This episode features an interview with Ali Diab and Halle Tecco. Ali is the CEO and Co-founder of Collective Health, the world’s leading employer health benefit plan administration platform. Prior to co-founding Collective Health, he held executive and management positions at AdMob by Google, Goldman Sachs, Microsoft, and Yahoo!. Halle is an entrepreneur and Adjunct Professor at Columbia Business School, Course Director at Harvard Medical School, and Collective Health Board Member. Passionate about fixing the U.S. healthcare system, she founded Rock Health, the first venture fund dedicated to digital health, and co-founded companies such as Cofertility and Natalist. Halle is also the co-host of The Heart of Healthcare podcast. In this episode, Sasha, Ali, and Halle discuss consumer-focused healthcare, the role of AI in enhancing member experience and the care economy, and the potential for public-private partnerships in managing healthcare costs.
This episode features an interview with Ali Diab and Halle Tecco. Ali is the CEO and Co-founder of Collective Health, the world’s leading employer health benefit plan administration platform. Prior to co-founding Collective Health, he held executive and management positions at AdMob by Google, Goldman Sachs, Microsoft, and Yahoo!. Halle is an entrepreneur and Adjunct Professor at Columbia Business School, Course Director at Harvard Medical School, and Collective Health Board Member. Passionate about fixing the U.S. healthcare system, she founded Rock Health, the first venture fund dedicated to digital health, and co-founded companies such as Cofertility and Natalist. Halle is also the co-host of The Heart of Healthcare podcast.
In this episode, Sasha, Ali, and Halle discuss consumer-focused healthcare, the role of AI in enhancing member experience and the care economy, and the potential for public-private partnerships in managing healthcare costs.
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“Are you a consumer-focused or customer-focused healthcare company? Or are you a self-interested healthcare company? I think, sadly, a lot of the incumbent players in our industry are more self-interested than they are customer-focused. I think that's the thing that is the hallmark of Collective Health. That's why we exist because we don't think people are being served in the way that they should with that kind of customer obsession that we see in other industries that leads to great things, including the appropriate use of technology to make that experience better.” – Ali Diab
“I think that because we are the end payers through tax dollars, through lower wages, through direct payment, out-of-pocket spending, we deserve to have the players listen to our needs and our demands to lower the cost. But unfortunately, we have an industry that's profiting quite nicely from us, so it's going to take a lot of work, collective work. But, we have no choice. We can't leave the system to our children and grandchildren like this.” – Halle Tecco
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Episode Timestamps:
*(01:04): Ali’s personal health journey that led to Collective Health
*(06:28): Halle’s journey in digital health
*(15:42): How digital health is changing the industry
*(25:55): The impact of member experience
*(31:19): The role of AI in healthcare
*(44:27): Future trends in healthcare
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Links:
Connect with Halle on LinkedIn
Listen to The Heart of Healthcare
Connect with Sasha on LinkedIn
Learn more about Collective Health
Sasha Yamaguchi: Let's face it, healthcare is confusing and costs are continuing to rise. Employers are looking for ways to improve the health of their people and their bottom lines. The good news? Many leading companies are leveraging self funded health plans and innovative benefit solutions to do just that. Learn from some of the best minds in employee health.
Sasha Yamaguchi: Welcome to the Benefits Playbook, Strategies for Self Funded Health Plans. I'm your host, Sasha Yamaguchi. Commercial Leader at Collective Health. On today's episode, we are joined by Ali Diab, CEO and Co Founder of Collective Health, as well as Halle Techo, Entrepreneur and Adjunct Professor at Columbia Business School and Course Director at Harvard Medical School.
Sasha Yamaguchi: She is also a newly minted Collective Health Board Member. Thank you both for being with us today. I'm really excited to have you both for our season finale.
Ali Diab: Thank you for having me, Sasha. It's great to be here.
Halle Tecco: Yeah, likewise. I'm excited to be here.
Sasha Yamaguchi: Great. I really want to start, Ali, with you. Obviously, those that know the story of how you started Collective Health, but some may not, I would love for you to share a little bit about the backstory, what led you to starting Collective Health, and then, of course, where we're at now.
Ali Diab: Yeah, I'd be happy to. Collective Health, as you know, being here, is an 11 year old company. I started the company in mid 2013 with my co founder. After a pretty harrowing personal experience with my own health, I was hospitalized earlier in the year, in March 2013, with a small intestinal obstruction. I had most of my small intestine removed.
Ali Diab: through a series of surgeries, and I ended up spending almost three weeks at the hospital. Once I was discharged, you know, obviously after an experience like that, pretty deconditioned and pretty poor health, I came home and, you know, was looking forward to a somewhat quiet recovery. And a few weeks later, I started to receive notices from our insurance company, health insurance company, at the time that most of my build hospital charges were being denied.
Ali Diab: And the reasons that You know, very difficult to decipher on those kinds of denial forms from your typical health insurance company. Were that, ultimately I discovered, were the procedures that I had done were experimental, and therefore out of sort of range of what would be typically covered. And that I was basically on the hook for about half of my hospital bill, which was pretty shocking for me, because it was a multi hundred thousand dollar hospital bill.
Ali Diab: I didn't have the means to cover that expense. So that's really what sort of sparked my interest in trying to understand, you know, why these things happen. And then the experience of actually trying to advocate for myself to get that denial overturned is actually really what motivated me to start Collective Health with my co founder who was actually practicing medicine at the Stanford Hospital where I was treated at the time because it just felt like customer service by attrition.
Ali Diab: They wanted really nothing to do with me and basically were just trying to make me go away. And so I ultimately ended up suing the health insurance company in order to get my case notes and in order to fight back. And ultimately did get the denial reversed, but it was months and hundreds of hours on call center lines and writing letters, writing faxes.
Ali Diab: And I just remember thinking to myself, like, you know, I'm a native, I'm well educated, I have the means, I have the time to do this. What happens to people who. Don't speak English as their native language. What happens to people who are working two or three jobs and don't have the means to spend the time or to spend the money to do something like this?
