This week on Too Embarrassed to Ask, the CEO of health care startup Forward, Adrian Aoun, joined Kara Swisher and Lauren Goode to talk about technology and health.
You can read some of the highlights from their discussion here, or listen to it in the audio player above. Below, we’ve posted a lightly edited complete transcript of their conversation.
Kara Swisher: Hi, I’m Kara Swisher, executive editor of Recode.
Lauren Goode: And I’m Lauren Goode, senior technology editor at the Verge.
KS: You’re listening to Too Embarrassed to Ask, coming to you from the Vox Media podcast network. This is a show where we answer all of your embarrassing questions about consumer tech.
LG: It could be anything, like, “How do I make my home Wi-Fi faster, and why do I need to?”
KS: You don’t need to.
LG: Hint, because we’re all streaming Netflix and chilling. “Should tech companies be able to moderate online content, even if it’s coming from neo-Nazi sites?”
KS: That is the question of the day.
LG: It was a really good question, and we addressed it last week with the head of the EFF and the CloudFlare CEO, which I highly recommend you go listen to.
KS: I have to say, I don’t think we should be doxxing them. I don’t know, it’s a very controversial thing.
LG: It’s a controversial topic, and we really got into last week. So check that out. What I want to know, though, this week is, “Why did Kara lose the Uber job to Dara Khosrowshahi?” Am I saying that correctly? I’d better get used to it.
KS: I have not yet talked to him, so ...
KS: Now you’re being rude. Anyway, Dara who is the CEO of Expedia, he’s fantastic. He’s a very nice guy, I think, from what I understand. Which will make him at odds with the people at Uber. Anyway, so send us your questions, we do read them all. Find us on the Twitter and tweet them to @Recode or to myself or to Lauren with the hashtag Too Embarrassed.
LG: We also have an email address, it’s TooEmbarrassed@Recode.net and a friendly reminder that “embarrassed” has two Rs and two Ss.
KS: Yes, indeed it does.
LG: And that Kara’s password has seven numbers and it is 1234567.
KS: Very funny.
LG: You’re welcome. Today on Too Embarrassed to Ask, we are talking to Adrian Aoun. He is the CEO of Forward.
LG: Cue the Aoun. That’s literally how we were told to pronounce it, hence we are howling.
LG: Adrian is the CEO of Forward. It’s a company that bills itself as a new kind of doctor’s office, which uses high-tech tools to help patients manage their health. We’re going to talk about all the ways this is different from what you’d consider to be a normal doctor’s office and the changing landscape of health care, more generally. We’re also going to talk about Silicon Valley’s obsession with health care.
LG: Adrian, thank you so much for joining us.
Adrian Aoun: It’s a pleasure to be here.
KS: Welcome to Too Embarrassed to Ask.
KS: The general Recode universe.
That’s not creepy at all.
LG: He’s sitting in the red chair right now and he looks alarmed.
KS: He looks alarmed. Listen, I’ve been there, so I’m going to talk about my experience there a little bit, but I want to get your background, because it’s super interesting. You’ve had a varied background, which this was sort of a shift for you. So why don’t talk a little bit of your history, ’cause it’s really unusual.
Yeah. My background is a little more kind of your traditional tech, right? I’ve done a few startups. I did one in the AI space a few years ago that Google ended up acquiring, and then kinda helped on a lot of the AI efforts over there. Then as I was doing that, I kind of switched into a different role working for Larry, kind of helping on some of these Alphabet projects and creating some of the Alphabet companies.
KS: The moon shots.
LG: And this is Larry Page.
Larry Page, sorry.
KS: These are the moon shots. Some of the moon, no, that’s in ... Some of the moon shots.
I’m not sure.
I never reached the moon. The interesting thing about that is the vast majority of technology that we do in the Bay Area is really tech for the sake of tech. It’s like truly tech companies. But a lot of the Alphabet companies are tech applied to different sectors. So you’re merging. One of the companies I started is Sidewalk Labs, which you might have heard of. That was really interesting because we took a lot of tech folks, but we also took a bunch of folks from the world of urban planning and the world of politics and we merged them together and said, “Okay, now let’s go. Let’s go work on an urban innovation.” And so I started to get really interested in this notion of just kind of mixing tech and other sectors.
As I was doing that, I had the maybe less fortunate experience, which is a close family member of mine, my brother, had a heart attack a few years ago. I’m young, I’m decently healthy, I haven’t really paid attention to health care that much, frankly, like a lot of folks. But then I saw what he went through. You always hear heath care is broken, this, that, and the other. But it’s a super foreign concept until you experience it yourself.
