Building the Largest Health Data Ecosystem in the US | Datavant CEO Kyle Armbrester

Health cares the only industry where you go in, you have no idea what you're gonna pay, you have no idea when the bill's gonna come, and there's a million different ping-pong balls that go on in the middle with payers and secondary payers until that actually gets sorted out. What if all that could be done right when clinical data is captured, and so day-to-day advance powering that in a big way? Today on the show, I talked to the CEO of one of the largest, most successful health tech companies that most people don't know about. I'm Halle Teco, the creator and co-host of this show. If you enjoy listening to the Heart of Healthcare, then I think you'll enjoy my upcoming book, Massively Better Healthcare. The book shows you how to spot opportunities for meaningful change and turn obstacles into your competitive advantage. You'll learn about who really holds power in healthcare, and strategies for bending the system without being broken by it. Massively Better Healthcare is out very soon, and you can pre-order it on Amazon. Welcome to The Heart of Healthcare Podcast. I'm Halle Teco. I'm Michael Eskadell, and I'm Steve Krause, and every Monday we bring you the latest in healthcare innovation as we sit down with entrepreneurs and industry experts. So buckle up and join us as we figure out how to improve healthcare for all. Hello listeners, and welcome back to the show. Today, we're talking with my friend, Kyle Armrester. He is the CEO of DataVont, the largest health data ecosystem in the U.S. Previously, he was CEO of Signify, which he led through its 2021 IPO, and later it's $8 billion acquisition by CVS in 2023. Before that, he spent seven years at Athena Health on strategy, corporate development, and product teams. Kyle, welcome to the show. Thank you. So great to be here. You have literally been on every side of business. You've grown companies, you've worked on strategy, product, IPOs, getting acquired, making acquisitions, probably like the most diverse background of anyone I've ever known. Can you tell our listeners how you ended up in healthcare in the first place what drew you into this industry? Yeah, absolutely. I was kind of a pure technologist for a long time, and loved tackling complex problems with technology, especially where there were areas of administrative burden or inefficiency. So I could see something could be automated or streamlined, and there's plenty of that to do in healthcare, oh, without a doubt. But what really drew me towards healthcare was I was actually helping Charlie Baker with his gubernatorial campaign in Massachusetts, just volunteering and doing a lot of the tech infrastructure for him. It just sold a pure tech company and wanted to get involved and help him out. I met him through someone that was very close to, and he introduced me to Jonathan Bush, who was CEO of Athena Health at the time, and I didn't know quite what to make of healthcare. I was at HBS, and Athena was a mile down the road, and so I started spending more time with Jonathan, and then around that same time, my grandmother, who was very, very close to, and my father, both ended up passing away, and I got thrown into the middle of trying to put information out of meta-tech and reconciling med lists, trying to coordinate end-of-life care hospice from my grandmother in particular, and it was just absolute chaos. And so it was serendipitous almost, if you will, to have had this introduction to Jonathan and the team of Athena, who were trying to spread the cloud-based, you know, Jonathan called it the Internet of Healthcare at the time, from a really small and medium business standpoint up to bigger enterprises and scaling tech and product, and this whole open API mindset that we built out there. And so, yeah, it all came together really in a short amount of time, and that was a very long time ago, and I've since then decided to dedicate the rest of my career and there's my life towards moving the ball forward in the healthcare space and in particular in technology. Athena Health has such a notable diaspora, including yourself, the park brothers, an entire generation of healthcare leaders that have gone on and done really interesting things. So was it like working there and working for Jonathan Bush, who is kind of, he's a very influential, but he's also a polarizing leader. Yeah, it was, it was the most wild time of my career, I'm not sure if you were obligated. We owned a mountain and main, you know, we did big conferences up there with 160 cabins on it. I mean, it was. We're not busy. He's running, you know, running for governor of Maine. For governor. Yeah, that's right. Yeah, it's funny how that all comes around, but yeah, it was, you know, what I will say about my time at Athena, we were genuinely in the cappard seat of this kind of, the internet exploding, but also healthcare kind of catching up, meaningful use, which was the democratization of government funded democratization of electronic medical records across the whole country. All these things were converging at once and so, you know, we were, we were the cool kids on the street. We could get a meeting with anybody and it was an amazing opportunity for me just to meet so many folks doing so many amazing things. When I started off there, as you mentioned, in corporate development and running more disruption pleas, which was our