Ali Diab: So that's really ultimately what drove me to start the company.
Sasha Yamaguchi: No, and that's wonderful because I think you hit on a couple of points in just that of, look how much time you personally spent. Not everyone has that time, you know, the knowledge, and they do just go away, right? And you fought for your situation.
Sasha Yamaguchi: And then luckily started Collective Health, which of course advocates for members every day.
Ali Diab: Yeah. And one thing I would add also, I mean, I remember, you know, when I was interested in starting a company, you know, just sort of start a company like this, you know, as a, Total naive person, although I was somewhat naive at the time about what I was getting into.
Ali Diab: I remember doing research and just reading things. You know, Elizabeth Warren, when she was at Harvard Law School, did some research and estimated that 70 percent of personal bankruptcies in the U. S. were the direct consequence of under insurance of a health event or non insurance of a health event. And I remember thinking, Oh my God, if two out of three personal bankruptcies are related to a very, very, very personal issue like this, I can only imagine how pervasive This must be, I'm not an N of one.
Ali Diab: There's lots of people dealing with exactly what I'm dealing with. And then, you know, there's confirmation bias when you get into something. I just started to talk to people randomly and literally discover like almost every other person had some health insurance issue that they were battling with or a family member was battling with.
Ali Diab: So it was clearly something that was pretty endemic.
Sasha Yamaguchi: Agree. And I think for everyone listening that don't know, you're obviously you started the company from a personal situation, but I think people would love to hear, you did not come from a company or a position that really was in healthcare. Just share a minute about kind of your background there, because as you know, and I've said this to you many times, the fact that you quite literally started a healthcare company 11 years ago without having that background, I think is really fascinating.
Ali Diab: Yeah, I mean, my only exposure to healthcare, other than having been a user of healthcare or a patient, was my mom being a doctor and my brother being a doctor, but other than that, I had literally no experience in the healthcare industry. I'm a consumer internet person by background. And again, I think maybe that perspective, and maybe even you could call it that naivete, was helpful.
Ali Diab: Because again, I didn't know what I was getting into, and I wasn't sort of conditioned to think that things aren't possible. I also took very much an end user's perspective in terms of how to fix this, which I think is deeply lacking in healthcare in general, but I think in health insurance very specifically.
Ali Diab: And I think it's one of the reasons why health insurance companies have such low net promoter scores even still, because they don't really focus on the customer or the user and then sort of design everything around that. They really focus around themselves and how to entrench their profitability and focus everything around that.
Sasha Yamaguchi: Thank you for sharing a little bit more about that. I think it's important for those listening. So Halle, I feel like what Ali has just shared is very similar to your journey and story and trying to help members help our industry. So can you share a little bit about the digital health space, which I think is broad, but really where did you start?
Sasha Yamaguchi: What has your journey been and how did you get passionate about very similar things to what Ali just shared?
Halle Tecco: Yeah, and I'm just sitting here smiling as Ali is telling the story because we face such enormous challenges in healthcare and we need all the brilliant minds we can get. And the fact that healthcare has traditionally really gatekeeped outsiders, not allowing them in and naysaying all their brilliant ideas does no service to innovation in healthcare.
Halle Tecco: And I've really dedicated my career to trying and changing that. Trying to be a welcoming, supportive guide for folks who want to genuinely come in and make healthcare better. That's not to say that sometimes outsiders make big messes, but I think that outsiders like Ali, who come in thoughtfully, study the sector, bring in folks who know different parts of the, system and how it works, really the greatest hope that we have for change.
Halle Tecco: And so I've throughout my career in healthcare have, I guess, gotten to where I am by advocating for change, advocating for the people who are well positioned to make change and learning in the open. I mean, I'm, we're all healthcare outsiders, but at the same time, we're all the biggest stakeholder that matters.
Halle Tecco: And so, is outsider even the right word for it, because we all are both sometimes passive receivers of care, but we pay for 100 percent of the care we receive, and we pay for it when we don't receive the right care, and it costs more down the line because our system focuses on solving problems, not preventing them in the first place.
Halle Tecco: And so, as a healthcare consumer, As I said, I've learned in the open. I have a finance background. I have an MBA. I did end up getting my MPH, which makes me on paper more of an insider now, but I've kind of just shared everything as I'm learning. Through my blog, I have a podcast, meeting people, talking to people, and just not gatekeeping any information.
Sasha Yamaguchi: I love that. And to your podcast, what I think is important is there's the big things that we're trying to do by starting companies that advocate for members, but it's also just. education. I feel like it's really important, even through this conversation today and through your podcast and ours, of having everyone just learn more than they knew before, right?
Sasha Yamaguchi: Members, employers, brokers, everyone in our industry. You both made me think of a question that could be a big question, but if you think of the last 10 years, do you mind sharing, you know, when we talk about advocating for change, what is one, I guess, Maybe a simple thing that you feel has started to change out of curiosity.
Sasha Yamaguchi: Ali, I'll have you go first, but what's the first thing that pops in your mind when you say, yeah, over the last 10 years, there has been change here, even if it's not at the final result of what we want to see.
Ali Diab: Yeah, I mean, to me, the thing that makes me most optimistic, if I can answer your question maybe in that way, is just seeing the level of interest among, kind of continuing on the conversation we just have, among quote unquote outsiders to want to fix this.
Ali Diab: the problem with US healthcare. I mean, it's GDP. It'll be 1 4th of GDP soon enough, and 1 3rd of GDP, not that much longer after that if we continue on the current inflationary trajectory. And so I think as a result, it's viewed as a very meaningful problem. In particular, among young people, I just spoke with a very large cohort of Y Combinator, you know, entrepreneurs the other night, and these people could be doing anything.
