Lantern's Dickon Waterfield on rising healthcare costs and how Medicaid cuts will impact businesses

It's a fundamental component of American healthcare as commercial pays a very, very different price than Medicare. If I think about a total near replacement, average cost in the US for commercial is maybe $45,000. Medicare pays 17,000 roughly, right? It's a really interesting component. Essentially, Americans have never had nationalized healthcare and this became a way to compete on talent. If you think about it now, it has now become the normalized standard that you offer health insurance as part of your total compensation employee benefits package. The situation that we have today feels completely unsustainable. Employers are responsible for the healthcare of a very good chunk of Americans. I believe it's in the 60 to 70 percent range. So what point do you think employers just turn around and say, "I'm done. Like, I'm out." I think employers are going to get much tighter on what a cover from a services basis in benefits. They will continue to be a narrowing in terms of what we're offering. I think the more forward-thinking advanced employers are defining value across a number of different parameters, achieving the clinical outcome and achieving the experience, but then they're also thinking, "Hey, is this going to help me attract and retain talent?" Hi there. I'm Christina Far and this is Second Opinion, the podcast that cuts through the noise and digital health to deliver what you actually need to know. We're tackling the topics of matter with brutal honesty and depth through conversations you won't find elsewhere. No talking points, no hype, just clear insights to help you navigate what's really happening at the intersection of health, technology and biology. Let's dive in. Hey guys, welcome back to the Second Opinion podcast. This week we have an incredible guest in Dick and Worsafield. He's the president of a company called Lantern. If you haven't heard of them, you certainly will by the end of this episode, but he's also had a really long career in digital health and really in the commercial sales side, which I think we don't really talk about enough or hear about enough. I'm excited to talk to him about just the past decade that he's been working in the industry at not just Lantern, but companies like Big Health as well, and he's seen just so much evolution in the space. He's also fellow Brett, which is always fun. Just having another Brett on the show talking about US health care, and we both live on the East Coast, so just lots in common and excited to have him on the pod. So hey, Dick and let's chat. Awesome. Excited to be here. Thanks, Chrissy. Yeah, so let's start out by just for people who are not familiar. Lantern, you're quite a big company. I didn't know how big the company was until we spent some time together with the team last year, and I was like, whoa, this is like a very big company that honestly I not heard about. So how is that possible that you're at this company that's, you know, if you compare it to some of the ones that just went public, like probably of that size or close to that size, but just so on the radar. So great question. First of all, I would say that I joined four years ago, and probably to be joining, there were not a significant number of people in the company who were what I'd call part of the digital health world previously. So simply, there wasn't many people's radars, and also the world of sense of excellence, which is the world that we then played in and we now play in now, but we think it's got a bigger calling than quite a sense of excellence. It was still a pretty emerging and growing space, and there's two factors. Also, we haven't had any of the, well, I'd call traditional digital health investors. So therefore, we weren't on a lot of the normal lists that many people are. So that was sort of the starting point, and then quite frankly, we've been trying to change that view over the past four years. And I think we've successfully done that in the last two years, but really with the rebrand, we've been able to fundamentally change that, and no surprise, the name of the company previously was not particularly sexy or exciting. You have to tell us what it was. Employer at Talfkeh, it was very much what it said on the tin, and then the product was called Sirdry class, which is great when you're communicating to a employee because they can get pretty quickly what we do. But it certainly doesn't evoke much emotion and excitement from a brand perspective, and also creates a lot of complexity, believe it or not, we've been financed in processes where they've had employer direct and Sirdry classes, two different participants. So also created a bunch of confusion in the process as well. So yeah, so when I think about the business and what you do, it's one of those companies that exists in part because the system is broken. And if the system were rational, it would not exist. And maybe I'll just kind of break it down for people. But you know, what you guys do is you reduce the gap in cost between what a Medicare type rate might be for a service and what a commercial rate might be for that same service. And you and I have had these conversations that are so mind boggling around how you know, you take say a specific type of surgery that is done every single day in America, you know, same surgery and just the difference in