big partner API program, and I probably met a thousand companies in the first few years. And they were all looking for rails, right, like minutes, unfortunately, still quasi-similar today, but medical records and practice management systems are barbarians at the gate, like you have to get through them to give them to the provider space, certainly, and you need to use them to get information out, which is, we'll talk about data vent in a minute. But it was, it was awesome. And Jonathan had this mindset where he didn't want to do everything, right, so it was kind of almost the opposite of some of the other players in the space. But he wanted to open up and allow entrepreneurs, and I think he was scarred as a younger entrepreneur for a lot of people shutting the door on him and saying, no, he wanted us to not be that way. And that mindset is something I certainly took away. The second thing I would say is, you know, Jonathan and Ed, in particular, just maniacally focused on the fact that physician cost was basically rising at the rate of inflation, but administrative cost was rising at, you've seen that chart multiple times that rate. And let's protect the physician. Let's not charge them money for not adding value, and let's instead attack that bloat. And that's something I've kept close to my chest through every company I've done, you know, even signify and data vent, like do not believe in charging clients in healthcare just fees for no reason, like you have to be there saving the money or making the money or adding some value that's, you know, driving real benefit to them. I just don't think that a traditional SaaS platform fee where you kind of hope and hand a wave and argue about attribution works. And so I really took that away from my time at Athena. And the last thing I would say was just a wild focus on talent. I mean, we had one of the best teams ever and just spent, you alluded to it, but so much time recruiting and nurturing talent. And I've taken that with me to each and every one of my companies. And I still have a gang of folks that were at Athena, then signify an hour at data vent, you know, with me. I questioned their mental health every once in a while, just stayed with me this long. They need a sabbatical. Yeah, exactly. But, you know, it's, it's fun, like, you know, people talk about blind passing and there was a lot of that at Athena and this group that has exploded all across healthcare and landscape. There's a lot of trust in assuming positive regard is something we talked a lot about. And I brought that to all my companies, since then. I think for our listeners, anyone who wants to know a little bit more about the Athena health story, I actually really enjoy Jonathan Bush's book, Where Does It Hurt is really interesting. And this was really one of the early, like, innovative technology companies in the space. So I think a lot to learn and really cool to just see folks leave, stay within healthcare and continue to take those lessons and make an impact. So on that note, let's talk about DataVent. As you know, I've had a plus one ticket to watching this organization grow and evolve. My husband's been on the board for a decade yet. I don't think. Literally a decade. Literally a decade. Very cool. I don't think I could actually, like, confidently pitch the company beyond just like this data ecosystem. Can you explain what you guys do for a lay audience, like what problem you're solving and how you're solving it? Yeah. I mean, at the crux of what we do is a problem I have not solved. You know, I'll just go back to some of the root issues that we're trying to move past. When medical records were implemented, the one thing that they did not put in place was an operability standards or common data frameworks or, you know, like, the ATM networks have star and nice. Like, you can go to an ATM and London or New York, pop a card in, and it's going to hit your account. Like, no matter who owns the ATM, no matter what card you're using, that type of infrastructure doesn't exist in healthcare. And so that is caused an unbelievable amount of administrative burden. And in particular, I would say the one thing that happened and it was really exacerbated was we had already, because medical records were paper-based for so long, this whole crazy world of claims and all this like post-billing chaos kind of crept up and was digitized before the medical record was to deal with payment, right? And so when medical records came into the space, they were focused on payment. And Athena Health was very much that way, right? And you have these weird asoteric terms like CPT code and DRG and groupers and all these other things that have really governed and dominated the way that medical, clinical, financial, all data has been moved around inside the healthcare space. And I think at its core, DataMan is trying to break away from those kind of legacy infrastructure constraints and move us into an age where digital real-time, secure and compliant health information is exciting. with authorization and consent to anyone who wants it. You know, in a nutshell, what we've done, there was a department inside the hospitals and health systems and clinics that has existed for 40 plus years called the HIM department, the Health Information Management Department. And it started off with fax machines and mailing medical records around 'cause there was again, there is no digital interchange. And