Ali Diab: I mean, they could be working at great tech startups, they could be starting consumer tech companies, but they're all very, very interested and motivated. By fixing the US healthcare system for precisely all of the reasons that we're talking about. And so to me, the thing that makes me most optimistic that I have seen over the last 10 years, if not more, is just the number of quote unquote outsiders who are coming in, who could be using their huge brains, to Halle's point, to do other things, but are really trying to fix the system.
Ali Diab: Um, and that I actually think, I mean, I might be over exaggerating here, but I think if we don't fix healthcare, I think that is the biggest. national security risk that we face. I don't think we are going to get defeated by forces from the outside. We have the world's most powerful military by far. We have still, thankfully, the best governance system in the world, I think by far, but we are way over our skis in terms of our federal obligations and our ability to fund them.
Ali Diab: And if we continue to let actors abuse us. All of us, like taxpayers, government agencies, employers, by continuing to pull the wool over our eyes and take the money out of our wallets, I think we could end up in a really, really tough spot. And the last thing I'll say is, I think a lot of sort of closed, protected industries have been demonstrably well managed.
Ali Diab: Disrupted by outsiders. Jeff Bezos is not a retail exec by background. Elon Musk is certainly not a transportation or aerospace exec by background. Similarly, Travis Kalanick is not a transportation services person by background, but they are smart people who looked at a problem and said, there's no reason why.
Ali Diab: I can't try to fix this. And I think that level of try is something that I'm really, really, really happy to see in healthcare. Yeah.
Halle Tecco: As healthcare spending goes up and up and up with no stop in sight, consumers are getting upset about it. And we've seen Even recently, the Sierra seen two lawsuits of former employees that have sued their employers for negligence because they say that the PBMs they've partnered with were not giving them the best deal possible.
Halle Tecco: And so I think we're, we're starting to see, and you asked kind of in the last 10 years, What I'm most excited about, I think 10 years ago, there was a decent, there were decent solutions for people who were both motivated and pretty healthy. We've had a lot of tracking devices, a lot of wellness solutions, and I think that market has been well served.
Halle Tecco: Certainly there's more to do, but it's been well served. Where What we really have failed is to engage the chronically unengaged healthcare consumers. And I do believe that's starting to change. And I, I do something in my home state of Ohio where I ask my family when I'm home or on a call of, what healthcare brands have you heard of lately or seen ads for or used?
Halle Tecco: And I'm starting to hear like my mom was, she had heard of Devoted Health. She was telling me about Devoted Health, and 23andMe, they did years ago, and Hymns, they're getting ads for. And so these are now becoming household names in Ohio, which gets me really excited because it's not just the, you know, healthy, engaged, you employee in New York City who is going to be a little, little of a burden to our healthcare system, but hopefully we're starting to get to folks that would otherwise be perhaps overlooked or just unengaged because of medical disenfranchisement or other factors.
Sasha Yamaguchi: So I love that point, Halle, because, you know, years ago it was popping up in New York, in LA, right? But those services and those companies you just mentioned in Ohio, in small town Texas, in wherever, that's actually where people need it the most right now as well. They don't have access. They don't have enough providers.
Sasha Yamaguchi: And so I agree in that some of these things popped up in big cities, but it's actually the rural areas where people really need more access.
Halle Tecco: Yeah.
Sasha Yamaguchi: Otherwise they're really not getting health.
Halle Tecco: Yeah. And, and digital health is doing this, right? Like Rock Health just came out with a report about how rural health is more plugged into telehealth and growing faster than other segments, which is so cool to see because they're the ones that are going to be least likely close to a specialist or someone, you know, who can help.
Halle Tecco: So where it makes sense, it's happening, which is just super exciting.
Ali Diab: And I would add what's exciting too, is that people have a positive impression of those brands.
Halle Tecco: Mhm. Probably more positive, like 23andMe is a good example, right? Like, people love 23andMe. They don't know that they're probably going to be delisted from the stock market and aren't doing, performing well financially, but they don't, you know, they don't care.
Halle Tecco: They know that they get this valuable information and they can just do this quick test at home.
Ali Diab: Exactly. And that, to me, is in contrast to what people think of, like, the big health insurance companies. I don't know anyone who has a really positive impression of their health insurer. Still.
Sasha Yamaguchi: Yeah, it's just nice members have options now too, right?
Sasha Yamaguchi: It's not just going to your network provider. So, Halle, let's stay on digital health for a minute. I think that's a big topic and could mean a lot of different things. I would love for you to share with the audience, you know, when you think of digital health, all the work that you've personally done in your company, what does that kind of mean to you and where do you see the biggest opportunity of digital health changing our industry and helping everyone?
Halle Tecco: Yeah, you know, there's no agreed upon definition of digital health. We need to work on that, but it would be anywhere where software can improve a process or experience. And this can span from a tech enabled service where it's still a provider, but we're using software to enable them to do their best work all the way to a standalone digital only product for someone like the Aura Ring.
Halle Tecco: You know, it's broad and it can be direct to consumer, it can be B2B, it can be B2C, it can be B2C2B. There's a lot of ways that it can look from a business standpoint. It's a kind of a broad category.
Sasha Yamaguchi: I love how you hit on actually experience or process, because I think most people when they think digital health, it's Fitbit, it's tracking.
Sasha Yamaguchi: And so actually the process part, I think would be really interesting for people to hear a little bit more about.
Halle Tecco: Yeah. Yeah. I mean, the scope of digital health has grown quite a bit and especially the pandemic, which really quickly lowered the barriers for use for providers. Yeah. And what would have otherwise taken years and years and years happened very quickly and just like broke the seal, which was fantastic.
Halle Tecco: And so providers are, I think, more open to using more tools to do their jobs more efficiently and more effectively and free them up to do what they want to do and why they studied so hard and not do as much administration, you know, but unfortunately there's still a lot of work to be done. And I think EHR is an example of technology that has both.