KS: Enter the system.
Yeah, and then it becomes super visceral, as you know. I just watched what he went through, and I saw a bunch of different problems. I saw first, just the experience is so rough, and we take it for granted. We’re like “Yeah, but it’s health care. Why does the experience need to be good?” But actually, what you find is that people don’t go to the doctor, they don’t engage their health. A lot of us have access to great care, but we don’t even use it.
KS: This a guy who had good care compared to most people who just ...
Some of the best.
KS: So the person who has good care had bad care.
Exactly. Because that experience causes us not to go. The second thing — it really only makes sense when you experience it yourself — is that health care is reactive, not preventative. Everybody was by his side after he had the heart attack, but where were they before? It’s so simple, because you can take these, I don’t know, $100,000 of bills and all this pain and you can solve it for really, really simple treatments. It turns out a lot of the time the technology is there.
Then the third thing, and this I actually put on us as technologists, this is where we really screwed up. We haven’t set up doctors for success. In this day and age, you wouldn’t go up to a software engineer and say, “Hey, build me a website,” and not hand her a laptop, but it’s totally okay to go up to a doctor and say, “Save my life,” and then you hand them a stethoscope. It just seems absurd, this is my life we’re talking about.
Then the last thing I saw is what I think of as health care equality. There’s seven billion people on the planet, less than two billion of them have access to any form of real care. And so, how odd is it in this day and age that we can take the entirety of the world’s information via Google and a smartphone and get it to the middle of India for just a few dollars, but we can’t get basic health care there. It just seems odd. Obviously, it’s because health care is a labor-based business, and labor doesn’t scale anywhere near the same way that technology scales. One of the things that we think is a real opportunity is to take all these super routine, really inefficient things and move them from labor to technology.
KS: I don’t mean to carp on Silicon Valley people, but they always think they are going to fix everything. I mean, I think President Obama said, “Not everything is fixable by a tech solution.” Obviously health care has gotten sucked into this political mess, in this country, not everywhere in the world, but in this country for sure. You’re sort of taking on the idea that just if you only apply a few apps and taps to it, it will be fine. Think about it, because it is labor intensive, people’s bodies are analog and they’re made of not the things you make digital out of.
Yeah. I agree with you. I don’t think tech’s the solution. I think it’s necessary, but not sufficient. The same way in Sidewalk, we didn’t just say, “Hey, we’re a bunch of tech people, let’s go figure out cities.”
LG: Saving the city, yeah.
Yeah, what we said is, “Hey, let’s partner with people that are in that industry, that bring a lot of expertise.” We’ve been fortunate from the very beginning to have a lot of great doctors, nurses, medical assistants, tons of people from the world of health care. And from all the great institutions — you know, the Stanfords, UCSF, Kaiser, etc., so people that have actually done it, as opposed to people in the tech world that have just talked about it.
KS: And they all gripe, too. My brother’s a doctor.
KS: All he does is gripe about the system.
And that’s actually the opportunity, because they want to solve the problem, people from tech want to solve the problem, customers, they want to solve the problem. It turns out everybody is unhappy with the system. At Forward, we just said, “Well, okay, why don’t we just get everybody together and work on it together.”
KS: To try on one solution.
LG: And so your solution is ... It’s an analog one, ultimately, because what you’re doing is you’re creating a physical space, it’s a clinic, where people go to. So you could have been solving EMRs, you could have been ... I know that your clinics have lots of high-tech gadgets and diagnostic tools and stuff like that, but ultimately, it’s a place where people go. Talk about that and talk about the pricing of it, too.
You brought up a great thing. It’s like, “You could have solved the EMR. You could have solved the gadget. You could have solved this one thing or that one thing.” But whenever you do that, you end up in this world where you’re kind of still playing inside that legacy system. It’s really, really hard to screw around with the legacy system. I’m sure a lot of people are good at that.
KS: Such as using an old computer system, like mainframes, just get rid of them completely.
Exactly, Exactly. Well, we just said, “Hey, let’s come out with a new product.” And it’s not digital, it’s not analog, it’s all of the above. There’s humans, there’s technology, and they’re all working in concert. That’s really, really important. You see that in every modern great service. You wouldn’t look at Uber and say, “Uber is just a tech company.” Turns out it’s tech, it’s ops, it’s people, it’s cars, it’s everything all packaged together and that’s what makes it work.