price that you can see across whether it's an academic medical center, whether it's, you know, something that is more of an ambulatory center, such a huge difference. And then who's paying for it is also a massive factor. And then obviously the physician is a big factor. And all these things can just have so much impact on on cost. So maybe tell us a little bit more about about that reality. And just some of the things that you've learned in kind of running this business. Yeah, it is a amazing reality. And some people sometimes ask me, how does this exist? And it is, it's a fundamental component of American healthcare, especially when I go back to England, try and explain how we can do it. It makes no sense at all. When you think about American healthcare and you think about the fact that commercial pays a very, very different price than Medicare, that's exactly what we're doing is we're narrowing the gap between what commercial pays versus what Medicare pays and there's also this conversation about the fact that commercial somewhat funds Medicare. But I think in the reality, there are certain areas of commercial that are much more profitable. And so therefore there is bigger ability to move the needle on cost to make it really specific. Medicare pays 17,000 roughly. Various depending on geography and also the setting for the hospital and the complexity of the hospital. But let's call it that. That's a huge difference in cost. And yet, elective surgery is one of the most profitable area for any hospital. So there's a real ability to narrow the cost. And then you also have to think about where is all the money going. If you think about any total near replacement, 90% of that cost is the facility. Only about 10% is being split between the surgeon and anesthesia. So suddenly you look at that and you go great. That means that 37,000 is going to the facility. And yet in Medicare they do that same service for call at 14,000. So there's a huge saving opportunity. Just like there is when an airplane is empty, any hotel is empty. There's essentially a marginal cost. It's like, hey, I'm there as well full of space. And so they can look at it very simply as great. I've got room in my OR. I can fill that with a case that I still make money on in Medicare. And I can now increase my rate of fell from a higher value patient than in Medicare. So again, if we pay call it 20,000, and the Medicare rate would be 17, more of my patients are more profitable than the Medicare patients. And that's the sort of sad reality. It's that there is a benefit to having commercial patients because they pay more. We're just now in that gap between commercial and Medicare very significant. Yeah. So the other part of this that is almost incestated, is that you have to have a scale. Because otherwise how do you have any leverage to then say, I want to get these lower rates. And so you've been able to get a lot of that scale through going to some of the biggest employers in the country that hire hundreds of thousands of people and tend to be in specific geographies. So how do you build a business like this? That's a question I've always had when thinking about it. Because at the beginning you have none of that leverage. So how do you then, it's like a chicken and egg thing. How do you then get an employer? Because what's in it for them? So what was the process of getting the first group of employers to believe in this? So those are one of the reasons why the company's been around for 14 years. And it's taken real time to get to scale. I joined a point where the company had already established a little of that scale. So had buying parents at markets. But I think there's also an aspect to recognize is that we will typically never be the predominant parent given market. It's always going to be across that always have the most. But this is a really important difference is that any of the typical commercial carriers today have to contract with basically everybody in the local marketplace. They work with everybody almost indiscriminately. Yes, they have narrow networks, but they're not that narrow. Whereas in a given market, I will typically contract with one or two providers only. And so I'm steering all of my members to a specific set of providers. And so with that, I can therefore delivered to them, real incremental volume. The second piece is that I will actually be helping them pull market share from their peers in a given marketplace. So six providers or big six big systems in a market I'll work with one. I will help them win market share from all those others. How do I do that? Because my client sponsors waived them that because share to drive that shift. So a total new replacement for somebody, some of my kind of deeper might be I'll hit the out of pocket max is $5,000. If I waive that member cost share, suddenly I'd brought down that cost that surgery dramatically. That member will happily drive across town on 45 minutes through traffic to go to a provider they wouldn't normally because it's the other side of where they live to suddenly get that waive the member cost share. So that's really is that steerage and that benefit of what I'm driving. That's how we compete because we provide incremental volume versus actual total volume. But to go back to your original question of like how do you build it? We believe you have to build it in local networks and essentially build that. And so that's how