We Have Evidence-Based Medicine. Now It’s Time for Evidence-Based Operations (with Imaad Rashied, VP of Health Systems at Assort Health)

Welcome to Claims Denied, one man's quest to learn everything there is to know about the business of healthcare. I'm Blake Matten, your host and creator of Hospitalogy, a healthcare newsletter and ecosystem discussing the latest in the business of healthcare transformation. Each week on Claims Denied, I sit down with healthcare leaders and peers to talk shop about emerging trends and health system transformation, health tech startups changing the game, and scalding hot takes on the future of the industry. Hey guys, I've written a lot about patient access AI and here's the thing most vendors get wrong. They measure the call and not the outcome. A sort health measures what happens after. Scheduling, referrals, intake all the way to the appointment landing in the EHR. Visit assorthealth.com/hospitalogy to learn more today. Okay guys, welcome back once again to another episode of Claims Denied, a Hospitalogy podcast. Today we're going to be talking all things, a sort health and agentic AI and health systems and everything in between with Amod over here. Amod, how are you doing today? How's life? Oh, doing great. You know, it's Tuesday morning in San Francisco. It's as great as it can be in October and yeah, so all things as expected. Great. Yeah, and right before we jumped on here, we were talking about the crazy college football week and for those, for the folks who are potentially watching this on video or YouTube after the fact, I am sadly presenting a Texas long horns flag in my background, which we just fell for the second week in the road to Florida. But as I understand, you are, you are also facing a loss, you know, the post-loss blues as a Georgia fan, is that right? Oh, yeah. Had a heartbreaking lost Auburn there. Got down to the last two, four minutes. And of course, growing up in the SEC, you've got friends at every one of these schools. So the the group chat was full of smack talk and we all had to take a breather, say, hey, we'll be friends again in 24 hours. That's tough though. You know, you get those emotions going and I think my least favorite part of college football is obviously like after a loss. And you have to sit through for a week or however long, both the memes, the social media, especially as a Texas man because like everybody hates us for whatever reason. And you know, everybody, a lot of people hate Georgia too because you guys are winning all the time, right? But you see the highlights and like what went wrong and then there's like the fan base, the rabid fan base around like the message boards and should arch be benched and all these things. And so all of that will be sorted out once this podcast is published. So it'll be interesting to you know, come back to it and see what happened has happened since then. But it's a mess man. College football is a glorious, wonderful mess. Yeah. But I mean, we love the chaos, right? That's why we part ourselves through it year after year. Absolutely. That's yeah, that's what it's all about. That's what it's all about. Absolutely. The journey, the journey. And so speaking of the journey, it's a great segue into I would love for you to give your background on, you know, your journey through healthcare today and how you found yourself at a sort health and what you do today. Yeah. So I'd like to call my journey in healthcare long and me entering and sometimes random. So yeah, obviously went to university of Georgia. I've been, you know, like any good person out of school when it was consulting for a little bit, which was soul sucking and I do not wish on my worst enemy. Sorry if anybody's a consultant out there and loves consulting. I'm also a former consultant. So I reformed consultant like that's what we call ourselves reformed. Okay. There you go. Yeah. I love it. But then yeah, I got into healthcare with my own company called Blue Check Health. We started on the radiation oncology side helping to asymmetric and physical calibrate radiation therapy machines and expanded to help quality teams reduce hospital card infections after, you know, selling that, you know, that was out of Atlanta. And after selling that, worked for a company called Clockwise MD, which was my friend like Birx company ran product and account management for that org. We were urgent care and a D throughput. And if you've, are you in San Francisco, Blake, where are you? I'm in Dallas. Oh, you're in Dallas. Yeah. I don't know if we penetrated that market well, but all the go-out healthcare is across the country. Use our platform. It's kind of cool to see the software that I built still being used out in the wild. And then, yeah. So we saw that company in Warburg, PINKIS. And then last eight years before a sort, I spent the Qventus automating hospital operations kind of sat on every side of that business, starting with hospital command centers in patient length of stay, perioperative work, pre anesthesia work, and then joy to sort in January as our VP of health systems to run our health systems business unit. Yeah. That's awesome. So pretty, pretty cool lock there. And, you know, it sounds like as they moved along, but the theme throughout all of this kind of like, you know, connecting systems and bringing all those connected tissues together. So I'd love for you to kind of send, you know, since your time in joining a sort in January, what's your experience been like? And can you walk me through kind of like the, you know, how 2026 has been for you guys and what you guys are focused on? Yeah. I mean, 2026 has been fantastic. I mean, when I joined, we already had a very robust provider group business that, you know, had been going for about three years before I joined. And that just has hit escape velocity. And it's kind of in the stratosphere we're working with over 15,000 providers nationwide. You know, we've done about 310 million patient interactions now. We're working across 23 sub-specialties now working on sub-specialties 24 and 25. We've expanded across the entire ambulatory care continuum. And so, you know, with, and then, you know, along the way, raised a good chunk of money across, you know, to fuel that you've been more in general, so we're, thank you, that we're facing. And yeah, and then on the health system side, it's been, you know, electric as well, getting into the space. There's been, you know, essentially a new competitor every month. And so staying ahead of curve, but, you know, health systems are like pushing a boulder uphill that's, you know, and you're deep in mud and snow. And eventually, you will make it to the top. And once you do, it kind of snowballs and goes from there. And I'm happy to say that, you know, I told the board what I enjoyed that he takes 10 to 12 months to stand up the health system business. And basically 30 days early on my target, which is nice. That's nice. That's a larger health systems that are starting to partner with us. And so, yeah, it's been, it's been fantastic. I mean, I thought I knew what hypergrowth was, but I had no idea until I got to a sort and it's a whole different beast. Yeah, that's really cool. So, so maybe we can start there real quick just for folks. And maybe there's, there's health system folks who are listening who are maybe a little less familiar with you guys, though, maybe kind of doubt that since you've raised so much money in our everywhere, you back with us across kind of patient access and agent to