Forward would be nonsense and ridiculous without the humans that power it. Without having great doctors, it’s a non-starter. Forward would also be nonsense and not moving the ball forward if we didn’t have great technology. We want to bring those together.
KS: To explain the process ... and it’s expensive, for regular people it’s not going to be affordable.
You’re totally right, and the way we think about it is just kinda the beginning. We charge $149 a month, for some people that’s a lot and for some people that’s a little. It’s ...
LG: Isn’t that just the membership? That’s just to go to your clinic.
Yeah, but the membership is all-inclusive. There’s no co-pays, there’s no up-sells, we’ve got our labs who are doing blood tests, urine tests, all that stuff’s included. Your vaccines, included. If we have something in our pharmacy, we give it to you, that’s included. Sensors, included.
We’re not up-selling you, and that’s actually one of the things that makes it pretty cheap for a lot of people. Your normal health care, every time you go, you get a bill in the mail for a few hundred bucks, and that stuff adds up.
Now, the way we think about it, our goal is to bring this to the masses. Again, we think back to that seven billion number, and it’s a long road to get there. We’re not going to get there in the next two years, or even 10 years, which in Silicon Valley isn’t popular to say. We’re just at the very beginning, but the same way that the first iPhone was $700 and now you have smartphones in the middle of India.
KS: Oh, the next one’s going to be $900.
You know what’s cool about the iPhone?
LG: You heard it here first, coming up, Kara Swisher apparently knows.
KS: No, it is, right?
LG: Well, that’s the report.
KS: But, expensive.
But what’s cool is that they showed the way. They developed the technologies that other people ... They started a movement towards that and that’s really exciting. Or you look at Elon saying, “I want to solve the hydrocarbon problem.”
KS: Elon Musk.
KS: Elon Musk, for those of you who are listening. I’m just going to insert last names when you ...
KS: It’s okay. When we get into Silicon Valley-speak here ...
LG: She hates that.
KS: I’m going to bring it back down to earth, people.
LG: They know.
In a second I’m going to talk about Cher, and you’re going to be totally ... When Elon Musk, Mr. Musk, said he wanted to solve hydrocarbons, he then came out with $150,000 car. You’re like, “Wait a minute, wait a minute. How are you going to solve this problem with a $150,000 car?” But, again, he’s patient and he said, “Yeah, yeah, but give it time.” Ten years, what, 12 ... I forget the number ... 12, 13 years later now we’re just at the beginning of that $35,000 a year ... But there’s two things that have happened.
One, over that time he has start to lower that cost, using technology, and that’s really awesome. But the second thing is, and maybe his legacy won’t really be the effect Tesla had, but the effect he had on the industry. Because now everybody else is going, “Uh oh, we better build these cars too and play the same game.” And that’s really exciting.
KS: Your service had been compared to the Apple Store. It’s been described as the Apple Store of health care, but you’re saying you actually see your company as being more analogous to Tesla?
I think that there’s elements of all these. There’s elements of design that cause us to be compared to Apple. There’s elements in our mission to lower the cost over time and make it more and more accessible, that can compare us to things like Tesla. I’m not sure it’s necessarily a one-size-fits-all, but even because we’re built on this technology platform, you see us lowering our cost every day.
Let me explain that. Every single day we’re launching new features. We’re coming out with things like weight loss programs or sleep and anxiety programs. Medication management, which honestly doesn’t sound sexy until it turns out you’re 65 and on 15 meds. All these new features that we’re launching, we’re building on top of a tech platform, we’re not just throwing more labor at it, which means we’re able to offer it without having to increase our cost every day.
When we think of launching optometry, as a really great example, we don’t think of hiring optometrists, we think of sensors that scan your eyes. Why is that valuable? Again, now it’s just the marginal cost, the ability to bring it out to the masses is super, super, super inexpensive. So that’s why ...
KS: You want to add on services into these services.
KS: Someone comes in and what are they getting for this? They’re getting full checkups whenever they want?
Yeah, so you have ...
KS: So you want healthy people coming in there, so they don’t bug you that much.
No, no. Actually that’s not really true. The way you have to think about it is that you want people that want to engage their health. One place where we differ from the traditional system is if you walk into a public hospital, a lot of those ... Or county hospitals, things like that, a lot of what they are doing is they’re treating people that really don’t want to be treated. We haven’t gone after that market, yet. Eventually we’d love to, but it’s tricky to do that. It’s tricky because a lot of the health-care system today is super paternalistic. It’s like, “You don’t know what’s good for you, so I’m going to con you into this, or I’m going to force you into this, or I’m going to trick you into this.” That’s not what we want, we want people who want to engage their health.