the company did it. It started out solving the problem of cost and quality for school districts in Austin, which is other companies that originally found it. And then we built up a building localized networks to then ultimately then having a natural footprint. That is how we can now work with the big national employers because those national employers like Hamlet Per, they have very small volume in any given market. Their biggest markets, Hamlet Per's headquartered in Atlanta is 20,000 members. That tip of the year isn't enough to actually go and get an interesting direct contract with the provider partner because if you then calculate the number of new replacements in that market, it's actually not very many. So you have to build scale locally, work in the local market to build that volume. And then from now we are able to build national footprint. That makes sense and I've always kind of believed that healthcare is so local and like it really is everything happens on a local level. Hey everyone, we'll get right back to the conversation after a word from our sponsors. I wanted to shift gears a little bit to something that's right now in the news, a couple things that are in the news. I think the biggest thing today is this big, beautiful bell and a lot of people in America kind of staring down the barrel of losing Medicaid coverage that I think we're talking about 10% of people who have Medicaid could lose coverage. So curious just if you have any thoughts on if employers really should be thinking about this strategizing around this, I mean, you know, look at the gig economy market. So Medicaid picks up the bill for so many people who need healthcare in that whole economy. And I can think of many more examples. I'm wondering if what you were thinking is on just how this would change things for employers who are already really strapped today. Yeah, I think there's two interesting places where it impacts and some employers rely on Medicaid to cover unfortunately the healthcare costs for many of their people. All right, this is sad reality if you think about some of these services and the retail segments. A lot of those members are actually covered by Medicaid not the employees plan because they don't get enough hours. So that's that's one thing to consider is that you'll have more people working for big well-known companies that no longer have healthcare because they're not covered by Medicaid. More broadly, how it's going to impact the market though is when you cut Medicaid, essentially you have more uninsured individuals, to then make up that cost. What the providers do is increase the rate on commercial, so trend increases further. So ultimately what we believe is going to happen here is that as you decrease Medicaid funding that will ultimately increase cost of care within commercial. So employers are going to see increased trend. And that's going to be particularly relevant within the biggest cost component in the market, which is hospital costs. We spent a lot of time talking about farm seed gelp ones, specialty care rising. That's ultimately only 30% of total cost of care, 70% to there is really hospital cost. And that is driving the big impact. And as you decrease Medicaid funding, it means hospitals increase price on commercial. So that is going to impact employers, which is them going to increasingly put pressure in terms of what they can cover, what they can't cover, how they cover things and continuously look at how they battle that trend component. I think that's a really good point. And it kind of brings me to my next question, which was a lot of folks don't know this, but I actually last year attended some of the summits that your company put on, which invited some of the biggest employers in the country. And it was really a few days of just sitting around in a basically a very nice hotel talking about what was going on. And in their world, what was going on in your world. And I was really a fly on the wall. And what struck me was just the level of frustration that I was already hearing from a lot of big employers about this cost that you just mentioned, rising trend. And some kind of even explicitly saying like, why is this even a problem that in other countries, employers are not really responsible for healthcare. And in this one, they're responsible for the healthcare of a very good chunk of Americans. I believe it's in the 60 to 70% range. And just sort of wondering why. And I think that was a really good question. And I remember one of the, I won't name names, but I remember one of the heads of benefits from a very wealthy kind of tech company saying, you know, if not us, then who, which I think was a very noble statement. But if you are one of those companies that employees people, like you just said, you know, many of whom rely on on Medicaid, you employ a lot of people who are making barely above minimum wage, lots of churn as well. Like I think those are all very valid questions. And if your business is making razor-thin margins, you know, it's another consideration of things just go, if trend just increases year after year. So now you're talking about even further increases. So what point do you think employers just turn around and say, this is, I'm done. Like I'm out. So first of all, let's go back in time like why it's a really interesting component. This is essentially Americans have never had national and healthcare. And this