what DataVan has become is that standard. You know, we are the digital interchange for clinical data in particular across, really the entire healthcare ecosystem, whether it's providers, health insurance companies, life sciences companies, legal and attorney, and even patients. And what's happened, you know, the last several years, when I started off, we were about 20% digital. This over the last two years in particular, we're now at about 55% digital. And so we've shown up with a bunch of engineers, redone incentives, and really pushed out a digital first mindset, let's say two things are happening. One, it is opening up you use cases. And so, you know, all that chaos, that billing and all the stuff that I mentioned that sits downstream, it's actually starting to move upstream. And administrative burden is going away as a result of that. And I'll even be more specific. Companies like SmarterDX, which is a sister portfolio company of ours, they are moving way upstream to value chain on doing coding and clinical data information edits before anything goes to downstream revenue cycle, claims, editing, et cetera. And what's happening in effect is like so much of that bloat on the backside, because again, healthcare's the only industry where you go in, you have no idea what you're going to pay. You have no idea when the bill is going to come. And there's a million different ping-pong balls that go on in the middle with payers and secondary payers that until that actually gets sorted out. What if all that could be done right when clinical data is captured? And so data is powering that in a big way. The second thing I would say, as we digitize, our other customers are expanding their use cases too. And so instead of just using us for traditional population health or risk adjustment use cases, we're now seeing vast quality programs, clinical trial recruitment, we've tokenized a lot of the data, which means we've linked and connected the data to other desperate data sets, 350 real-world data partners with a de facto standard in the space. Like, what would another data partner? Is it other EHRs or other sources of the data? - Yeah, EHRs are a big one. And we just announced that we're helping Athena Health going back to my roots tokenize their data. They've got it all in a snowflake instance. But it's really everything under the sun. It is labs, genomic companies, it's claims. So that legacy payment information, it's other EHRs, it is pharmaceutical companies, it's payers, it's consumer companies. And we have the ability to identify and de-identify that data always with authorization and consent. Again, at the course, we're doing it securely privately. And so I guess, zooming back out, we're leading the digital connectivity revolution in healthcare and opening up more use cases. But in doing so, we are killing administrative burden at scale. And really knocking, where we win is when call centers go away or fax machines go away. Or all these things that should never exist and just put friction back on them. But ultimately, the consumer in healthcare and just really quick on a sense of scale, we're in about half of all the hospitals and health systems and clinics in the country. And we do the majority of all payer and life sciences volume that are sitting there asking and wanting that data. And we sit uniquely in the middle of that supply and demand. And so we have a data collaboration platform that can view both sides of the ledger. And as you said, you work with nearly every healthcare stakeholder in terms of your working with providers, payers, life science, maybe you can just tell us giving those three examples and any other customer segments you want to add. Like what is the key value proposition? Because obviously what a payer is coming to you for is very different from a life science company. - Yeah, and that's the trick. Like you nailed it. We, to digitize, you have to see both sides, right? Because it's not enough to just digitally enable the source because the demand side system has its own requirements and its own use cases, and you are absolutely right, every single one of them is nuance. And where we drive a lot of values through the curation and finished product work that we do around the data and connecting those to the supply and demand. Second, there's a lot of tension between these healthcare stakeholders, right? Like a health insurance company and a provider, like there's frequently tension between the two. - Lots of finger pointing. - Yes. They actually need a neutral third party to sit in the middle and just neutrally blindly using consent authorization so making sure we have all the boxes checked. 