Our average member is about 40 years old. We have tons of people in their 50s, 60s, tons in their 30s, 40s. But a lot of those are unfortunately not the healthiest person you’ve ever seen. We have people with real issues.
KS: ’Cause the way you get your money’s worth is by going in a lot. Like in here ... My arm hurts ... “My arm’s twitching today, what’s that?”
Yeah, I wouldn’t think of it necessarily as going in a lot. Some of that is true but also we have a pretty strong kind of telemedicine program. When you come into Forward, think of it as when you’re onsite, we’re going to take the opportunity to use all of our technology and all of our doctor’s time to really learn you. Learn everything we can, from head to toe. Not metaphorically, but literally everything that we can learn about you. That way, it’s really easy for us to be by your side on an ongoing basis so that when you message into us, and we’ve got that kind of 24/7 team ...
KS: You have a nice app.
Thank you. When you message into us, we know right away what you’re talking about. You say you have a headache, it’s not, “Whoa, whoa, whoa. Do you have any family history of this, that and the other.?” We already know, so we can give you guidance.
KS: Well, your doctor is presumably supposed to know, but they never do. It’s true.
Exactly. The reason that doctors in a normal system don’t know is honestly, they don’t have the time, nor unfortunately do they have the technology to kind of help them.
LG: This is like boutique health care, in a way? But what happens ...
KS: Concierge doctor.
LG: Yeah, concierge style, that’s a good word, you talk about this ...
KS: I watched that whole show about the Hamptons, I know all about it.
LG: You talk about this $149 fee that includes everything. What happens if someone comes in and they’re getting a checkup and they need more advanced diagnostics? MRIs can be very expensive, things like that, or a CAT scans. Or what if they come in and they are diagnosed with something chronic that requires long-term care. At that point, they still need some kind of insurance ...
LG: And so, how does that relationship work between Forward and insurance companies? Are you in-network for people? How does that work?
It’s a great question. Forward itself, when you’re at Forward, we’re not billing your insurance, it’s just all that membership fee. Everything inside of our four walls, you never have to worry about insurance.
LG: You can go anytime?
Go at anytime. You schedule it ...
LG: Text anytime?
Exactly. You’re just super, super easy. But you’re right, we have tons of members, unfortunately, that come in and sometimes you really do find those serious things. Whether it’s the cancer or whatever it happens to be.
KS: I like that you said “the cancer.” It’s how an old lady says it.
KS: The cancer.
Thank you, Kara.
KS: It’s true, it’s how my grandmother says it.
What would we do without you? One of the big problems of the traditional health-care system today is it’s really a throw-it-over-the-fence model. It’s like, “Oops, sorry, gotta refer you over there. Good luck. Peace out. See yeah.” And then you never hear back, you never know ... It’s super fragmented, non-integrated care. We didn’t like that.
We do work with the existing system. What we do is we refer you to partners of ours, kind of a specialist network that we’ve built. We make sure that they’re in network for your insurance, so we’re happy to help with that. We’ll actually help you get that appointment, get you in quickly. We send your records over, and then you see them, and then what we do is we get the records back — and this is really, really important, we get the records back and we do that ongoing care management. Because they only have the time to see you and diagnose you and give you your treatment, but that kind of day to day is still being done by your primary care doctor, which is us. That’s why they call it your primary care doctor.
LG: But the primary care doctor isn’t necessarily reading the results of your exams.
KS: No, no. The experts do, right?
The experts over there ...
The oncologist, whomever it may be, who is reading it, but they are also sending us that information and giving us guidance.
KS: And then you all make sure ... and have oversight. It’s interesting because I literally just had an MRI for my stroke many years ago, and literally, I can’t get the doctor to call me back to tell me whether I’m dying or not.
Yeah, I’m sorry about that, yeah.
KS: No, but seriously. I guess I’m not, ’cause he’d call me, but ...
LG: I was just going to say I feel very fortunate listening to this, because I go to a family care practice, where they’re very responsive via email and they happen to be integrated. When I walk in and they say you need to get more tests, it’s literally right down the hall.
KS: But they don’t hand do it for you. It’s a really interesting thing. Having had a major illness, it’s really ... And having great insurance ... It’s fascinating, I can’t even imagine if you didn’t have ... It’s already onerous.