became a way to compete on talent was to provide post-World War II, right? It's an accident of history. All right. Then if you think about it now, it has now become the normalized standard that you offer health insurance as part of your total compensation employee benefits package, your total reward package. And ultimately, I think because there is no other approach in America today, unless you fall into Medicare or Medicaid, employers will continue to cover it at the end of the day. Yes, we're seeing slow movement to things like Iqra. I think they're going to be really challenged to drive change. I think what we will continuously see is employers wage this battle on cost and trend. But I equally think we are so entrenched in the system that it's going to be very, very hard to change because you'd need to have a system-wide shift or have a really essentially weak economy where employers could hire talent very easily. Because when you have a really tight talent market and people are competing for talent, ultimately the decision is, am I going to grow and drive growth by having the best employee use? Or actually, is the labor market suddenly really, really open and I can hire anybody I want? When you have a lot of tight labor market, you can't change your benefits, your total rewards package. So I think we'd have to see a world where you've got very higher unemployment rates, where employers start they could hire anybody to then be able to dramatically change this. Because that's the conflict. It's part of the overall compensation package. And so for anybody to grow, you want to have a great benefits package to get the best people and to do that, you need to cover health insurance, which is why I think people are going to find it really hard to change it. But back to the trend comment. I mean, you're saying that we could see the impact of these Medicaid cuts in increasing trend. Or already, I think folks were even without that very concerned about trend because of some of the things that we talked about like saline gene therapies, like GRP ones, like the increasing cost associated with hospital stays and procedures done at hospitals. Let's just take saline gene therapies. We're talking about like one to five million for a treatment that could be curative, mostly, you see it in children, but these are dependents. How many of these can, you know, take your own company? If there were three of these, saline gene therapy patients within the population in one year, what would that do to, you know, the profitability and performance of the business? Like at what point are companies going to say, we simply cannot cover these things. Despite the, I think, what will be a massive PR crisis for a lot of employers, if they say we can't treat, you know, and cure sick kids with rare diseases and cancer, it's, I just see this kind of nightmare emerging where they're just, like I said, it's like, keep using this language of rock and hard place, but it just seems like we're moving to a very impossible future. - Agreed. I think employers are going to get much tighter on what they cover from a services basis in benefits. So I think they will continue to be a narrowing in terms of what we're offering. Best actors will be less rich. More people will be more selective, be that formaries, be that networks, ways to lower cost of care. The question is how long can you sustain that model while costs continue to get up? My view is that you need to have a massive hit to the overall economy to suddenly put us in a position where employers can wrestle control back from essentially the talent team who is out there trying to gain candidates for roles. And so to do that, we're going to need to see the economy slide massively. We've got a growth tear. Every time we think there's going to be a big depression there isn't. And so the national economy's got a fundamental change. So I hope we continue on the path where the economy continues to grow. We don't have it, but it means healthcare costs to rise. So then the only thing you can do is continuously focus on new innovations in the market to shift and limit trends. I think if we look at 10 to 15 years, so if we care on the trend, you've got to look at, is there a government shift of actually it's Medicare for all and it's funded differently? I think it's really hard to see that in today's political system or any political system, quite frankly, within America. And because the system's so entrenched. But yeah, I agree with that. Yeah, it's hard to imagine what the alternative would be in yet like the situation that we have today feels completely unsustainable for all the reasons that we outlined. So, okay, so you mentioned you think that there's going to be a focus on cost containment and doing more with less. What do you think the future will be for point solutions and digital health? And some of these point solutions, I think have had very mixed evidence around are they delivering real ROI? Are they actually lowering costs? A lot of them, it seems like, just sort of sit on top of the employer and they're in a little point solution world. And there is a PM PM cost associated with them. And it's, I've seen analyses of like it's roughly equates to $50 or something per employee. And are they getting that back outside of the talent retention piece that you mentioned, which I think is big? But is there a reckoning coming for these point solutions that