AI, but maybe like walk us through, you know, a sort of health thesis, like what you do, where you started and kind of the different workflows you enable through your platform. Yeah. So we started three years ago as the first agent ticket voice to schedule into specialty care. We started with orthopedics. We started in an epic environment. So it's like the most complex thing you could tackle right away. And I think we've just we're just gladens for punishment, which could just keep bashing ourselves over the heads with more and more specialties. And so, yeah, we've grown since then. We started with an agentic voice because, you know, especially when you're looking at specialty care, regardless of all of the nice things for access, we've set up for patients, whether it's chatbots or online scheduling, so on and so forth, a lot of specialty care, diagnostic care, referral care, a lot of the care that's complex and drives revenue still resorts to a phone call at the end of the day. And so we had to make sure that we we leveraged agentic voice to be able to solve specialty care. But that's essentially where our wedge is, right? We built a library of 1.8 million decision pathways and clinical care protocols across those 23 sub specialties. And what that's done is burned us the right to do everything from inbound voice and chat and online scheduling all the way through, you know, referrals management and outbound campaigns and care gap closures. And our goal essentially is no patient should have to navigate their care alone because the technology solved that, right? I mean, you you worked during the business hours, you can only call during after hours your patient portal doesn't let you do everything that needs to be done. You have, you know, five different things to navigate and you shouldn't have to do it alone. The system should be working on your behalf. Like we created the complexity, right, in healthcare. And then we asked patients to navigate it. And that's unfair. And that's that's technology is likely solved that. Yeah. Yeah. That's awesome. I appreciate you walking me through that. And I mean, I can imagine why health systems would be attracted to working in provider groups in general be attracted to working with you guys when it comes to specialty care and patient facing interactions and adding capacity and those sorts of things. But can you kind of walk through like you mentioned, you're at 10 health system partners today. What attracted them to you versus a competitor versus all of the noise you mentioned out there. Like how do you kind of sit through all that and like, you know, clearly articulate your ROI and then work with the health system to execute on that. Yeah. I mean, it comes down to expertise. So in order to navigate specialty care, right, we to put it in perspective, open scheduling opened up in EMRs back in like 2013, 2014. And so you had the ability to put your specialist schedules out there to the market for anybody book in for the last 13 years. And we're still talking about it. But the reason why a lot of that all had hasn't happened yet is because A, sub-specialty care is complex, but B, there's actually an interesting human problem that surfaced. After the ACA, we saw a lot of consolidation in the provider market, and a lot of these independent provider groups were told, "Hey, we're going to give you a few million dollar checks per partner, we're going to take over your back office, all your reporting, all the stuff that you hate doing, and you can continue practice medicine, and you still have a level of autonomy over your schedule, who you see, you refer all relationships, all and so forth." But slowly, as margins have compressed, as the landscape has shifted, as there's been more pressure to go to value-based care, that autonomy has slowly eroded away. However, and the last bastion of autonomy, the sub-specialists have, essentially, are their schedules. And what it takes to navigate those schedules are, you know, every provider wants completely different prep, or not completely, but they want nuanced prep for their patients, right? And the provider wants to memorize within 30 days, the other ones okay with 60 days, the other way it will take any patient. And you have to be able to, the technology has to be able to solve that human part in order to convince these very, you know, specialized providers to open up their schedules and say, "Hey, I will let some central entity navigate my patients and navigate my schedule for me." And you have to keep in mind, like, Debbie has been scheduling for them, and sorry, I used this, you know, this, this avatar, Debbie, and then my chief medical officer, when I was talking to him, said, "Fun fact, Debbie's my wife's name." And so I've been looking for a different avatar there, but Debbie's been scheduling for them for 30 years and knows exactly how they like things done and knows when they need to go see their kids' graduation or step out and play golf with their referral partner and so on and so forth, and all of that nuance matters. And so they've never opened up their schedules to centralize contact centers. And the way that health systems have tried to solve this over time are decision trees because that's the, those are the tools that have been available to them in their EMRs. But the decision trees are, if then statements, one size fits all, one size fits most, and so they will never be good enough to navigate down to this level. At the end of the day, your centralized center will still have to, even if they get to write some specialty, transfer somebody to a clinic to finish the workflow. And then the clinic will then get to decide and you're not having something look across every subspecialist, only the ones in that clinic. And so when health systems hear that, when they hear that level of expertise, when they hear that we're solving the human problem that they've been trying to solve for 13 years, that's where the trust gets built. That's where they look at us and say, oh, interesting. And what I tell folks is like, you know, if you abstract everything away, ambulatory care workflows boil down to basically putting patients on calendars in various places, right, whether it's a diagnostic calendar, an urgent care calendar, a surgeon's calendar, so on and so forth, they're all calendars. That's all commoditized. And then you have a dime, a dozen voice vendors coming out every week. And even if I tell you my voice is the best, it doesn't matter. That's commoditized. So what really matters is that it's solving that human problem and giving them the unlock that they've been, you know, literally banging their heads against the walls over less 10 years, over a decade to solve. And so that's where the trust gets built and that's why they see us as different. And yeah, I could probably keep going on that, but all that answers probably got along enough. No, no, that's great. And there's a couple of different things that I want to unpack there. Trust being one, you know, you talk about trust being central. And in general, we talking about technological implementation in health care. Trust in kind of like the human processes is such a central component and like the governance part of it and the, hey, what are you doing? And what's the liability and all those things versus, you know, the technological capabilities. I've heard from a lot of executives in the industry, they're saying, hey, the tech is there to your point, like a lot of it is commoditized, but it's the trust in getting