Halle Tecco: had benefits and had some consequences and providers are spending more time charting than ever before. So we always have to think about the trade offs of any new technology and bringing the stakeholders in so that these sort of considerations are thought up. Upfront. The good news on the EHR is there's some really exciting companies like Abridge, Nuance that are helping with charting.
Halle Tecco: So I have a friend who she was telling me she's a cardiologist and she was telling me now she just is able to record all the sessions and her notes, her charting just happens automatically. And she goes, when it first came out, it was kind of lousy and I had to edit it. She's like, but within six months, it was just perfect.
Halle Tecco: an incredible improvement, and it's saving me hours a day, which is so exciting to hear that we're kind of solving some of the problems that were created with the EHR. We've had some large companies in the space for a while. One of my favorite companies is Dexcom, and they have a continuous glucose supply.
Halle Tecco: monitoring system. But they recently just announced that they're going to go direct to consumer, which is so cool, right? They've traditionally only gone through the provider system. Now they're like, well, anyone should be able to monitor their blood glucose on their own. And so we're seeing a lot of exciting overlap of models that were previously just through the system to kind of go direct to consumer.
Halle Tecco: And this all goes back to What we were saying earlier of there's this quiet awakening that's happening right now where consumers are getting fed up with the high cost and are starting to take things into their own hands. And guess what? The industry is starting to listen.
Sasha Yamaguchi: Yeah, I love that point. And while I was going to get to it later on in the episode, I actually would love Ali to hit on that.
Sasha Yamaguchi: So because you, you mentioned it earlier and now we're hitting on it again, I think it's really important for people to understand. Anyone listening that has a contribution into their health plan should know more about that plan. And Halle mentioned some lawsuits, but just members, individuals learning more and more about how the plans work.
Sasha Yamaguchi: Ali, I would love to, for you to hit on, we had this conversation the other day, the three of us, but your thoughts around that and what people should really be paying attention to.
Ali Diab: Yeah, I mean, I really I love what Halle just said. To me, I actually don't even think about it in terms of digital health or tech enabled health.
Ali Diab: I mean, I think that's actually the wrong distinction. I think what's really lacking in healthcare and in health insurance in the space where we operate most specifically or more specifically, is quality. Consumer focused. So to me, it's are you a consumer focused or customer focused healthcare company or are you a self interested healthcare company?
Ali Diab: And I think, sadly, a lot of the incumbent players in our industry are more self interested than they are customer focused. However, as Halle just mentioned, Dexcom is not a, Brand new player, but they've been around for a while, but they have always been very customer focused as an organization. And there are others.
Ali Diab: So to me, that's actually the distinction that I think we should be thinking about when we look at the landscape. And obviously I think that's the thing that is the hallmark of collective health. I mean, that's why we exist because we don't think people, meaning people on a self insured employer health plan today, that's the market that we serve today.
Ali Diab: are being served in the way that they should, that kind of customer obsession that we see in other industries that leads to great things, including the appropriate use of technology to make that experience better. You know, if you think about Halle's cardiologist friend example, I think a lot of people fixate on the tech, and as you know, a tech person by background, I think that's great, but technology is not a service unto itself.
Ali Diab: It's, technology is in service of something else, so it accomplishes the task of freeing up her friend to spend more time with patients and doing less legwork. And so the tech is in service of a very customer focused objective. And I think that's what great companies do again, from the Amazons to the Apples to whoever that we kind of all idolize as technology companies.
Ali Diab: Actually the distinction is that they're really customer obsessed, customer focused companies.
Halle Tecco: I love what Ali just said and if we just take a step back and think about why we haven't been consumer focused, I mean, paternalism in healthcare is as old as healthcare itself. If you read kind of some of the early readings around physician theory and patient, like patients should just follow suit and listen to the doctor say and not push back and if they do, then, you know, they should be punished and it's.
Halle Tecco: We've come a long way in the last 100 years, but there's still a, just in general, a paternalistic undertone of healthcare. And I think that's because in a lot of ways, consumers have had their hands tied. And so no one's been forced to cater to the patient experience.
Ali Diab: Yeah, and I would say I don't, I don't think that paternalism is unique to healthcare.
Ali Diab: We just unfortunately have suffered from it for far longer because people hide behind regulations and other things to
Ali Diab: obviate the need to actually just explain things clearly to people. But if you think about how people bought and sold stocks 30 years ago, like when I was growing up, my dad would, you know, pick up the phone and call his broker and be like, Hey Bill, what do you think is going on?
Ali Diab: Good to buy. And now, I mean, we all use Robinhood or Coinbase or whatever and do our own investing sort of directly. A lot of things. Travel was no different. You had travel agents who would kind of find you the best deal. You weren't always sure if they were finding you the best deal. And I think technology and consumer focus helped to kind of blow those doors open.
Ali Diab: I think healthcare is the last. Bastion of that. But there is no reason people can't be engaged in that decision making. I mean, there have been plenty of studies. There's a very important New England Journal of Medicine study that I read not that long ago that showed when physicians just explain their patient's conditions and treatment plans and paths simply to them, the outcomes are significantly better than otherwise.
Ali Diab: And so I do think the walls of that paternalistic healthcare culture, and I think health insurance actually is. But right at the center of it all are getting torn down.
Sasha Yamaguchi: I love that we're hitting on the technology. And before I move on, I'll share, listening to you both talk about it, I just had an experience with my son, and it was the first time I noticed, one, the doctor spent tons of time with us, but it was the first time I noticed as she was talking to him, she was plugging in information into a program, into a system.
Sasha Yamaguchi: And I remember thinking, wow, if all of this helps her come to a better diagnosis, then I'm all for it. And I got to see it firsthand. So it was definitely different and interesting, and I appreciated it. And she spent plenty of time, you know, walking through everything instead of rushing through it. So.
Ali Diab: Yeah. And even as I'd say, even as a physician, so my co founder is a physician, as you all know, he would tell me, I'd spend. probably fully half of my time actually explaining the coverage and health insurance implications of the treatment and the diagnosis that my patients are about to go through, because they're bewildered by that.