don't live about you? What do you think? Yes, we're really seeing it happening. People are talking about consolidation market for a long time. We finally started seeing it happen. We've also seen companies that have been on the path to going public delay significantly for a number of years to get out there. And that has been because there's greatest scrutiny on what is needed to succeed in the marketplace. So what we've all seen is there was a huge proliferation, but we've seen very few companies get a public in the world digital health. And part of that is that their growth has been encumbered by are they showing real retirement investment in terms of lower cost? That is increasingly the burden to really scale beyond, what I call the innovative seven players. So as a result, we'll see greatest scrutiny on that. We'll see greatest scrutiny on real clinical evidence. But I think we've seen scrutiny on clinical evidence for a long time. The real connection point is to take that and transition that to achieving the engagement that is expected for the program in place. And that varies dramatically depending on what are you talking about? Are you talking about mental health? Are you talking about physical therapy? Are you talking about diabetes management? They all have very different engagement models. And you've got to think about engagement to achieve the goals of the clinical outcomes that you're trying to achieve. Then there'll be much greater connection to the appropriate engagement to achieve the clinical outcomes. And then much closer time between the clinical outcomes to actually lowering cost of care. First is actually just increasing cost of care because it's on top of standard cost of care today as well. When that happens, that's when you'll see success. I think one of the big challenges to call a spade of spade though is digital health is being held to higher standards than pharmacotherapy in many instances. So drugs come out, show yes, but not necessarily the level of evidence that you actually require from a digital health company today in terms of actual impacts and downstream cost. So you've got a two-tier system going on in terms of the level of scrutiny that digital health is getting than pharmacotherapy is in many cases, but they're reimbursed to different levels. Very similarly to how you look at the differences between reimbursement, between physical therapy and mental health. Mental health is a story of being reimbursed really poorly in this company. And that is improving, but it's still significantly further behind physical health. Yeah, I think I agree with you that there is a really high level of scrutiny on digital health. I'm wondering if you can give an example of what I think what's wrong to mind for me when you mentioned the pharmaceuticals was a lot of the drugs used for depression and anxiety, the SSRIs, not a very efficacious class of drugs. And yet, you know, you look at therapy and whether that be kind of in-person or virtual. And there is quite a bit of evidence around it and yet, you know, you still see. So that was what came into mind for me. And I know you have a background in behavioral health. So I'm eager to hear what like you were thinking about as well. Well, I only need an example. I think depression, anxiety, one set of medications, also the bento line subpoenas for insomnia is another great set of examples in terms of what is the sort of standard. And yet, the clinical impact you see from those medications is pretty limited. Yeah, there's an agreed rate you wish to get reimbursed out for a new drug. And suddenly that then means that they're available. That's added cough for the employees just incurring. Because there's an accepted standardized pathway versus what is actually happening in the world, the digital therapeutics and digital health more broadly. The good example is that increasingly people are being, I think, appropriately pushed to pay for session completion as one portion of the payment model. The other one is the clinical outcome connected to it, all the clinical outcome, but the end of that time period. Yeah, drugs are not, right? You pay for the bottle of pills at the beginning, and then you may never take them. And they may never have any clinical impact to you, but we're not measuring that. So we're holding ourselves to two very, very different standards in the industry. And no one's really questioning the reimbursement process for drugs when it comes to that at all. But yet digital health is held to the, you need to completely engage when and get the clinical outcome for me to pay. Yeah, I think the same is actually true for just brick and mortar providers versus the virtual providers. And we demand so much more evidence from the digital ones. And it's like the same thing. You're literally just doing the same thing, but with a laptop in the middle. And so I, yeah, I think there's something there. But then, you know, I think another point that you made that was interesting is, I think we often talk about ROI, but then we don't define what that means. And so people jump to this idea of cost savings very quickly. And I think if you are in an area like MSK, like if you're a sword or a hinge, like you can probably show that, 'cause if somebody doesn't get a surgery and does physical therapy, that's obviously, you know, cost savings, same is probably also true for an area like GI. And, you know, I think