The first thing, my foundational premise is that you can't make a good strategic decision if you don't know your market share. And the second foundational premise is nobody in healthcare knows their market share because nobody knows how many providers actually are in the market.

[00:08:04] And so when you talk to any large health system in a large city, say LA, if you talk to people in LA, they say my competition is UCLA and Cedars-Sinai and USC and Providence. And that's true. Those are all competitors, but there are literally thousands of other providers

[00:08:21] in the market, surgery centers and clinics and doctors who are doing things that are part of the total addressable market of health. And so our starting point is always trying to get the most accurate representation of all the providers in a market.

[00:08:37] However, somebody defines that market so that you have a true understanding of the competition. And from that, you can then start to build upon what the needs are in that community, what the demand for healthcare is in that community.

[00:08:50] What resources are already available to people in that community, in that market, and then start to build a strategic plan from that. So for us, it's always tell me what you're interested in. Are you interested in surgery centers or are you interested in physical therapy?

[00:09:05] Are you interested in home health? And let's start by zeroing in on what you think the market is. Is it a city? Is it a metropolitan area? Is it a state? Is it a region? And then what is it that you're doing?

[00:09:19] And let's figure out what the total addressable market is in that market for the thing that you do as the baseline. And that's not how it happens, right? People really build business plans off of what happened last year or in the case of

[00:09:35] hospitals that rely on state hospital data, what happened two or three years ago. And assume that is the future. And gang, that's never the future. The past is not prologue in healthcare. No, I love that. Great concrete example. And it's surprising, right?

[00:09:50] How many people run with assumptions in their business model instead of the data. And so I always like to explore what things look like before and after. So a case study, so to speak. Talk to us about that, Hal.

[00:10:06] I'd love to just hear about what things look like before and after Trilliant. The most common use case is around referrals, which different people call different things. They call it leakage or keepage or network integrity, those sorts of.

[00:10:23] Again, my belief is that all of these individual physician patient interactions affect everybody. And so the sum total of those interactions turn into somebody's network performance. Either somebody stays in network or they don't, or they go to the high cost

[00:10:39] provider or they don't, or they get the genetic drug or they don't. The best example for us is where people start to see a retention of patients that they, that started with them. So a patient starts with the health system at an urgent care center or a

[00:10:57] primary care office or the emergency department. And you start to understand where the patients wander off. Usually everybody's looking at from their perspective. This was my patient. When did my patient leave? My network is fundamental question. And by starting to understand patient behaviors, patient patterns, referral

[00:11:20] patterns, you can start to keep that business in your network, whatever your network is. And we think that good network performance is about 70%. One of the fallacies of the health system is that everybody has a hundred percent

[00:11:38] of the loyalty of their member or patient or customer, whoever that is. And the example I always use with people is how many grocery stores do you shop at? And usually in a room, people raise their hand and say two or three or four.

[00:11:54] They got Whole Foods for this and Kroger for that and Walmart for this. And somehow in healthcare, we've fallen in love with the idea that we have one interaction with somebody in their mind. And that's not how people act. Right. That's not how consumers act.

[00:12:10] We've been we've been telling people to be consumers for 20 years and then we're surprised when they are. And so you start to say, what's good? And we think on average 70% is good. If you can do all of the things for somebody who started with you 70% of the

[00:12:28] time, that's pretty good. Now, you're never going to do that because of convenience, because of price, because maybe they need a service that you don't render. Maybe you don't have a doctor and network for the thing they need, whatever the things are.

[00:12:42] But we have a number of examples where we worked with people who were below that 70% threshold here now above it and see a real return on the investment. That's great. Appreciate that. And the 70% is retention. Am I thinking about that right? Yes, that's right. Yeah.

[00:12:57] So 30% turn is respectable. Yeah. Again, just because we're humans. Um, we, we sometimes make decisions on convenience or price or those things. I'm a good example. I have an internist at one of the systems here in Nashville.

[00:13:14] I had two hip replacements at another one of the systems in Nashville and I had two shoulder replacements and another one of the systems in Nashville. And so whenever I go to my internist, they look into Epic to see all about me.

[00:13:27] And then after remind them, I'm like Zuzu's pedals, right? I'm not there because I did all these things somewhere else. So I'm the living, breathing example of the fact that patients aren't loyal. And it's getting even more complex, right?

[00:13:40] How like now you have consumer brands entering the picture and different care engagements. You mentioned grocery stores at the grocery store. I think that's a huge. I think the rest of the health economy is missing the real implication of that.

[00:13:58] When you talk to particularly health systems and physicians, they talk about Amazon and Walmart disintermediating them, right? I'm sorry. They say fragmenting. They said the care is getting fragmented. The what's happening is disintermediation.

[00:14:14] If you think about Amazon, Amazon wants to sell you everything that they have all the time, right? If they provide, if they sell a book or if they deliver something to your door, if they have it, they want you to buy it from them.

[00:14:30] If they don't have it, they don't care who you buy it from. And Walmart's not quite as they're not quite as aggressive in that. But think about how many things are in a Walmart. And so now I can walk into a Walmart.