physicians to relinquish that and getting in. There's a friction there because you don't want to change Debbie's role, right? And Debbie's worried about her role, so can you talk a little bit more about like, you know, how are you, how do you thoughtfully introduce trust, get physicians and clinicians to, you know, adopt your technology and, you know, that whole dynamic, I'd love to explore. Yeah. I mean, one, there is no easy way to do it. We have a clinical operations team, a clinical advisor team, and they are the ones that come in because, hey, doctors are not going to trust anybody besides doctors, right? I mean, they've had, you know, throughout their entire careers, they could probably, they've lost count on how many consultants have come in and tried to help them practice better. But, you know, you have to hear from somebody who's gone through a day in and day out. Second, there's a way that the conversation shifts when you show a subspecialist because they don't believe that you can handle their complexity. And why should they, right? I mean, they've been let down by technology ever since they got forced to adopt DMRs and probably even before that. And so you have to be able to show them like, hey, here are the permutations of your basically what comes down to your clinical pref card, just like your surgical pref card, right? And here's how it's represented and here's how it's navigated. And here you talk to the AI. You try to book yourself something, right? And having them go through that, there's just nothing more powerful for them to feel that it's actually navigating their schedule appropriately or their preferences appropriately. The other nice thing, and this is just something we can do at our scale, is they can, they look at our list of logos and they probably went to residency or fellowship with somebody on that list. And then they just pick up the phone and call. I had an academic medical center earlier this year, literally look at the logo list and say, yeah, I know a few of those folks. And I was like, okay, great. And without even telling us, they picked up the phone and called three of our big clients and back channel them because they knew, I mean, they were in the trenches together in their residency. And then they just said, hey, what's going on? And is that a subspecialist level? There's nothing more powerful than an ortho chair calling his ortho chair buddy somewhere else or a cardiology chair calling her fellow somewhere else and saying, oh, did you see this? You're seeing this in your practice. You guys have been able to grow. You've been able to keep costs steady. Okay, fantastic. Let's talk. So, but I mean, but that's what, that's the trust we've earned and kind of the work we've done over past three and a half years. So yeah, I mean, unfortunately, there's no shortcut. There's no easy answer. You have to build a trust brick by brick. You have to be able to show it to them. And then you build an army of folks that actually evangelize on your behalf and put them in contact. You know, the best thing is our partners and new partners talk to each other and we get out of the way. Yeah. Yeah. And to your point, like word of mouth is the most powerful thing. Like, that's probably the biggest market signal in general. Like, if you're growing through other physicians or decision makers, evangelizing on your behalf, that's a win-win because your acquisition costs are going down. But also, that's probably better technology, right? And so forth. So, speaking of technology, I love you to kind of demystify, you know, a couple of terms talking about like, because you've mentioned permutations, you've mentioned EMR is kind of working with decision trees. Um, one, like how relevant is that to what you guys do? And two, can you kind of walk me through the technological side a little bit? Just at a curiosity? Yeah. Absolutely. So, I mean, decision trees are essentially, if then statements and a patient or a software essentially has to navigate every piece of it to get to the rest. But that is not how the human schedulers are actually processing the information, right? The reason why it's so much easier and more seamless for you to talk to somebody on the phone is because they're actually doing a level of inference, right? They're talking to you. They're getting a couple of signals based off of the first two to three questions they ask. They're looking at your med list, they're looking at your problem list, they're looking at, you know, your latest visit note, et cetera, and able to say, okay, without even asking any more questions, I have a 90 to 95% idea of what this patient needs, and able to jump to that directly without having to say, do you do this? Did you do this? Do you have this? Do you have this? I see. And so that's what a decision tree does and that's what if you layer agentic frameworks on top of a legacy decision tree like that, that's what it's going to do. It's just going to navigate it better, right? Well, or not navigated better, it's just going to navigate it in a more human voice that seems more seamless, but it's not actually getting to the level of intentionality or intense signals that an agentic infrastructure can get to. And what that does is, hey, the agent picks up the AI agent, interacts with you, maybe learns who you are after a couple of questions, but it's also reading your contact from the EMR. And it knows that, okay, based off of what I'm seeing, I need to skip to step 21 and actually start interacting with the patient on step 21. And I don't need to go through two through 18 to actually get to the next step and get the patient navigated. Moreover, you also need the ability to jump around. So even if you have, I wish I could show visualization of this, but you can see all of our nodes and the tool calls that they're making in our agentic workflows. And it's clearly segmented into, okay, these are the types of things that need to happen first, these are the types of things that need to happen second and third and so on and so forth. But what you're watching as it happened in real time is that the agent skipping to step five, then step two, then step four, then going to step 20, and it needs to be able to bob and weave with the patient as the patient, because the best experience is the patient should just say whatever they want. agent is able to navigate it. You shouldn't have to, like, I mean, we've all dealt with terrible IVR systems, right? Where you just pronounce the word wrong and it sends you off into completely random path. And so the best, the best experience for the patient is being able to say what you want, take the conversation the way you want and the agent is responding just like a person would. But unlike the folks, like the agent doesn't get tired, it doesn't have a bad day, it doesn't skip steps, it always sticks to the script, it always sticks to the evidence-based mispractice so on and so forth. So you don't have to worry about variation and quality, variation in outcomes and things like that. - Yeah, that's super helpful. And my mind immediately jumps to, that's not too dissimilar from when we were talking before. And you mentioned kind of, hey, access needs to come through the front door, it needs to come through the garage door and it needs to come through the side door. So can you talk a little bit more about, like, you know, what's your experience been like with getting a patient who's coming through, you know, the garage door, like different access points in the healthcare