that's an interesting area because it tends to be really expensive when somebody's going through a big diagnostic odyssey related to their GI symptoms. There's a lot of procedures and a lot of specialists. And so that one to me, like those two make sense. But then if you're looking at something like fertility, like what is the potential for cost savings by helping somebody have a baby? And yet like that is their dream. That's a huge quality of life thing. It's like I see people all the time, even in my friend group who have in fertility saying, I'm gonna go work at employer X, Y, OZ because they have good fertility benefits. So that actually would be a win for many employers to offer those benefits and many do. But what is the cost savings, you know, and maybe you could argue it's, it's steroids to the right clinic. And that there's probably some value there. But overall, you know, you're enabling somebody to spend a bunch of money, you know, through the employer, $15,000, $20,000. And then also spend a bunch of their own money to pursue what is essentially, you know, it's something that they want to achieve in their life. And so how do you quantify that outcome? And so I don't think we sometimes talk about those nuances. - So I agree. I think the more forward thinking of our employers are defining value across a number of different parameters that they think about for, and they think about differently based on programs. So fertility program is gonna be thinking about value in terms of achieving the clinical outcome and achieving the experience. But then they're also thinking, hey, is this gonna help me attract and retain talent? - Yes. - Right, versus cost savings might be a much smaller component of their value essentially score sheet they're looking at. Right, so there's a different score card, depending on the clinical condition that they're looking at. I mean, fertility is a great example of that. And I think this is a great example of where America has got to benefit that we don't have in the UK, right? Like you're gonna go through the NHS, you're gonna get covered up to a certain level. You've also then got to think about essentially the rationing of what the overall spends to the NHS is to allow you through that. And otherwise you're getting out of pocket, right? Unless your employer is offering that in the UK as a real added benefit, That'll be my. more rare. So those are the things to think about in terms of the pros and cons of each. I think if you also think about other clinical conditions, cost is not necessarily just the way to think about it. And certainly the benchmark used in the UK with more of that quality adjusted life years, that you're thinking about. And you can think about that as a more effective measure versus just cost reduction. Right? Whose cost reduction will send you down a pathway to choose certain things, but also equally probably never invest in other things that have a huge impact in workforce productivity, happiness, sustainability and mental health is probably the best example there. The ROI on that is achievable and possible to share from cost homes perspective. It's really hard because it's tied to multiple different things. You're mental health has a huge impact on your overall cardiovascular, metabolic health. That cardiovascular health is more closely tied to a lever that is going to impact cost than the direct mental health aspect to it and the cost of care. And that was why some categories of care were growing far so others and one mental health shifted during the pandemic because it suddenly became a CEO level issue because it was actually more about workforce productivity than anything else. And also they were probably seeing it in their own homes in terms of the mental health impact that was happening on their families and their people close to them suddenly it was a relevant topic but yeah, I think five years prior to that I've been begging the drum on it. I think that's really useful and it it you write that there is actually some some goodness and how the US kind of thinks about this relative to other countries. So I have to ask you about these two IPOs that just happened. I'm sure you watch Kosi as did I, Hinge and Omar I had a call last week with a friend who's an investment banker and this will make you laugh. So he picks up the phone and says what are you doing spending so much time in that dog and then I will not repeat the rest of the word category. And I immediately jumped onto the defensive and I said you know those just these are great companies the market is still really uneducated like you know lots of investors actually got some good liquidity. I did my whole thing but I think that whether or not you agree or disagree with this person I think that there is a feeling out there that this is a really really tough category and that if you want to make money this is not the way to make money and that these companies are trading at a sort of three to five X revenue multiple maybe it'll get to a six or a seven but SaaS companies trade at much much higher revenue multiples and so you know I think a lot of people who are in finance kind of don't really quite get it yet and maybe lean a bit skeptical because of some of the early generation companies that have not done very well kind of over the long time. So as you think about your own company and just getting to that space of going public then like how do you