75 plus steps in some states. Like it's a really onerous, rightfully so process. And that's where we set to. So we're a neutral arbiter of all this information. Just move it from point A to point B and we do a ton of transformation and build all the rails out to enable all that transformation. But we actually don't have agency, right? And we're not selling data, right? We don't like go and buy data, market up and resell it. Folks, you don't even store it, right? You're not storing data. - No, we keep it in our client's native environment, which is what they're demanding, right? We've actually done a lot of work with Amazon, Databricks, and Snowflake in particular and others, Azure, and et cetera, to enable our services to be launched natively inside any environment. And what's happened is you don't need to build some master data warehouse or master patient index anymore that's what's happened with the token and our digitization. You're able to put technology natively in your environment and connect securely, completely with consent authorization to all these other environments. And some in once you have consent and not the right data to solve the problems that you need. The last thing I'll say, we do play a heavy hand in contract management. And so it's not enough to just neutrally facilitate. They also need a vehicle for payment and to hold contracts, data use rights, like all of these things. And we do all of that neutrally, like we don't get involved in the negotiation. But we make sure that it's seamless for folks to engage in data exchange when they have consent and off as a part of joining our data collaboration platform. - And I mean, data on as a B2B company, but most people don't realize you do have a consumer product, you have a white label product that providers can use for their patients. Can you talk a little bit about that? - Yeah, absolutely. Right when I came on one of the first decisions that I in the board made was to make that product completely free. And so there is a ton of consumer demand, you know, anything from, I need a school form filled out for my kids and a medical record attached to it, to hey, I'm changing hospitals or I'm moving, or I need to go see another specialist and take my record with me. There's a million different use cases. And we can facilitate all that. We have a digital interface for folks to get their information. They don't have to go down to the HIM department that I described earlier. Instead, they can interface with us digitally and spend a huge success. It's a bit of a big win for the industry too. - And you guys don't take any credit for it. You're not like building consumer brand recognition 'cause you're allowing the providers to kind of take that credit from that product. - Yeah, that's exactly right. And I say this to everybody and all of our client segments know this, but the providers who we serve are our most sacred kind of asset, right? And they perform the medical care. They have the patients and we work in partnership with them, right? It's their data and their patients data, not our data. And you're absolutely right. We work with them and their brands, especially in their communities to help drive that. Another interesting fact. We are one of the largest consumers. We are the largest consumer of Epic's Fire APIs. We also push and help enroll a lot of folks into my chart. Right, we're not competing with my chart. My chart's a great place to go chat with your doctor, see a result, right, if you just had a test or a lab done. What we provide is again, access to the comprehensive medical records, you can move it around and digitize it and move it all over the place and move it into any system you need to, not just Epic. And so we're very complimentary and Epic spent a great partner of ours for many years and we spent a lot of time with them building out digital connectivity across the landscape. - Can you give our listeners an idea of the skill that you guys are at right now? Are there any numbers that you can share? - Yeah, absolutely, we're closing our books this year. We'll be north of a billion five in revenues. We're a larger organization, again, been around in our current kind of iteration for almost a decade, as you and I mentioned before. We're at about 80,000 locations across the US on the provider side. So I think of that as our supply, if you will, and that's massive hospital systems all the way down to critical access hospitals in rural communities. And then we have 350 real-world data partners. And so all that's the supply. And then on the demand side, we have payer, life sciences, and legal and attorney are big kind of verticals that we serve. We obviously do patience as you alluded to, but we don't charge money for that. And we are the number one player in each one of those markets. Serving, you know, I can confidently say the majority of all of the demand side requests from those segments come from us, even if it's not us on the supply side, right? So we'll go work with a hospital trying to run their, you know, data exchange on their own and help them digitize even if we're not staffing and running the whole thing for them. - Okay, let's talk about data. I have like an entire chapter of my upcoming book on data and the fact that we have this really odd problem of data being both misused and underused in healthcare. So I want to talk about both of those things, starting with misuse. And when I say that healthcare data is misused, I mean, very literally misused as in stolen. We all remember when United Health paid $20,000. $22 million in Bitcoin ransom to Russian cyber criminals after their cyber attack shut down their operations at clinics and pharmacies for over a week and it up costing the company over two billion and that stolen data for all we know is like still out there. Why is the healthcare sector such a prime target for cyber criminals? Yeah, I would say three things. One is the value. The ability to grab health data, it's more valuable than credit card data, you know, it's one of those areas where your willingness to pay exceeds your capacity to pay and so if you have the ability to market or know what individuals are going through, like it's wildly