LG: Right, which is what this country is going through. I mean, what, millions of people are going through right now.
KS: Yeah, like either not good enough health care ... It’s either not good enough or it’s difficult to obtain unless you’re very wealthy.
This comes back to what I said at the beginning. Where it’s easy to say, “Wow, $149 a month is a lot.” And maybe for you it is. Maybe you’re super healthy and you know what? That’s not the stage of life that you’re in. But I challenge you to go up to somebody who maybe isn’t super wealthy, and maybe they’re in their 50s, maybe they’re in their 60s, and they are suffering from a lot of things. They don’t have a solution today. They can’t afford the $20,000-a-year doctor that everybody in Silicon Valley seems to have. And it turns out that going to your normal primary care doctor ... Kaiser ... We have one of our physicians who came from Kaiser who tells me he had appointment times that were seven minutes, and 12 minutes, and 14 minutes.
KS: Yeah, they’ve got it down to a science.
What do you do in that time? It’s not enough time to say hello, much less figure out somebody’s real issues and coach them on ...
LG: It takes Kara and me 14 minutes to start a podcast.
We’ve noticed. It’s not lost on us.
KS: Oh my goodness, Adrian. Now listen, explain how people go through it. I have done it, I can explain it, but I would rather you ... You walk into your beautiful little storefront. You have a storefront, it looks like it’s like a ...
LG: It’s in San Francisco.
We wanted to make ...
KS: It’s like a juice store, possibly. People wandering in looking for a kale smoothie.
LG: Kara knows her juice stores.
I don’t drink much kale. But ...
KS: I really like a kale smoothie.
As you’re wearing your kale shirt.
KS: And I ... Oh I am, you’re right.
So it was really important for us that a doctor’s office feels like something that you can just walk into any day. Not this thing that you’re super afraid of. In fact, there’s this thing in health care that I’ve learned about called White Coat Hypertension, have you guys heard of this?
It’s basically everybody’s metrics, like your blood pressure goes up because you see the person in the white coat. You’re just scared, you’re just anxious. We started by just making it a place that honestly is just pleasant. It’s a little like walking into the Apple Store. I don’t know if you remember what life was like before Apple, when we were all using Dells. It was really scary to deal with Tech Support. And then Apple’s like, “Nah, I don’t mind swinging by, hey, can you fix my phone?”
That was the first thing, let’s say it’s your first time at Forward. Or it’s been a while. We want to get what we call a baseline of understanding of your health. Health care today is all about, “Oh, you’ve got a rash? I’m gonna get you in and out in seven minutes and be done.” But we know people aren’t really dying of rashes that often. We’re dying of the heart diseases, the cancers, etc. And so what we wanted to do was make sure that we take the time to get this full, kind of comprehensive understanding, and we do that in a few different ways.
The first way after you check in at an iPad, you walk up to a body scanner, it just takes what you would think of as your vitals. And this is your heart rate, your pulse oxymetry, things like that.
KS: Your height, your weight. It’s cool looking, it’s cool looking.
Height, weight ... Thank you, but what’s cool about it ...
LG: Wait, how does the body scanner take your pulse oxymetry? Do you have to put on a finger sensor or something? Interesting.
You just slide your hand into it, and it takes a bunch of readings. What’s cool about it is, once again, it’s a platform, so we’re constantly trying to add more and more sensors to it. It’s just, again, super inexpensively taking more information. And what’s great about it is, it sends it into exam room for you and the doctor to go over, but it actually also sends it down to your phone. So that you can start to be in control of your information, be empowered. The second step is you walk into that exam room and one of our great medical assistants greets you and we take, typically, blood, and if appropriate, urine, as well as giving you your vaccines.
LG: At what point does the young blood of people in Silicon Valley get injected into you?
You might have to talk to somebody else about that. That’s not yet a feature we support.
LG: Oh okay, wrong company. Continue.
LG: Are there blood boys on staff?
KS: Blood boys. I’ve got one myself.
Anyway ... What’s cool about that is we actually ...
KS: I do, Travis Kalanick 00:21:11, it’s great.
KS: No, I wouldn’t want that blood.
Hey, snap with it.
KS: All right, focus on Adrian. Go ahead. Aoun.
What’s cool about it is that we actually have our own blood-processing facilities on site. We take your blood, we take it back and we process it. It’s pretty thorough, it’s your electrolytes, your lipids, your kidney function, liver function, urinalysis, STD testing. And all that sort of stuff ...