Ali Diab: And he would often say like, I don't know why this isn't more part of the core curriculum in medical schools. Like physicians are constantly asked. Well, what does this mean? Like, what is this going to cost? And they don't necessarily have an ability to answer that question well. And that's also, I think, another angle to all of this that is unfortunately leading to all of us as consumers and patients being underserved and uninformed.
Halle Tecco: And uninformed. I had actually had a great physician who, my asthma doctor, who told me, I don't know how he knew what my plan would cover, but he was like, you're going to have to this generic form. And he told me this, he said, use A toilet paper roll to put between you and the inhaler for inhaling because that's, you know, I, I like this inhaler other than the actual like mechanics of it.
Halle Tecco: And so you want a little bit of space and, you know, like for him to go out of his way to like teach me this hack so that I could get something more affordably was pretty great. It shouldn't be their job to do that, but you know, occasionally you meet a doctor who really goes above and beyond and I'm sure that he's learned to do that because there are patients who probably don't get treated because they can't afford the brand name inhaler medication, which is super expensive.
Sasha Yamaguchi: Yeah, and I feel like this all ties to member experience because I'm thinking when you leave that doctor's office. You still have questions or you forgot something they said. And so obviously putting a plug in for things that we all three care about, but that's why, and I would love if you both agree, why it's so important for when that person walks out, that there's a care advocate or a member advocate that can help them once it all kind of settles in and they have more questions.
Ali Diab: Definitely. And, and even, I mean, even though we are very sort of focused on the people on our health benefit plans, we have plenty of interactions with physicians and with providers more generally. And we take the same approach when they call us with a question. Like, they're a customer or a member of another kind in many ways, so simplifying the answer for them also saves a ton of time, whether it's getting a prior authorization, Authorized in a much shorter period of time and not making that poor person have to wait days or weeks before they can have their surgery or their treatment or whatever, or whether it's just helping them, I think to Holly, your point, understand what the patient's exposure is from a cost standpoint so that they can then Communicate that back to the member.
Ali Diab: Like there's just simple things that aren't done well still across the industry that it just takes a little bit of care. And I think actually that's the one thing that is so ironic about all this, you know, it's supposed to be health care, but there is such little care to helping people understand like what they're about to go through.
Ali Diab: And that needs to be fixed. Just that. And that's why we write things in like a third grade level language, because we know a lot of people just are bewildered by just basic terminology.
Halle Tecco: I think if you think about it, someone on the provider side is doing a procedure multiple times a day. It's so routine and common for them.
Halle Tecco: They don't realize that this is the biggest deal. medical deal of someone's life. Like this is the biggest thing that's ever happened to them. And you know, it's an intense experience for them. And when you're doing every day, you kind of, it becomes neutral, becomes like just a process, which in some ways is good because we know that the amount of times a doctor has done a procedure, is also correlates with quality.
Halle Tecco: So in that way, it's good. But we don't want to lose the humanity, we don't want to lose the fact that there's still a human being on the other side, who's afraid, who's nervous, who's, you know, wants to recover as quickly as possible, but doesn't necessarily want to. know what to do.
Ali Diab: Yeah, and I think, I mean, kind of following from that, and perhaps I'm biased because, you know, I'm the son and sibling of physicians.
Ali Diab: I don't know any physicians who willfully try to harm patients. Yes, you have the occasional tabloid story about somebody who does, but people don't go into medicine to practice medicine in order to hurt people. I mean, it's the exact opposite reason of why you go into medicine, but for some reason, and again, I, I personally believe the health insurance industry has been completely complicit in this.
Ali Diab: Providers are villainized as not being interested in their patients, to your point, Halle, and just kind of trying to drive as much volume as possible to make as much money because they're rich doctors that drive big cars and live in fancy houses, and I can attest that's not the case anymore. By, by any means.
Ali Diab: And if you just look at the raw data, you know that physicians on real, in real terms are making less money than they have in the last 40 years, whereas insurance companies and drug distribution companies are all flush with cash and just like rolling in the dough. And so I think to your point, I think the health insurance industry, in my opinion, has also created an image of physicians and providers that is highly negative and to justify their position by erecting barriers.
Ali Diab: to them performing that care in a more humane, more consumer friendly way. I'll just give one very personal example. My brother's one of the world's leading pediatric orthopedic surgeons. He performs, I think, more spine procedures than almost anybody every year. And he's like, the number of hoops that my office and I have to jump in, almost every surgery to get something pre authorized, you'd think I had never done spine surgery in my life until that day.
Ali Diab: And I edit or author like one of the world's leading textbooks on this topic. And he's like, and I'm being interrogated or my staff is being interrogated by people who don't have any knowledge of the subject. And so I do think the health insurance sort of industry's domination. of the healthcare industry and landscape in the U.
Ali Diab: S. is also what creates a lot of these really negative artifacts for us as consumers of healthcare.
Halle Tecco: Well, and similar to the kind of consumer health awakening that we're having, we are having a clinician awakening too. And clinicians are sick of the corporatization of medicine, and we're seeing in the primary care more physicians.
Halle Tecco: Breaking free and saying, I'm going to do direct primary care and you can just pay me a monthly fee for as much as you need me and I'm not going to have to staff someone for billing. I'm not going to have to worry about having all this administrative burden for a health plan. I'm just going to see my patients directly.
Halle Tecco: And so folks with high deductible plans are starting to go to these sort of direct primary care services. Setups and it's going to be interesting to see where that goes, but everybody's getting fed up. So something's going to happen.
Sasha Yamaguchi: So switching gears a little, but I feel like ties to this because things that are happening in our industry that will change it over time.