valuable to a whole bunch of stakeholders like out there and many of them, especially in, you know, other areas of the world are willing to pay for that data where there's less privacy and less IP controls, etc. There's a lot of value, number two, wildly antiquated systems, you know, I joke with Jeff all the time, like you don't even have to be a great technologist in healthcare to make a hell of an impact because the bar is so low with so much of the legacy infrastructure that's come across and I think that a few things cause that to happen. One, I think HIPAA regs are very, very, very, that's a very high bar and we need to re-look at HIPAA as a society and I can tell you like having work with providers for a very long time. If you put a HIPAA waiver in front of a patient, they sign it like every time, right? So what really are we solving for and so I think we need to bottoms up, you know, what HIPAA is and have it keep pace with technology and the change in some of the work we're talking about and I think it's constrained systems more than helped them because it's not actually solving the root underlying problem. The second thing I would say is because of the way healthcare data moves around and is stored, you know, in all these stored procedures and legacy systems and legacy infrastructure across the environment, it is very hard to actually quantify risk and so a big thing that we do with all of our clients is we, you know, spend north of $50 million a year on with our CSO, our chief information security officer and his team going out, not only secure in our own infrastructure but doing that with our clients as well and if I had to tell, you know, you or anybody what we ultimately sell, it is trust and security, right? They're removing very sensitive, very expensive, very valuable data around and it's something that we take very seriously but unfortunately, like I think until we push and mandate and I think high trust has been a good foundational movement, you know, more of a federal level. This is where I get frustrated when I see the government waning on things like Tefka and interoperability standards and regs, like put incentives in market and drive behavior but let's ramp up penalties for information blocking, let's ramp up penalties for cybersecurity breaches, right? Like put out incentives that will drive behavior and allow innovation in the market. Me and my team spent a lot of time in DC pushing and showing and demonstrating, you know, paths forward. The last thing I'll say technology has caught up in a big way. The technology sector has figured out the healthcare is 25% at GDP, Amazon when I was at Athena, AWS, you couldn't get them to sign a BAA, business associates agreements. You could store PHI securely inside an Amazon environment. They do that at scale, you know, now today. Another, yeah, acquiring companies and the billions for, yeah, yeah, in the space. Cloud strikes, got a big healthcare presence, Databricks, Snowflake, you know, all these organizations have come in. So the infrastructure is available now, which was not the case, certainly not 10, but not even really five years ago. There needs to be a big modernization effort of a lot of these legacy technology platforms that sit out there. And I think that, you know, Optimus, a very large client of ours, like they're going through that at scale after the change breach that you just mentioned and have been spending more money than ever attacking that problem. Getting up to face. Okay. So you said we need to relook at HIPAA. What would you, what would you recommend is change to updated? Yeah. Look, I mean, not, not tooting our own horn. And there's other options out there, but tokenization and like these concepts of privacy, enhancing, linking technologies did not exist or even formulated when HIPAA was originally constructed, right? And it's, I think it's, every time I've gone to DC, you get consumer advocacy groups pushing HIPAA at a million foot level without getting to the nuance of technology change. And I think we've got to bridge the gap there and make it to where we take a look and do a refresh, probably regulate a refresh of HIPAA every so often, given how fast the pace of technology, technological change, you know, is happening to market. You know, the other thing that I think we have to improve federal coordination and communication of cybersecurity incidents and near misses, like when one or two records go out or, you know, it's going to happen, right? Like we need to, you can't protect everything and we need to make it so folks feel comfortable and safe, especially some of these hospitals and other organizations who don't have all the resources necessary to do all the upgrades I'm talking about. And federally fond of the ability to start to upgrade our infrastructure, I think it's a national security conversation. This is not just a nice to have. We need to start treating it as such. And you think it can change with the current administration? Yeah. I think it can change. I think it's, you know, the good thing about healthcare data and healthcare data regs, it has transcended many Democratic and Republican administrations. No one's going to argue with you against it. The bigger problem though is you need probably an eight-year admin to get some of the changes pushed through because there's so much turnover inside CMS and CMMI and some of the other vehicles right now. But a lot of the