get investors not saying things like that and thinking differently about the category and how do you feel about the two IPOs we just saw. So I think the first thing is we're always being benchmarked against SaaS. I think that's not necessarily the best benchmark to think about but but that is the benchmark that that particular individual would be looking at is to go hey why would you ever create a company here when you could build SaaS company to do something different and I think one of the reasons why people in healthcare is because no one have a more meaningful impact in life and you can build a great business and do that in healthcare I think that's one of the really special pieces about it. It is a challenging market to build companies in for all the reasons we know about the regulation the setup of how the healthcare market is built in the steps we have to get through and how we have to access things. There's no denying that. I also believe that the market's recalling a little bit from some of the previous companies that have gone public and not delivered on that vision opportunity and I think in the ones that have gone public recently we've got some great examples of companies that will continue to grow that have got a great vision for the future. So I think we'll see that rebound further the right way. That will require them to continue to perform and demonstrate that they can grow with the margins and the unique economics that the investor market wants and I think there is being a fair correction in terms of everyone's expectations because the investment period during COVID essentially misled people for quite a while in terms of what the market would pay. I think we're actually getting to much more rational numbers at the moment and the market's being much fairer on ultimately what the opportunity is and I think what you'll see is these companies continue to grow and have a real impact. And I wanted to ask you too about just the evolution in business models because I think maybe a lot of investors are seeing sort of an early generation of digital health companies. The companies that I used to see even five years ago when I was in venture capital, they were spending so much more. It was not uncommon for me to see a company on the kind of clinic side that would have like 30 people in revenue cycle and dozens of people in kind of on the clinical operation side. These were very expensive businesses to run for a long time and required a lot of capital. And I think now we're starting to see a lot more capital efficiency and some of that driven by the way that I think AI is really having an impact on kind of the operational side of the house. Like you see companies now that have one person that used to do the work of say 30 and so you see bone rates coming down. Like there's a lot of things that I'm starting to see with this newer generation that feel really positive. And then also just new and interesting ways of selling. Like we you and I were just texting about kind of a new cohort of businesses like Oshi Health and many health that have been not selling to directly to employers, which a lot of the point solutions did. But instead of just gotten in network with health plans, so an employee can just use them whenever they choose to and it's in network. It's just covered. And so that's a totally different model than the long, long sales cycles that you used to see with all the kind of director, employer motions, I think, but more common with the prior generation. So I think we don't talk about that enough that we're sort of in a newer there's a newer generation around that's like learned a few things. And you've been through a few of these companies. I think you're like both you know part of the older generation and the newer generation. So yeah, curious how you think things have evolved like, you know, maybe even further better. Yeah, I mean, it is pretty funny to think back to 2014 where there was no accepted go to market route for selling to employers. And Sean and the motto was the first one to crack it. And and and our number one goal when we first landed in the States was become great friends of Sean's, we can understand how he cracked it, right? And now I think that could also Sean, by the way, like he had to like figure it out so that everyone else could Yeah, he absolutely was an absolute pioneer in terms of how to solve the challenge and figure out how all the pieces were. So I remember standing front of a way board once with him explaining it to us the complexity of how everything's funded how employees pay for different things, how health plans work and and the level of detail that you need to get into to understand where monies held and when employers can say yes, easily versus when it's much harder and tougher. Are you going into claims? Are you going into an admin fee is then finance looking at that admin fee versus completely skipping that to what you're talking about now. Are you going to need that provider where they are by default part of the normal process from claims billing standpoint and looked at just the same way as the provider down the street from me from the employer standpoint. And it's actually just about how do I suddenly get you to communicate and direct care to that new virtual site versus that clinic. So we step forward multiple steps in terms of how things happen and not just the sales process, but also how things are