[00:14:44] I can see how much this primary care visit is going to cost. And then I can see on the wall that this person went to Emory or Duke or UCLA and they're board certified. And I can see a board certified primary care physician for 40 bucks that as

[00:14:59] consumers, we get drawn into that. And so I think the historical belief in lack of care coordination is probably understated because again, once if Amazon's not doing that thing, they don't really have a dog in the fight where you go.

[00:15:18] And so whatever it is that you're going to somebody else for that Amazon doesn't do, doesn't have any context for what Amazon did to you and what Amazon knows. And so I think back to your starting point on data, I think we're basically breaking the information bridges now.

[00:15:36] They've never worked that right in the historic health care system. But there you could at least if you went to a doctor affiliated with a different system, that doctor could call the other doctor's office and say, hey, can you tell

[00:15:49] me about this patient or can you send me the medical record? I don't know how many of your listeners have tried to get their medical records from Amazon, but it's not the easiest thing in the world. And so I think the impact of the retailers is actually underestimated.

[00:16:03] I think people are just looking at the tip of the iceberg of I didn't get that primary care visit and they don't understand the power of filling somebody's prescriptions and doing the other stuff.

[00:16:14] Yeah, no, definitely a lot to consider as this becomes more and more real every year. And I still can't get past the fact that I go to these large health care conferences and I see Best Buy smack dab in the middle of it. Right.

[00:16:31] Like Geek Squad and Best Buy. It was like right there is a prime example of this is not going anywhere. And no, I always ask the audience how many of them have Amazon Prime?

[00:16:43] And then I just let that sit there for a second and then it starts to seep in. Right. Because they they're not thinking about the way they act as consumers when they show up at their health care job, whatever that is. Now, that's good stuff.

[00:16:57] Hal, so definitely sounds like you have a great platform that people can leverage for the data and insights to inform their strategy on how they could tackle these types of challenges. And I always like to ask about technology and trends right now.

[00:17:13] What's on your mind for tech and trends that's really changing health care? I think I might start with a contrarian observation. I think people are at those same conferences that I occasionally attend. They're talking about AI in a way that is.

[00:17:31] Just not going to happen, and I think people spend a lot of time thinking about AI doing the really crazy things. There's a lot of talk about things like precision medicine and things like that. And maybe we'll get there, maybe not.

[00:17:46] Implicit in precision medicine is probably a compounding pharmacy. And we don't have enough of those around the country to do precision medicine for everybody. But what we learned in a previous engagement is that AI can be really good for the

[00:18:01] boring, repetitive, mindless tasks that we're paying humans to do. And humans are doing them poorly, not because they're not smart enough, but because of fatigue. And the best example that we've been a part of was building a little, a small AI

[00:18:20] program to read pathology and radiology reports and look for incidental findings of cancer. And it took about eight months to train the machine to do that with the right level of precision and recall.

[00:18:35] But then once you did it, the machine could do the work in minutes that took hours and days of humans. And the machine did it more accurately, more consistently than the humans. And you think about the downstream implications of who was reading those reports previously was nurses.

[00:18:53] And so I've gone from 96 hours to 29 minutes. So I now have 95 hours for nurses to go spend more time doing other things. And the use of AI for those boring tasks is massive. And that's not what anybody's talking about because talking about reading radiology

[00:19:12] reports doesn't make for a great keynote, but it's really valuable. And I think that's probably the so much talk about chat GPT. I don't know what the right use cases are, but I know people can't afford to compute. I think that's one of the big things.

[00:19:28] I think the other policy initiative is price transparency. I think that it's time for the employers to step up and be good fiduciary stewards of their money. And if they don't, the system's going to break.

[00:19:43] Last week, the Secretary Yellen sent to the White House their scoring of the budget and buried in 252 pages or so is the fact that this country has 75 trillion unfunded Medicare and Medicaid liabilities. And so we have to really quit talking about innovation and actually start doing

[00:20:04] some things and eliminating human time doing repetitive tasks is a good start. Yeah, no, I love the sober perspective you have on this because at the end of the day, it is what's going to make the biggest impact. And look, phenomenal discussion with you, Hal.

[00:20:21] We really love the work that you and the team are doing. If you were to leave our listeners with a closing thought today, what would you leave them with and where's the best place they could learn more about you and your company?

[00:20:34] So I think something we've done recently, which is I've told the team is my life's work. We have, we've taken number of examples that we have done for clients, done with clients, things that we've learned over the years, and we've put them in what's

[00:20:51] called the field guide to surviving healthcare's negative sum game. And so it is full of free examples, real examples, real data, real use cases to turn data into action. And if you go to our website, trillionhealth.com and you search for field guide,

[00:21:10] you'll see chapters that are relevant for every stakeholder for really every part of the business. And that's probably the best place to jump in and find something relevant. I really do think there's something for everybody in the field guide and they find something that's interesting there.

[00:21:27] They can probably find more in our research section. Thank you for that Hal. And yeah, I was checking out your site earlier today and definitely was impressed with the level of detail and the depth of analysis on your homepage. Yeah.

[00:21:40] So for anybody looking for insights and ways to improve your strategy, I think that's a really great place to start. We will link up Mr. Hal Andrews website in the show notes. So make sure you check that out and really appreciate everybody tuning in for

[00:21:56] this podcast with Hal Andrews, amazing entrepreneur at Trilliant Health. Hal, thanks for joining us. Thanks all.