staffers and folks have been there for some time are moving the ball forward in a great way. And I think that, you know, we've had more conversations with the federal government in the last two years or so since I've been here, FDA, CMS, you know, HHS all over the map, with them starting to think about more modern tech and going out and reaching out to constituents to start to answer this problem, you know, that you and I are laying out right now. Yeah. So, okay, back to the data misuse and underuse problems. So underuse, there are some estimates that about 97% of healthcare data remains untapped because it's in isolated, unstructured networks, closed ecosystems. This is obviously like the core of your mission and what you're doing. In your view, where is healthcare leaving the most value on the table when it comes to data? Yeah. It's so much of it, you know, the number one in my view is just the way we capture information, right? And so if you've got a medical record system that is predominantly designed for billing, it is going to be billing focused on the inputs and outputs, right? It's word about coding and it's word about reimbursement. And so the other information that's captured largely goes into an unstructured bucket and it sits there and it's very hard to clean it up. It's very hard to transfer it if you switch general practitioners if you're going to a specialist. Next, you have imaging and imaging systems are largely disconnected from this stream of data that I'm mentioning and they're very valuable. I do believe the very strong use case of artificial intelligence is going to be at the very least summarizing all this information and a clean concise, you know, statistically significant way where a clinician or a lab tech or whoever on the healthcare delivery supply chain can have better information at their fingertips. The other top of mind thing for me is the med list, right? One of the things we did it signify, we would go into these predominantly seniors homes and say, all right, give me everything you're taking. Get it meet from, you know, the bathroom, medicine cabinet, get it from the fridge, your bedside table, like let's lay it all out. And that was the best med list ever, right? Because it wasn't what they were prescribed. It wasn't what they remember to bring to the doc. It was like what they were actually doing. And we got to see seniors splitting pills because they were their digestive system or they couldn't afford the full pill every day. And so that's like a real med list. Getting closer to that from a consumer centric standpoint at scale is absolutely critical for us bending the cost curve and driving, you know, better outcomes. And reimbursement centric medical record does not have that at the heart of its, you know, mission or charge. And so again, like if I was running CMS for a day, like figuring out incentives and vehicles to get that level of med list, like pulled together and with consent and authorization spread to providers, drug on drug interaction and all the other drug issues I just mentioned are huge things that go really untouched. And pharmacy has been largely pushed out of the kind of central care team, you know, historically that's starting to change in a lot of places. But tackling that problem, I think, is one that does not get talked about enough. No, it really doesn't. And do you feel like that is more possible within like a value-based care world where if your patient population is under a capitated model, you have more incentive to kind of track at more of a patient centered level? I don't even know what value-based care means anymore. Like unfortunately, like, I, you're not being paid for, you're, you're being paid a flat-capitated fee to manage a patient population. In that case, you would imagine a billing-based EHR isn't as important as one that is like clinically more relevant. The problem is all the EHRs, especially the ones at any desospitals are so billing-centric. Like, you put, so what do you do? You buy wrapper software like Arcadia and others that sit around the whole thing. and it's logging in at different screens. You've got an overlay. I just don't think it's been cracked at its core. And I'm a broken record on this. This, you know, the new models that are coming out right now, they're not paying off money to primary care physicians period. And you're not going to get behavior change until you rip the bandaid on incentives and drive alignment downstream. And we are too scared as a society with negative incentives and influencing behavior and all these other things. And instead of actually taking more risk and pushing an agenda, that is patient-centric, which is what you're articulating, I think we've gotten ourselves wrapped up in a constraint-centric point of view versus taking risks and experimenting with reimbursement, you know, in particular, to see how we can drive better change. But the systems are a real constraint. The systems of record are real constraint inside of that today. No, absolutely. And as you talk about being, like, focused more on reimbursement and billing, like, of course, then the product is, you know, health data that is about billing codes, and not necessarily about, like, the actual patient experience, is there-- I'm just, like, brainstorming out loud here with you. Now, the proliferation of ambient scribes, we are capturing more of the encounter than we have ever done before. Do