paid for how they're approved that dramatically changes how quickly you can scale. So I think the world has changed dramatically in terms of that. I think you're completely right in terms of have come as a belt and like the infrastructure that we've all got to build on just from a go-to-market basis, the data and the systems in terms of who to go after and how to go after them, but also the channels are much more effectively built out. I mean, there are now a number of channels. One of them, the CVS point solution management platform was a channel that we built a big health in partnership with CDS. That didn't exist. And then we became the first company to be on that platform and then many companies are following us. So some of these things we had to pioneer for the absolute first time versus now because I can go through them really effectively. I think there's even a question of is that the right pathway I would argue no, it's actually skipping to what the likes of me the ocean ruler at doing is it being that network provider makes it a lot faster. But there are new things to figure out with those models that some of us haven't had to go through before. So a lot of this is still in evolution versus what you can look at elsewhere in Sass and being. They've been working through that for the last 20 years. So we're still earlier in that journey that I think many of them are. Yeah, I totally agree and I love the idea of the whiteboard and kind of which I was in the room. So last question for you is you've come up the ranks as a commercial leader and I have come for you to tell me all the time it's the hardest role to find. So do you have any parting thoughts on just how do you go about kind of building the skills to do that job, especially like in a world now where it's so hard to sell employers and it's maybe even harder to sell plans. Like what are some of the things that you've had to learn to be able to do the job and then what are you looking for in people that you hire? I'm biased on my own background and the background I've seen of people be successful in the space, but I think someone who comes with a broader more strategic background is going to be able to think and problem solve things in a different way than necessarily someone who grew up in the traditional sales. Well, I was the reverse. I didn't grew up in sales. Growing up in strategy consulting had to learn sales, and that became a really important thing to understand. I got the benefit of when I was a big health of being given an amazing chief revenue officer who literally he was my mentor and coach for two years to understand all aspects of selling because I really was brand new to it in terms of building a new pipeline, understanding how to convert that pipeline, how to think about forecasting, understanding what to give potential clients to different phases. So there's a lot to learn there. I think giving advice to people in terms of how to think about it, especially if you think about building the partnerships on a health plan. It's actually really simple and this is simple selling stuff, which is really understand the buyer their needs and come to them with a solution based on you understanding their world, understanding your world and finding a way to help them. And if you can do that fantastic, you're going to have an everlasting partnership. And if you can be a strategic thought partner to solve their problems and that happens to fit your solution, you're in a great spot. But the moment you're trying to solve them a solution is really hard to build a partnership or any kind of relationship with somebody. So I always come back to help solve people's problems and you have a great opportunity to build a long term high value relationship. But if your selling a solution is really challenging. I think it's a reason to be very bullish at the early stage on Founder-led sales because you just got to even know if the buyer wants it or not. And if not, you got to quickly pivot. So Founder, how's the start, the sales process? Because again, you can't hire someone who is going to care as much or understand as much more listeners acutely to the feedback you're getting to enable you to pivot. And that is the massive, massive challenge. Peter at Big Health did a great job of doing that initially. I came in alongside him and just that that was a lot of the other success we had. Because he was great at doing it and I just picked up the mantle from him. Don't even get me started on Founder-led communications, which is actually the subject of my of my book, but I feel just as strongly about that as I as I do sales. So I've loved having this chat with you. Thank you so much for joining me on the podcast. I hope you'll come back and wow, just like so much going on the world of health care. So really appreciated having you kind of unpack it with me. Likewise, Chris, you always awesome to us. All right, cheers. Bye. Bye. Thank you for tuning into Second Opinion. If you got value after this conversation, please share it with colleagues and slight groups and friends now engaged in the industry. If you haven't already checked out the Second Opinion newsletter, you will get a link to subscribe in the episode description. Second Opinion is a positive turventine, the podcast network behind Econ 102 with Noah Smith, turventine VC, complex systems with Patrick McKenzie, and more shows for experts. Bye, experts in tech.