kind of system or network, 'cause I know a lot of health system executives are thinking about, you know, how do we expand our access? How do we reach the patient where they are, you know, multi-modality interfaces, those sorts of things. Talk to me about how you kind of capture those different points. - Yeah, the interesting thing is everybody recognizes that there's so many different modalities and entry points, everybody still talks about this magical thing called the digital front door. And it's just one of my pet peeves at this point is like, well, can we all just have an honest conversations? Patients are coming through the front door back door garage wherever and you got to meet them where they are. And wherever the digital house, the digital house, there you go, and you just got to meet them where they are. And wherever they enter and however they enter, how are they need to be engaged with, needs to be equally as seamless. You can't just say, hey, my call center's gonna be seamless, but I'm still gonna leave carigabs and referrals and diagnostics and prior off to some antiquated process, because then you're just thinking about everything in points of things that need to be done, right? But it's all one care continuum, it's all one interaction with the patient. And, you know, consumer brands have solved this, right? And they understand and they really, you know, take that to heart. But in healthcare, we still think of everything as disjointed because, I mean, realistically, some of these PNLs go up to completely different owners, right? And so you have to think about them slightly differently in that way. So, hey, I wanna disabuse everybody of the notion that there's this AI front door. And you have to meet patients where they are and whether they're coming in through the back door, or the garage. And then the second thing is also disabuse yourself of the notion that there's this nice linear patient journey, right? Patients are coming out of the ED and they've got an osteoarthritis, you know, diagnosis, they have CHF that needs to be managed, they've got a colorectal screening, they've missed for three years. All of those things need to happen. And one seamless interaction with the patient. And again, going back to my earlier point, patients leave with an AVS and then it's up to you as a patient to go figure out your AVS and navigate it. You know, I'll give you a good example of my dad, right? So he last November, he got turkey lodged in his esophagus with the first bite of Thanksgiving dinner. So he could breathe, he was just very uncomfortable 'cause it was in his esophagus. So I take him to the urgent care nearby and they take a look, they do some imaging and they say, hey, you actually, there's something lodged, you need to go to the local hospital. And so we go down to the local hospital, he gets an emergency endoscopy and it felt so bad for that GI surgeon and nurse that just had to come in and get an endoscopy done, but you know, they did the endoscopy and they broke up the food, but they found that he had an ulcer at the intersection of his esophagus and his stomach. So that's why the food was getting stuck. And so then they had to do the biopsy and the ulcer. So luckily I was there, this is in Atlanta, where my dad lives. And so I was able to navigate all that. We were back home by 4 a.m. the next morning, it was fantastic. But that's the rough Thanksgiving now. It was a rough Thanksgiving. And so, but you know, then I had to fly back to San Francisco, you know, 3,000 miles away. But I have access to his medical record. I help him navigate his care. And so I'm sitting there waiting for the email to say, hey, your results are available. Then I'm calling him and saying, hey dad, your results are available. We need to go see your PCP again. You got to skip water or remix this day, like you got to cancel your bridge, like you got to go to this appointment, let's get it done. Then the appointment gets done. And I know that he's going to put him, the doc's going to put him on, follow up on college or follow up GI pathways, depending on what the biopsy said. Luckily, it was follow up GI pathway. And so it's like, okay, great. You're going to need another endoscopy in six to eight weeks. You're going to need, you know, preannices of testing, update to labs, you know, all of that beforehand. And then I'm sitting with my dad helping him navigate all of this, right, because otherwise it would be up to him to navigate all of that. And you know, what would happen if he didn't take his medications on time or if he didn't show up at that follow-up and his ulcer got worse, he would end up back at the ED, right? And that's not great for anybody involved. And so that's what I'm saying. Like, you know, he has a nice digital front door, but that is the side door he came into. And then there's all the downstream stuff that need to happen for him. And every one of those needs to be a seamless experience. And so I, as a mod, was his AI agent essentially, but that's what a sort solves, right? And that's what we saw. And that's what the technology should do is, hey, Mr. Sheen, your results are in. Let's get you in for your PCP. Hey, Mr. Sheeds, looks like you're on a follow-up GI pathway here. The seven things that need to happen over the next six weeks. Let's get all of that sequence for you and working with you side by side on behalf of this health system. - Yeah, that's awesome. And a great example, although an unfortunate one, I'm sorry, your dad had to go through that. But I guess it happens to the best of us. - I mean, it's Turkey, I mean, it's so dry. (laughing) I was actually going to be my follow-up. You know, what's the best way to prepare the Turkey, the Thanksgiving Turkey? Because it's not, I'm not the biggest fan of Turkey myself. - Yeah, I was going to say has anybody figured that out yet? - Maybe you stray away from Turkey and go to, you know, barbecue or something else, you know. - I'm a fan of that. - I'm a fan of that. (laughing) - Your touch is a showing blake. - Right, yeah, why do you have to have Turkey on Thanksgiving? Let's just smoke a brisket and, you know, that's not going to get stuck. - Yeah. - Anyway, I digress. But like to your point around, you know, the health systems on their side of the equation, like they should care about the patient too, because more and more, they're on the hook economically and from a risk perspective for, you know, read missions, penalties and, you know, bundle payments and those sorts of things. So there's an onus on them to invest in technology and move toward that more, you know, collaborative and engaging model, right? And more, you know, to compound that point further, talk to a lot of health systems who historically, you know, the health system 1.0 model has been kind of tapped out, right, and the fever service is now this lagging indicator, but historically, they've invested in all of these points of care and optimized for those points of care. And now, they're moving more toward that, you know, your paradigm with the patient journey being at the center, right? And so they're thinking more about, hey, how can I optimize the patient journey rather than these fever service, like points in time, you know? So a really cool example I've got recently from somebody I was talking to was, you know, laboratory, for instance, like where are the bottlenecks when it comes to the patient themselves? And like laboratory access and like hours open for a lab is one of those because it kind of