you think that could be a push in the right direction for having data? That's, like, a little bit more able to be parsed and inclusive of clinical information that doesn't exist today, or doesn't exist yesterday? I wish I could say yes without a doubt. I'm hopeful, is what I would say. But I, you know, as I've gotten the ground and spent some time around the ambient space, like, first of all, transcription and scribing has been allowed around for a very long time. And there's people that were physically listening into the encounter and just typing it out. And like-- Oh, yeah. We backed dog medics at Rock Health. Yeah, and they were very early to this space. And so I've seen it around. When I sit with docs, and I do it frequently, because we're, like, so deep in the workflow, and we work with them, they've got macros. They're copying and pasting. Like, their method of data entry is very efficient, depending on the encounter. And so I'm not sure there's going to be some-- and if you really peel back utilization statistics on the various ambient providers, they're all over the place. And it's a very specialty centric. It's very health system centric. And do I think it makes the doctors feel better without a doubt? I mean, look at the growth and the kind of explosion in that space, like without a doubt-- The adoption is incredible. Yeah. But is it going to solve the problem you're talking about? I think we need more time. Is the answer to it. And I think, look, like, that space is under a lot of pressure. You've got Epic and Athena basically saying, and others, we're going to do this for free. Like, this is going to be a part of our, you know, native EHR system now, which puts all of the third parties like in the space and a really interesting space. So if the price goes to zero, where do they need to get the money from? It has to be the payers, life sciences, other providers. You need that information. Like, you've got to go back out to the ecosystem. But the second you do that, you're putting more administrative burden back in the dark, right? Because they're needing to think about another billing code or another clinical trial enrollment or whatever it might be. And so it's not a problem that I think is an easy solution. I'm very hopeful, though, that space is the path forward to taking some of that documentation burden off of providers, because they spend an awful lot of time, you know, on this. Oh, yeah. Let's talk about your job. Being CEO is the hardest. And in my opinion, the worst job. You're clearly very, very good at it. What part of the job do you love the most? I'd say it's two things. I love rolling up my sleeves and getting out with the customers and putting a headset on like sitting in the medical record room, understanding with the discovery team and our life sciences client, how they're recruiting patients and where they're running into problems. Like, and I push on my team constantly, that direct, especially in healthcare, like customer experience. Like, there is no shortcut. And no two organizations are the same. And so you have to physically spend time and re-implement yourselves. Like, you can't launch a product in healthcare or expect it to be static. Like, you have to be on some routine cadence of updating and reintegrating and changing is just a constant, like, inside this space. So I love that. And two, I love my teams. Like, and I mentioned, so many of them have come from outside of healthcare backgrounds. And so many of them have been with me for some time. And, you know, I've enjoyed a lot of the folks that when I was younger in my career, I had a lot of great mentors and people invested in me. I love doing that with folks now too. And I try to design my organizations and create them when we scale to still have that kind of human-centric mentoring and nurturing model at their core. And I think when all those things are happening, like, you have fun. And I think having fun at work is super important because there's especially in healthcare, a lot of chaos and challenges on an everyday basis that you face. Yeah, I think people, especially MBAs like us, you know, the role is like romanticized to us. Or it's almost assumed like the CEO is that goal for you in your career. But it's really not a job for everyone. What would you say to people kind of early in their career who are thinking about their trajectories of the companies that they're working at or starting? Yeah, it's the most full-time job there is. Like, I think you have to be willing. I say so my management teams too. Like, we are responsible for a massive pool of consumers in healthcare organizations and healthcare is 24/7. And there's sometimes like your joy is going to have to be on. You can't just close the laptop and just ignore what's going on. And so that's a sacrifice, right? And that's a decision that has to be made. Two, and my father-in-law loved this. He was a professor at HBS for a long time. He was very early on in the organizational behavior unit. But it's a whole bunch of people management, right? And people are complicated and it's messy and they're emotional and they have their own priorities and their own lives. And so I think leading with heart and paying attention to folks and their motivations and what they're trying to do, both clients and employees, it's a lot. And if you are not up for that type of engagement, I think real success is tough. There's a lot of CEOs