Sasha Yamaguchi: Ali, I would love to hit on AI. I think it's talked about every day in our industry. It means many different things, but I would love to transition to you to talk a little bit about. What does AI mean, first and foremost, in healthcare, and share with the audience, and then of course, I think, starting to talk about where will AI help and have good use, and then of course, with all good comes some risk, but where could it also maybe go a bad route?
Sasha Yamaguchi: But can you just touch a little bit on AI, what does it mean in healthcare?
Ali Diab: Yeah, I mean, I think the term AI is used generously to describe a lot of different things. Maybe I'll start by saying what I don't think AI is. So having been a programmer briefly for part of my career, you know, AI is not doing simple automation tasks using software or even large scale regression or analysis of large data sets.
Ali Diab: Like that's not AI. I think AI in the truly sort of strictest sense is using or developing a data driven system that can make decisions or draw inferences from the data. And, you know, traditionally, classically, AI really referred to things like neural networks or deep neural networks that use certain types of statistical techniques to analyze very, very, very large corpuses of data.
Ali Diab: And then from that training, be able to answer, actually, unexpectedly, well, questions that corpuses of data, and if you think about for example, self driving cars are a great example of things that are trained. I mean, you know, there are a lot of Waymo taxis in the city that I live in, San Francisco, and Waymo is a 15 year old company, and they've Driven those cars tens of millions of miles to train them on Potential kind of eventualities that they might encounter which allow them to be autonomous vehicles And so it's that training that then allows them to interpolate or to infer When they see something that they don't recognize that it kind of looks like this other thing that I've seen So I think the next best course of action is to turn right, not left, and run over that pedestrian very crudely.
Ali Diab: And I think chat GPT or open AIs, you know, large language models reflect that in a kind of speech and text standpoint where they go, they train themselves on a huge amount of data. And then you go ask it some really random, obscure, philosophical, even question, and it's able to infer and interpolate from that data and give you a response that seems Pretty good.
Ali Diab: And I think to Halle's point about her cardiologist friend again, and they get trained even through that interaction. And that's called reinforcement learning using human factors or RLHF. I think all of those kinds of technologies, simple automation, Large complex data analysis and machine learning, if you will, and then kind of more modern, let's call it generative.
Ali Diab: I don't love that term, but let's call it generative AI stuff. All I think has a place in healthcare. I think that the issue with healthcare to me, and I'm not unique in having this perspective, is that just the stakes are really high. So if you use a piece of software versus a human being to interpret a radiograph or radiology image, and you get it wrong, there's some real consequences for getting that wrong.
Ali Diab: If somebody uses a chatbot to ask us, hey, what will my out of pocket be for this procedure, and we get that wrong, that's not good. Like, that can lead to real economic and other consequences, and so I think the challenge in healthcare, to your point about using it responsibly, is training those systems, and then supervising.
Ali Diab: Those systems having kind of an on ramp from totally not autonomous to fully autonomous, where you can observe and you can even intercede if you need to and provide a human driven correct answer if needed. Because again, the consequences are really, really, really significant. If I tell you that you should go and get a certain kind of procedure done and I'm wrong, That's terrible.
Ali Diab: And there are also legal and other ramifications to doing that. So, we are employing all of those kinds of capabilities throughout our technology and user experience stack at Collective Health. But we do it with a lot of care and with a lot of guardrails because we can't afford to have people go and make the wrong decision, or we can't afford to give them the wrong information.
Ali Diab: That's just, like, not acceptable.
Sasha Yamaguchi: Halle, do you want to add to that?
Halle Tecco: I'll just circle back to the consumer and how we think AI can change their experience. There's so much that can be. done in the backend. But for years, physicians have complained about Dr. Google. And I just think like in a year, I want to hear what they think about Dr.
Halle Tecco: ChatGPT because it is so much better than Google in terms of being able to personalize it and just quick. example from just last night. So I've, my left hand wrist has been hurting me for a week. I got a brace. I thought, Oh, maybe this is carpal tunnel. I'm behind my computer all the time. Well, last night I woke up and both my wrists hurt.
Halle Tecco: And then I was worried. And instead of Googling, I opened up ChatGBT one in the morning and I'm like, what's going on? Do I have ALS? Like dark thoughts in the middle of the night and why both my hands are like numb and why it hurts. And it walked me through this and got me to realizing, by just asking questions and talking back and forth, that for the last week, my son is turning seven, we got him a new bike, and every night after dinner, we've been going on bike rides.
Halle Tecco: And so. So. I'm going to test this out, but Chat2BT is like, you know, it's probably the bike. It's probably the way you're holding the handlebars. I'm like, Oh, well, that makes sense because it's worse at night and then I wake up and it's worse. Then it gets better throughout the day. But I wouldn't have been able to Google that.
Halle Tecco: When I went to Google and said, my left wrist hurts, it was like, this is probably carpal tunnel. And, but with Chat2BT, when I can have that conversation, it led me in a better direction that I hope is correct.
Sasha Yamaguchi: That's fascinating because it reminds me of years ago when people would just WebMD and Google.
Sasha Yamaguchi: Right? But everyone you talk to would say, don't do that because it's going to give you so much. It's going to freak you out. And yet, in the middle of the night, you had a conversation with ChatGPT, so, and you felt more comfortable and had something to try.
Ali Diab: And I think that's the innovation in many ways, because I mean, having worked on search engines, I'm a little biased and going to defend Google a little bit here.
Ali Diab: The data is probably there in the Google search index. I mean, Google, for all intents and purposes, calls everything that's publicly available in the world. The problem is the user interface model isn't designed to answer a question like the one that you posed well.
Halle Tecco: Yeah, I should have asked Gemini.
Ali Diab: Yeah, and now they are embedding Gemini results in search.
Ali Diab: I think eventually that will also get a lot better. But I think that the brilliance, in my opinion, and obviously the language models are interesting, the transformers are interesting, but the brilliance of ChatTPT is actually the user interface model. So I actually think, to your point, Halle, earlier, ChatTPT, Google, Apple, others, in my opinion, are more interesting, as a technologist, for their care in terms of the design of the user interface and user experience than they are the underlying technology.