determines everything else, right? Like so your dad's biopsy results or whatever that is. Like if the lab is not open, maybe you don't get the results as fast and you can't push them through the journey. So I guess like my question for you within all that is as we're moving more toward that kind of future, how much like hidden capacity exists in healthcare that like can be unlocked if that makes sense? - My God, so much, so much. - See, but sorry, I'm okay with that, because I feel like everybody talks about shortages in deserts and all this and then all of that is very valid. But at the same time, you know, I do think AI and technology and in general, there's like a better way to, you know, smartly allocate resources to potentially cover up a lot of that. So I'd love to vet that pieces with you in your response. - Yeah, I mean, I will say that there is no doubt a body's problem as well, right? I mean, I think it's an N, not a, or. So we definitely have a shortage of caregivers in the country, but outside of that, there's absolutely latent capacity sitting there than nobody recognizes. Or it's very hard to recognize because oftentimes the folks navigating that latent capacity are, you know, folks in your call center that there's not that much training that takes them six to 10 months to ramp up. There's 30 to 40% turnover. And there's all this tribal knowledge sitting inside some experienced folks heads on how to navigate some of this effectively. So it never scales across the organization. But, you know, key examples here are things like visits that should be going to APPs and PAs or NPs that are going to surgeons instead. I had one organization where, you know, there was, you know, we were talking about, hey, I've got a 90% panel utilization. It's impossible to get to 100% panel utilization because everybody needs breaks. Everybody, you know, needs time to charge. So on and so forth, you just never get to get to 100% without burning people out. But, you know, when you look at it, even five to 10% of that ENT service line of the surgeon panels across the service line were patients who should have gone to allergy specialist, otologist, audiologists, and other sites of care that didn't require a surgeon level of care. At least not at that point, right? But that was what the surgeon was going to do. we're gonna see him. It was good. going to be a five to 10 minute visit, that was probably going to take another five to 10 minutes to document and say, all right, well, I saw this patient, but they need to go to analogy specialists as the next thing or an autologist as the next thing. They shouldn't be here. Maybe if everything doesn't work out with those and they come back to the E&T surgeon, that's five to 10% across an entire service line of latent capacity, right? And so you need to be able to fill that or identify it to open it up because it is also the most cost effective way to get capacity. 'Cause what does everybody generally do to get capacity? They acquire practices in their local area, right? So that's gonna cost you anywhere from five to $30 million depending on the size of practice. And some, you know, if you have free cash flows, sometimes you build a shiny new tower to attract people to then, you know, buy up practices and come work for you. So then you're spending $50 million in a new tower and then another 10 to 30 million per practice that comes into practice at that tower. These are all very expensive ways to get capacity. And some of that's needed, 'cause again, we have a body's problem, but there is, you know, and I'm just talking about E&T's, right? And we work across 23 service lines and there's even more than we don't even work with and how much latent capacity is sitting in those, especially with the complex ones like orthopedics or vascular or cardiology. We have very complex patients that have very complex needs but not every visit requires an MD or surgeon. A lot of visits can be going to APPs and NPs. So yeah, there's just so much latent capacity that can be filled with also the latent demand. - Do you find. Hey, hospitologists, I've talked a lot about patient access AI and most of it gets measured the wrong way. Tracking things like answer A, handle time or call containment. But the real outcome happens after the call. The referral resolved, the intake done, the appointment actually on the calendar. A sort of health AI agents handle that whole chain, built on more than 250 million patient interactions. Customers have captured up to $4.3 million in new annual revenue per 100 providers. Visit assorthealth.com/hospitology to learn more. - I'm thinking about status quo, both from a human perspective and then a fee-for-service chassis perspective and you obviously can work in any system. But from a human culture perspective with the physician, like, do you run into challenges around like, hey, no, like this surgeon wants to see everyone, you know, this is his domain, his or her domain and how do you kind of work around that or solve for that? I guess it kind of goes back to the whole, trust and adoption thing. But. - Yeah, and candidly maybe you don't start with that surgeon, right? - Sure. - You start with his or her partners, you start with the other part of the, I had one organization, an AMC, where they had an orthopedic surgeon that did nothing, but like joint replacements on valoriness. And that was their subspecialty. And I didn't even realize you could get that, you know. - That's niche. - That is niche upon niche. - That's like the guy that operates on, you know, NFL players, like, who's, that's a lot of pressure to perform the ACL surgery on like Patrick Mahomes, you know, like, that's a different level. - That's a $50 million surgery you're performing. For an organization. - Yeah. - Yeah. But yeah, I mean, so it is, it is the unsexy stuff of change management. And that's oftentimes what it comes back to. And, you know, I've been doing this for about 14, 15 years in healthcare and it always irks me when somebody thinks, oh, I could just throw technology at a problem, right? It's always people process first and then the technology. And so, yeah, you have to work with their peers, you have to work around them. And then, I mean, let's be honest, you're not going to get the 100% compliance for everybody wanting to do this, right? But even if you get 80, 90, 95%, that's massive amounts of capacity you're creating and then access you're creating and, you know, it has downstream effects. - Yeah, that makes a lot of sense, compounded over time. - Yeah. - Yeah, and I want to address your earlier points, which is so true around, you know, the typical kind of playbook for growth is to five physicians, whether they're primary care in a certain subspecialty or career-finished physicians or like build the capacity and, you know, as Medicaid disenrollments and OB-3 phase-in and those sorts of things, a lot of health systems are anticipating hits, right? And they're already seeing a lot of hits from the ACA subsidies expiring and, you know, who knows what happens with the midterms and all those sorts of things and whether all this truly comes through. But right now, the current status quo is, hey, we are anticipating margin declines next year and into the future. And so, what's the best way to counteract that is, you know, investing in technology, adopting technology and doing the things that you're saying a sort can do as far as expanding capacity of existing service lines and smart allocation of resources to the right specialists