that just choose to sit on top and do not do the two things I talked about. And there's a very different organizations. I think that have very statistically different outcomes. And I think that leading in a human centered way like that, both with clients and with your individuals you work with is super important. Yeah, I actually found that out as CEO that the people management piece was not congruent with what I was good at or what I wanted to do. I wanted to do the work. I enjoy doing the work. I love thinking through the problems. I love getting my hands dirty and solving the problems. But actually as CEO, you spend most of your time on people management. And if that is not your thing, if it is not your biggest skill, then you're probably not the right one for the job. You've now let a company through IPO and acquisition and acquiring companies. Most CEOs don't get those privileges. Given those two experiences, IPO, the acquisition, which one was actually harder to navigate? The IPO without a doubt. Public markets are the wild west. And we beaten raised our financial projections every single quarter that I was CEO. And just an amazing team. And our stock went from $40 to $11 during that time. So like almost a 4X, like Delta. And it's very amazing. Due to the market sentiment, due to the development of your company's public. And some of them shouldn't have been companies. Some of them should have American public. Some of them are never going to make money. And so who to compare you to is big when you're public. And that's very hard to educate employees on. All your metrics are green and going up. And everyone's working so hard. So it's a very tough spot to be in managing a team. I actually think public markets are more designed for large diversified businesses. And businesses that are more well known and understood kind of in market. Or something that's truly breakout disruption, like this whole AI craze that's going on right now, where there's so many data points and use cases and examples. I think public investors need more of that. And so I'd say that volatility was way harder to deal with than the acquisition. The acquisition was a lot. Like I don't want to downplay it. We had 21 folks bid on signify. I lived in a hotel room for weeks in New York. Just dry cleaning my clothes. Going back to Goldman Sachs every morning. Like it was the Groundhog Day repeating myself. Oh, Lincoln Mush. But CVS was a great place to land. An amazing management team. They're still a very large customer of ours. And I had a great time there. I spent almost two years there, learned a ton. And believe they've got a great platform to help really improve the consumer experience ultimately in healthcare. And so I was very happy to signify the land there. It's where I wanted to signify the land of all the folks that were out there. And we'll say even those great financial outcome, like when came to the crossroads of deciding, like it's a very personal decision for you as someone who's worked at a business so long. And all the employees and all the customers and all those relationships of where things to land. And at the end of the day, there's things matter, the most. And so it was very happy to see CVS continue to invest in signify. And we beat every number. We told them we would deliver them. And it's a part of my and the team's reputation. And that matters a lot. Totally. Yeah. So Kyle, this has been a great conversation. I always like to end the show by asking people if they could wave a magic wand and change one thing about healthcare, what would it be? I think for me, it would be having incentives really changed. And ensuring that, let's define-- the behavior we want, whether it's information sharing or as you alluded to a more value-based centric approach where payment and risk and clinical information is all bundled into one infrastructure buildout, whatever those things are, I think we need to be way more bold at experimenting and relax some historical notions of technology and alignment and market players if we're going to get out of this current, frankly, mess that we're in, right? The Medicare Trust is in distress, period, and we've got providers that are burned out, and if we're going to get past that, we've got to really start thinking outside of the box. I'm hopeful CMMI can get there again. I feel like under Patrick Conway, there was an explosion of innovation and new models coming out. The ability to price things and to transparently price things, I should say, is difficult because of system limitations and a whole bunch of other factors internally, we've got to strip those things away, because it's keeping capital and innovation away from those programs today. I look to governments the largest pair in the United States, and it will be forever, and we need to make sure that we keep removing constraints around its ability to innovate as well. Yep. Awesome. Well, Kyle, thank you for your time today. It was great to see you. Yeah, great to see you too, take care. Thanks for listening to The Heart of Healthcare. If you enjoyed this episode and you'd like to support the podcast, please leave a rating and review, and don't forget to subscribe. The Heart of Healthcare is produced by Halle Teco and hosted by Michael Eskivell, Steve Kraus, and Halle Teco. The show is engineered, edited, and mixed by Kyle Moore. Visit our website heartofhealthcarepodcast.com for show notes and details.