Ali Diab: Take the iPhone. I mean, it uses a lot of similar silicon, a lot of similar battery technology, radio frequency technology, as any other phone does. But the experience that you have with iOS And even how some of the hardware sort of interacts with the software of the device is actually what makes it so magical.
Ali Diab: Whether it's starting with multi touch when I first launched, but even using things like face ID and other stuff, it's just very clever ways of redesigning the user interface given that technical capability. It's neat. Like, that's what chat GPT is, it's just so amazing.
Sasha Yamaguchi: So Ali, you made a comment about human-driven, which I think is really important.
Sasha Yamaguchi: So anyone listening, let's say they're a member and they say, does this mean next year when I call in? Everything I interact with, collective or whoever, will be AI driven. I think, maybe spend a minute on what it will actually mean of how member experience, for example, how will AI help the member advocate give that human touch still, and where the AI will come into place, and where we still will have humans answering the phones and helping members.
Sasha Yamaguchi: I think that's the biggest question in our industry is like, is AI going to completely take over? I won't be able to talk to a live person anymore. Do you mind kind of expanding on that a little?
Ali Diab: Yeah, no, I definitely not. I think, as you know, I still feel humans have a very important role to play in the customer service experience.
Ali Diab: I think AI to me, I think about, and just more technology more generally, software technology in particular more generally, as like a, Bionic skin that you or bionic suit that you give somebody to basically enable them to do things 10x faster and answer 10x more questions than they might otherwise be able to do on their own.
Ali Diab: And that's how I think, as you know, we're deploying it internally where we're using certain kinds of models and other sorts of techniques to effectively graph all the information that we have about health benefits and plans and other information that might be pertinent to a member and then making that available to the people on the phone when you call in, you know, who answer so that they can service and answer your question a lot faster, a lot more precisely, faster than they're, than they otherwise would.
Ali Diab: I think over time, I think back to the point I was trying to make earlier in terms of we have to be careful in healthcare and trying to go full Waymo. Autonomous self driving vehicle too fast. I do think actually there will be a time where actually our customers tell us, I actually don't need you to sit between me and the task, the bot can do it for me.
Ali Diab: Whether it's like ordering ID cards or whether it's even doing a very simple provider search or lookup of something. I personally believe we have to make it human assisted all along the route and then give the user the choice to sort of self select out of that path if they want to, and go speak to a human being.
Ali Diab: I can't stand, having been on call center lines myself, both healthcare and non healthcare, I can't stand when companies put you in a labyrinth that you can't get to somebody if you need to. You know, and they give you this like forced sort of call tree that you have to pick options from but your option doesn't fall neatly into any one of the buckets.
Ali Diab: Like that is the opposite of customer centric and we will never do that.
Sasha Yamaguchi: Yeah. I also think demographics. Not everyone wants to use chat GPT or AI yet, right? So we will still have members that feel they want to talk to a human individual, right? And have that live conversation. I think back to an old client of mine that was all retirees.
Sasha Yamaguchi: They didn't want to get off the phone. So it's also not just assuming everybody's ready for it and we need to have a phased approach. Would you agree?
Ali Diab: Completely. And I mean, to me, it comes down to just very simple things like, are you wasting someone's time? And to your point about the retiree population, like you're not wasting their time if you're chit chatting with them, not in their mind.
Ali Diab: But for somebody else, maybe a millennial or somebody who's earlier in their career, yeah, they just kind of want to get the task done and they may not even want to talk to you. And I, and I think in many ways the financial services industry has actually painted a pretty good path of how this can be done well.
Ali Diab: You know, even when I was in college, you kind of had to go into a bank branch for almost everything. And now you rarely, if ever, go to a bank branch for anything. And you can do pretty much anything from your mobile app or from your desktop. And I think we will see a similar evolution in healthcare and in health insurance in particular, where things will just kind of get Picked off one thing at a time and then really the high value complex tasks that can't be automated or that can't be really inferred easily Using even the most powerful, you know, large language systems will still require a human to get involved Think about for example a mortgage application or even sitting down with like if you have one A financial advisor and having them kind of listen to your constraints and goals and map out a plan for you that involves a lot of complex tasks.
Ali Diab: Humans will still be needed to do a lot of that stuff for a very long time to come.
Sasha Yamaguchi: Agreed. Halle, are you in your conversations talking about AI as well all the time? Curious your thoughts in general of what you're hearing and what you're sharing.
Halle Tecco: Yeah, I, I mean, you can't have a healthcare startup today without having an AI strategy.
Halle Tecco: It's necessary, but not sufficient today. So yeah, absolutely. And I think how we keep the human element and trust really high in an industry where mistrust is a big issue, I think is going to be really important and to ensure that the algorithms aren't furthering AI. Any existing disparities.
Sasha Yamaguchi: I love that.
Sasha Yamaguchi: I love that comment. And trust, you use the word trust, which I think is so important in our industry. Switching gears. I would love to start to wrap up, Halle, on what are some of the trends that you're seeing, you're passionate about. You're spending a lot of time on, I would love for you to share with the audience, just things around GLP-1s or any other topic that you're having ongoing conversations around and what you're seeing.
Halle Tecco: I mean, I try to keep my pulse on what patients want, what employees want. And I think a big theme that we've seen over the last 18 months is really around family planning and the care economy. And so, thinking about the need for, in the wake of The repeal of Roe v. Wade, thinking about family planning and birth control, access to care, medical care, especially in states where it has been restricted, all the way to egg freezing and IVF is something that's on everybody's mind and there are rightfully so concerns about those Medical needs being taken from us.
Halle Tecco: So I'd say that's a, that's a big area that I spent a lot of time on. And then moving to the care economy, we've just seen how our care kind of, especially for people with young kids and elderly parents, has completely failed us. And folks are stretched the sandwich generation, stretched then trying to take care of everyone, not being able to afford care and where their employers could come in on that and just helping them be a better caregiver.