and care team members of the various domains and various specialties and, I mean, that makes sense to me versus the more capital intensive stuff. - Yeah, and there's a couple of things there, 'cause, you know, I start to wonder sometimes that everything that we're talking about is just basically good business, right? At the end of the day, yes, we're still providing care to patients and that we need to keep that at the forefront, but everything VBC stands for is just good business. You want efficient operations, you want patients getting to the right side of care, you want, you know, easy access, you want infrastructure to help them recognize that access and all of that. So, in a way, you know, I feel torn. I absolutely don't want anybody to lose eligibility or end up back in the ED or not get the care that they need, you know, in the time that they need, but this is also an interesting, like, forcing function where, hey, as a health system, you finally have to get your operations under control. Like, you've been putting it off, you've been thinking it's too tough, you don't want to do the dirty work in the change management, but you gotta do it now. It's existential. You do it or you set yourself to be acquired and the consolidation of healthcare work is the last thing any of us need, right? And so, it's a forcing function, but that being said, even as you're doing it, I think what, and this kind of goes to organizations that are here about, you know, building versus buying, right? You don't want to reinvent the wheel either. If you're building it yourself, you have no idea what good operations look like. You know, I think the last time people started, you know, cared about, you know, good operations and all of that was when lean was very hot in all the health systems back in, like, 20, I don't know, 16, 17, 18, 20, et cetera. But everybody's kind of forgotten about that moment and there's just so many nuances on how to develop these operations, how, you know, what great looks like, what great service line operations look like. And so, you know, I've been toying with this idea that I know you and I talked about a little bit, which is evidence-based operations, right? I mean, we went through a clinical, you know, renaissance back in the '90s when we realized we had too much clinical variability and we, you know, clinicians created their, you know, own kind of self-regulation mechanism of, hey, here's what evidence-based care looks like. These are best practice treatments at their putates and pharmaceuticals, so on and so forth. But operations have never, like, risen up to meet the clinical evidence-based, right? And so, we have to create what I'm calling evidence-based operations so that you learn from an external organization or you learn from how it's being done elsewhere and you're able to incorporate it to your operations without having to reinvent the wheel. But, unfortunately, you know, there's so many forces and politics inside organizations that, hey, we can do it ourselves and we, you know, I've got an agent factory now. I've got, you know, cloud code for all of my, you know, engineers, so we can figure out, like, yeah, but the technology is not the hard part. You can vibe could anything over a weekend. It's everything else around it. And you're just going to create great technologies that sets there in languages, but you've kind of checked something off the box and feel good about yourself. - Yeah, yeah, it's so interesting. That dynamic, and I love that term, by the way, the evidence-based operations. And it's more or less, you know, an interesting dynamic in healthcare today where we're so siloed off and there's a lot of incrementalism, right? Which is appropriate in a lot of ways and a lot of settings because healthcare is conservative and we treat the patient, there's liability considerations and all these things, but a lot of the time, a lot of people I find like to think and get stuck in that category where it's like, why can't we do this rather than how can we, or what's possible? And I'd love to, as both in my platform, but in general, move the discourse toward that bucket rather than the cynical bucket. And I'm just an optimist, so that's how it works. But there's a lot of follow the leader in healthcare and it's like, oh, now that this person did it, it's de-risk so I can do it, you know, kind of thing and there's some cool initiatives out there and you guys are obviously right there in the mix too of this health system transformation effort. But yeah, one of the things I've heard, which I'd love your opinion on from the health system perspective is, hey, access is the last battleground when it comes to like health system differentiation. Like this is how we, especially with all the rise in like consumerism and patient-facing AI as far as like, hey, I'm bringing an AI and I'm recording my conversation with my doctor and then I'm gonna check my notes versus them, those kinds of things. But also just, you know, there's a balance between, you know, how much of epic march art should we use for outreach versus something that's really gonna differentiate us. So I'd love to, for you to break down. how you think about, you know, access as differentiation and maybe like walk through different parts of access that really matter from, you know, an ROI perspective or like key considerations within that kind of thinking if that makes sense. Yeah. I think it's fundamentally a differentiation, especially in competitive markets. And I was actually talking to somebody in the Chicago market recently. And, you know, they've got Epic's foundation. They've got the AI tools and, you know, they're doing a lot of really great experimentation. And we were still having a conversation. It was pretty leaned in and I was like, look, you know, I've got to ask, you know, generally when people have all the bells and whistles turned on like you guys do you guys aren't talking to me, right? So what gives and he basically, and he changed my mind or made me see the light on this, which was, look, I'm surrounded by health systems with Epic in this, you know, however big Chicago land is. So all of us are running the same tools. And I don't look differentiated compared to any of the other health systems around me. So I need a digital strategy that fundamentally differentiates me so that I provide the most seamless access to my patients, right? And that matters even more now as patients are looking for their care on their AI agents and, you know, getting away from your Googles and SEOs that, you know, I'll give you an example. So I live in San Francisco. There's three, four big health systems here that all compete with each other. I had to get a ophthalmology referral for my son whose pediatric practice rolls up to one of the AMCs here. And I booked that appointment. And this is maybe two years ago, but it was in October because that's when I do his wellness visits, but I wasn't able to get an appointment until May of the next year. Right. Now, luckily, it wasn't something critical and it was something that could wait. It wasn't that big deal. He's only four. So, you know, the doctor wasn't that worried. But the easiest thing for me to have done was yes, this doctor wanted me to refer me within the AMC network. But it's like, look, this is in May. I got just getting the generic referral. I'm going to go to some, there's three other health systems I can go to that have great ophthalmologist pediatric ophthalmologist. I'm going to go to them. And, you know, not only that, every time I interact with this health system, I get pings constantly, like leading up to a visit. I get five pings through epic. You know, one a day, two a day. Did you do this? Did you do that? Did you do that? And, you know, my son went to one goes to one AMC. He was delivered at another hospital nearby. Some getting pings from both of them. And it's just infuriated. Right. And so this is not a differentiated experience for me. And, you know, the only thing keeping me at this AMC is because it's an AMC. And I know what he does see a pediatric specialist there. It's probably one of the best in the world. And I'm a paranoid parent. Right. But anything outside of that, I would have gone elsewhere easily. And so that's a great example of the differentiation. You could be using the same tools with the same pings over and over again. But chances are, you're not the only game in town that the that your patients are seeing. And you're just compounding your interactions with everybody else, your outreach. And so it's not differentiated. And so, you know, who would I go to? You know, where is my primary care still? One medical, right? It makes it super easy for me to get in. I've been seeing the same doc for eight years. I can do everything through my app. I can message him and he's back into, you know, within two days. The billing department takes care of everything I need to help and even helps me navigate referrals sometimes outside of the one medical network. That is a differentiated patient experience that is kept me with that entity, you know, even, you know, even though I've got great world class care options right around me living in San Francisco. And I just described them one patient with one family that has loyalty to three different health systems for three different things right now. But I like an educated consumer of some of this stuff. So I kind of optimized for that. But I would love to have one of those that just had a seamless experience. I could just navigate like a navigating one medical. And they would get all of my business for all of my family numbers. And heck if they opened up a vet clinic, they'd get my cat as well. So, I mean, yeah, that's the next step. Yeah, that's kind of a rant there. But like I fundamentally see access as differentiation. It's yes, there's a cost play. Yes, there's a revenue play. But like, you know, every other industry has figured out this consumer element. Yeah, now to be fair, to give health care credit, it is a very complex operating environment, right. And so oftentimes health systems have had to reduce the complexity of their operations in order to take advantage of cool technology. But as we discussed earlier, because some of the most complex care does not fit into these technological buckets because nobody's had an answer for them. You still have to go through the old methods of phone and during hours care, so on and so forth. So now the technology's finally been able to. And you know, there's a shameless plug here. It's not all technology. It's our technology, right. That's what I tell health health system leaders. Like, hey, for the first time since the first medical record was created in mass general, like 40 years ago, however long ago, you don't have to reduce your complexity for to take advantage of my cool technology. I meet your complexity where it's at. And that's the only way you're going to be able to differentiate yourself without having to go on a three year standardization journey before you even take advantage of some of this stuff. Sorry. Yeah. And rant. I get very passionate about some of this stuff. Gosh, I feel like that's that was so insightful and so interesting. And you know, I've written about and M of the opinion that access will be a key differentiator in the future, especially as you think about aspects of consumerism and how, you know, my thesis is this consumerism will continue to expand into health care. But in pockets. And so like the first pocket is primary care one because it's quote unquote relatively cheap enough to pay for on a cash pay, you know, outpatient basis. But then you have all these entrance coming in to your point, like, you know, whoop aura. You've got like one medical on Amazon. And then you've got like, you know, the peptide craze and GLP ones. But then there's a reduction and information asymmetry to where there's increasing gradually over time price transparency. And I'm sure there are new AI tools coming out helping people navigate from a patient perspective, things like that. I know for a fact that managed care and payers are investing in like consumer facing apps to get people into certain preferred, you know, network steerage and sites of care and those sorts of things taking something like autism, for instance. And so that's like a threat to a health systems, you know, network, right, and stability to acquire patients, which is needed. So I think I'm rambling now, but I'm with you as far as. Well, question for you on that because I'm glad to hear you say that you're actually probably one of the first people I've interacted with to hear say that because one thing I've been thinking about over the last three months or so, six months or so is. I don't know how much healthcare is underwritten the fact that, you know, so. If we boil it back the reason why healthcare is able to keep the note that it's been keeping is the information asymmetry talked about patients will never have gone to 12 years of medical residency, so on and so forth. And so, you know, and studies have shown even when you have full price transparency patients will often pick the more expensive care because there's some assumption that the quality is better there. But with things like Chatchy PT health, you know, everybody uploading the records things like that you're actually closing the gap on the information asymmetry to certain degree there never going to be experts, right, but they might be good enough to start shopping around. And I don't know how much of that risk has been underwritten into the healthcare ecosystem yet that hey, the information asymmetry that we built our entire business model around might be eroding and for the first time in my health health systems existence, I might actually have to properly compete and not just compete through regulatory capture or creating. We're relying on my competitors to have a, you know, as high friction experiences I do. Yeah, yeah, I'm with the opposite. I think it's so interesting. I feel like one of the fundamental like defining like macro forces that will shape the future is this rise in consumerism and what they can, like to your point around the reduction in information asymmetry again, not perfectly all the way there. But the consumer increasingly will think they know what they want, similar to every other industry, right, you know, the customer is always right, right, but there's a. I don't know civic dude medical duty for the doctor to do what he or she believes is right or like medically indicated right, and so it's like, I think that friction will define the future of healthcare, I don't know, I say that very existentially, but health systems are going to kind of have to grapple with that where it's like, you know, some customer, some patient says, I need an MRI and the doctor's like, no, you don't. And so they kind of go back and forth and maybe the patient goes to a different health system to a different doctor who lets them do what they want. And that's lost demand for that health system, but