Sasha Yamaguchi: Yeah. Ali, would you love to add to that? Any thoughts?
Ali Diab: I think all the things Halle said are pertinent in the employer space as well. You know, you mentioned GLP-1 agonist class drugs, definitely a topical subject now, especially given just how revolutionary it appears. It's still somewhat early days, but it appears that class of drugs is truly revolutionary for a multitude of clinical conditions and disease types.
Ali Diab: So it's very topical. The expense is probably the most topical aspect of it for employers trying to fund their employees and their families access to those drugs where needed and also the equity or equitableness of access. They were designed initially to help people with severe diabetes manage that diabetes.
Ali Diab: They're now also used now for obesity, which I think thankfully is finally classified as a syndrome in and of itself because it is. So I think the equity conversation is also something that's extremely topical for us. And, you know, there are strategies to manage both the equity of distribution and the cost, and we play a pretty central role in everything from the plan design for employers and enabling that, as you know, to who you sort of partner with to actually secure the drug supply for that membership.
Ali Diab: I do think this is an area, however, Given the kind of long term benefits, where I would like to see more noise, and our chief clinical officer and head of product, Dr. Ari Hoffman, talks about this a lot internally, seeing a lot more partnership between the public and the private worlds. If you think about somebody in their mid 40s, or let's say somebody like me who's 50, and they're on a GLP-1 agonist, and that helps manage conditions that, when I retire, would lower the cost burden on Medicare.
Ali Diab: Shouldn't the federal government also help chip in even as early as when I'm an employee, you know, and not on Medicare because I'm helping the long term, back to my point about financial obligations, the trajectory of that long term federal obligation for health care. And I do think there are some people starting to talk about that, but not enough.
Ali Diab: And we're starting to engage in that conversation because I do think, A, those drugs are still very expensive and in short supply, and they're expensive in part because of that short supply. And this is where I do think, not unlike highways, that everyone benefits from, including businesses, I think there is some room for innovation in terms of the public private partnership, which has existed in our country.
Ali Diab: Don't think that those two worlds kind of ever meet, but they actually do. And a lot of places, utilities are really good example of, of that. But again, highways, education, there's many other examples where there needs to be more discussion and more dialogue. And last point on that. I think that's also just a general theme where I think federal regulators haven't done their job,
Ali Diab: in my opinion, well, to help the private part of the healthcare market. Medicare sets prices and then everyone else has to absorb the cost of whatever price differential exists between what the true cost of delivering that care is and what Medicare tells people it is. And so the private employer and the private individual buyer of health insurance gets jammed because health insurance companies and big provider systems all try to recoup whatever money they lose from servicing Medicare, Medicaid by sticking it to us in the private sector.
Ali Diab: And so I think there needs to be a much I think more vibrant dialogue around what can regulators do to help make that a more equitable distribution of cost and the cost burden, including how you price things. Like everyone knows what the Medicare price is for almost every procedure. Why do we not know what the price of a private procedure is or a private drug purchase is?
Ali Diab: And the federal government, I think, could create a rubric where, you know, It's basically just a multiple of Medicare, and I think that is starting to happen, but very slowly. And I think, sadly, the incumbent big players in the industry don't want that conversation to happen because I think it will lay bare and make very transparent just how badly they are gouging all of us.
Sasha Yamaguchi: Well, I think that's a great final point. And Halle, I feel like this ties back to our overall theme of consumer awakening, Halle. So, Halle, any final comments on what Halle just said as it ties to when you think about consumer awakening? Just final thoughts out to the audience of what that means and what everybody listening can do to be, you know, more educated.
Sasha Yamaguchi: Or, Take an actual action when it comes to their healthcare.
Halle Tecco: Oh, goodness. Where could I start? I think holding folks accountable is where we can all start, whether it's holding our employers accountable, our health plans accountable, our politicians accountable, because as we've said over and over in this podcast, we're ultimately the ones paying for it.
Halle Tecco: And like Ali's example, you could pay for a GLP-1 now, or you could pay a lot more in 2021. 20 years. And so I think that because we are the end. payers through tax dollars, through lower wages, through direct payment, out of pocket spending. We deserve to have the players listen to our needs and our demands to lower the costs, but unfortunately we have an industry that's profiting quite nicely from us, so it's going to take a lot of work, collective work, but we have no choice.
Halle Tecco: We can't leave the system to our children and grandchildren like this. We have no choice. And then just circling back to the first thing I said is we need as many smart people as possible working on these problems. So I'm sure most of the folks listening in on this podcast are healthcare insiders, but you know, I encourage you to take a newcomer under your wing and welcome them to the challenges of healthcare and help them navigate because we need all the help we can get.
Sasha Yamaguchi: Agreed. Thank you for that. Well, I think this conversation, we touched on so many things. We may need a follow up. Appreciate you both, and excited that we were able to have a conversation with both of you on so many major topics affecting our industry. Please share with the audience where you would Ali, I'll start with you, where people can, I know they can find you on LinkedIn, if you want to give a plug there, because you're very active.
Sasha Yamaguchi: And then after you, I'll have Halle share a little bit about where people can find her.
Ali Diab: Yeah, LinkedIn is the easiest way to find me.
Halle Tecco: Same. I'm loving LinkedIn. I'm not really using X anymore. So you can also find me on LinkedIn. And while you're in your podcast app, you can find my podcast, The Heart of Healthcare.
Sasha Yamaguchi: Yes, it's a great podcast, amazing guests, and you will learn even more about our industry. So thank you both. Appreciate the conversation. And we'll talk again soon.
Ali Diab: Thank you, Sasha.
Halle Tecco: Thanks for having me.
Producer: This podcast is brought to you by Collective Health, a health benefits solution that guides employees toward healthier lives and companies toward healthier bottom lines.
Producer: Check us out at collectivehealth.com.