that's not, you know, medically indicated or whatever, like those kinds of questions. Health care in general has been an anti consumer industry for so long for so many reasons price access, you know, complexity, the fact that they don't, you don't directly purchase it like those sorts of things and some of those walls are coming down. And I think there's a lot of ugliness that's being surfaced because of it. And future generations are not going to accept the current experience. And so seeing folks like Assort be at the crux in the center of enabling a future where more consumerism is possible. That's the future I want to see. But there's a balance there as well between-- It can't be full consumerism, in my opinion, like there has to be some give-and-take without demand, works, and health care, and price and those sorts of things. So I think trust will become a bigger and bigger factor. Like the human trust will become a bigger factor. Because I got to think back to my doc who I've been saying for eight years, right? He's seen me from my 30s into my 40s now. And our conversations have slowly evolved over time to take into, you know, and higher stress jobs, so on and so forth. I mean, and we'll do the claw thing or chat TVD thing and like send them things and they'll be like, all right, where did you get this? 'Cause he knows me well enough. And then he'll be like, all right, here's why, and et cetera, et cetera, et cetera. And at the end of the day, I trust him more than I trust in the AI at the moment. And so, you know, I still listen every-- more or less everything, he says. He still gets frustrated with me sometimes when I don't listen, but. Yeah, but also it's like to talk about my personal experience. So, you know, the statistics, like a lot of young folks, like don't have longitudinal primary care relationships. Like, I just recently got a PCP, but before that, my first, like true, real big touch point with the health system was when we got pregnant and delivered a baby. And so, if, I don't know, there's, you think about the patient journey and just like in general, thinking about long-term value to acquisition cost from a pure business perspective. Like, if they can make that experience delightful, which is maybe not like the most lucrative service of the health system, you know, women's health and they'll be jamming those kinds of things. But if they can make that experience delightful, then you could potentially, like, win me as a quote unquote customer for life and be like, okay, they treated us really well. The digital experience was great. The building was seamless. All those things go into, I'm probably more likely to seek a physician from that health care system or hospital in the future, you know? So I think those are the considerations that health system needs to have moving forward. - Yeah, no, absolutely. One question for you on that. What was the latest you got a bill after your kid was born? - Well, let me tell you something. So this is the interesting thing. We put down a deposit for like the professional piece of the bill. And when we got pregnant again, we went back and they said, oh, like, we have a credit on your account. Like, you overpaid from the deposit and I was like, how is this possible? And also like, what were you gonna do with that money if we had never come back, you know? Like, do you eventually like, mail it to me? And so I just think about that. I'm like, how are things like that still possible in health care, you know? - Well, that's a nice delightful experience. And hey, you have free money sitting at this health system. - Yeah, maybe they just made it up. They're like, here's some money. So come back to us. - Yeah, mine was like, I think it was two years after he was born. We thought we had paid everything and got a random bill. Like, why the hell is, you know, what's going on here? And it was like, no, who's this random $200? What a, it was something nominal, but like two years later. It was like, I don't know if you follow Nikhil Krishnan out of pocket, but he's written about his, their birth experience as well. And that's fascinating because he's super thoughtful. But I can tell you from an actual billing perspective, I think we got the anesthesiology bill something like six months later or something, you know? And it's like, hey, they might be a network, they might not. And I'm just like, this is, you know, typical, like I write about healthcare. And I should quote unquote, know these things, but it's just impossible for everyone to get all of that figured out. So yeah, it's interesting to think about it and fun to hope for a more consumer-enabled, patient-facing future. But yeah, so, I think that's a great way to wrap up the conversation. I do just have one more question for you, which now we're kind of getting to the more personal stuff. And my question to kind of end every podcast is, what's an experience or book, piece of advice or a mentor who has fundamentally changed how you live your life? - Oh, that's a great question. There's one that I'm thinking about, but I'm forgetting its title. You can allude to it? - Yeah. Well, I mean, I'll just go with, you know, how I got into healthcare, which was through reading Dr. Tula Gwande's checklist manifesto. That's like we built our entire company around that and I was consulting at the time and the guys that I got set up with are like, "Look, you don't understand healthcare. Just read this book." And then let's talk and I read it over a weekend and I called them and I was like, "Are you kidding me? "This is how healthcare is practiced." And so yeah, I think that and then like being mortal yeah, I think that's what his other book is. If you haven't read that, it talks about end of life care and how we need to think about that in the United States compared to how others think about it. And that was fundamentally like immediately I read that and I called my parents and I was like, "Are you guys need a living well?" And you guys need like care instructions, you know, so on and so forth. This is not okay. - Yeah, that's super interesting. - Yeah, highly recommend that for anybody who has read it, he's a great author. - Yeah, I think that's on my, those are on my list. I just haven't gone around to it, but to that point, I do feel like society at large is in denial about death and there's a lot of considerations there. So I appreciate you bringing that up. - Very absolutely. - Yeah, Ahmad, you know, thanks so much for the conversation today. I thought this was fascinating. Lots of really interesting dynamics at play and it was fun to hash things out with you. So thanks for your time. I mean, it was so great to learn more about a sore health and you know, best of luck to you guys for the rest of 2026 and into 27 and beyond. - Yeah, I know, thanks for having me play because I mentioned before, you know, I read your newsletter, follow everything you're doing. So, you know, really appreciate the work you're doing to analyze the space. It's always great when people are doing it with some humor and some insight, you know, that's different than what you read kind of in the trades. But thanks for having me. - Thanks for listening to this episode of Claims Denied. Stay up to date with news and trends in healthcare by subscribing wherever you get your podcasts. You can find more resources and apply to join the hospitality community at hospitology.com. Also, if you love Claims Denied, please tell a friend and share it with a colleague. Until next time, hospitologists.