Yeah, it occurs in about 12 minutes, and the results come right back to the exam room.
KS: While you’re chit-chatting.
The way the exam rooms works is pretty cool. There’s this big futuristic fun-looking screen on the wall. It’s got a model of your body and all the data we’ve learned about it is overlaid onto that model. When you doctor is there, they’re kinda helping drive that screen, but it’s a little more of a collaborative experience. Anything you and your doctor are talking about is actually being live represented on the screen, so you can collaboratively build your plans and work together to really make sure it’s personalized ...
LG: And somebody is listening and typing, right?
KS: Somewhere else.
We have a scribe that’s basically powering the system. But what’s also cool about it is any sensors we use in the exam room ... Doctors all the time are using sensors. They don’t think of it as such, but that’s what stethoscopes, EKGs, otoscopes, that’s what they are, but all that data is getting lost, and we didn’t like that. In our case our sensors are actually live hooked up to that screen. If they are taking a heart reading, you actually see your heart wave on the screen in real time. Same with things like blood pressure, EKGs, and what’s cool is all that is getting saved into your profile and saved for later whenever the doctor or you want it. Because of course you can access all this on your phone. Once you come up with, “Hey, here’s the things I want to focus on,” we’ve screened through head to toe, every single part and really turned over every rock to make sure we understand you ...
LG: Let me ask about your drinking, drugs, they ask about personal things, stress.
Absolutely, it’s not just illness. It’s also wellness, which is something I think that we kind of look over a lot in the world of health care.
LG: So there would be a tab where I could say, “I work with Kara Swisher,” and they would ...
KS: Then all the red alerts would go off.
LG: Right, categorically.
’Cause we can help you find a new job, if that’s what you’re looking for.
LG: She laughs.
Yeah, this awkward laugh where everyone knows it’s true.
KS: I cackled.
We go through all these categories, so one is your body systems, that’s the head to toe. We go through things like cancer risk, because that’s super important. We go through wellness, and we just go through your tactical remedies. Are you up to date on all your vaccines? Are you traveling anywhere soon that might need some? What medications are you on? This, that, and the other. So, those kind of four categories we go through. Typically takes about an hour. It can run longer as well. It’s really, really thorough. Because, again, it’s super important we learn about you up front.
Now, at this point we’ve created with you all the relevant plans. We enroll you into what we think of almost like a curriculum. It’s like, “You know what, in your case, we really want to focus on your heart risk.” In my family, it turns out, there’s a lot of heart problems. For me, that’s really important. We say, “You know, we’re going to put that top of mind, top of the list.” And we show you over the course of the coming year, over the course of the next 12 months, these are the things we’re going to work with you on. These are the goals, these are the action items, but also here’s the check-in’s along the way and the metrics that we’re going to measure to ensure that this isn’t a bunch of hand-wavy stuff, that we’re actually getting to success.
Again, for some people, these things are truly, truly medical. Diabetes management, heart risk. For some people, these things are a little more wellness. “Hey, I just want to ... I’m young, I’m healthy, but you know what, I want to run a little faster.” Or the one that it turns out, everybody in this town has stress.
KS: Oh no.
LG: Oh, I manage stress.
You can tell us about your stress with colleagues.
LG: Yeah, I work with Kara Swisher. Now, is there ...
KS: I’m not stressed at all.
LG: Do you offer any type of tier for what you’re pricing? So, for example, if someone didn’t want to pay on a monthly basis, but they wanted to check in four times a year and then they wanted to use apps and wearables to monitor ... Quantify themselves otherwise.
That’s a great question. We don’t really think that health care is episodic. I think that’s one of the big mistakes that the existing health-care system has made. That incentivizes a super reactive nature as opposed to a preventative nature. Your body doesn’t stop changing on a daily basis. Your body doesn’t say, “Oh, I’m not going to think about health for the next three months, or six months.” Health needs to be something that is a routine, something that is built in to our daily lives.
We do that really well, as a society, in some ways. We all brush our teeth a couple times a day. That’s really awesome, because every single day you’ve gotten into the routine of managing the health. But, it turns out that when you think about what’s going on, whether again, it’s your heart, or even your mind. It’s not like, our day is any less stressful ...
LG: But at the same time, you don’t want everyone to come in all the time, right? You don’t care?
I actually think about it a little differently. I love when our customers engage their health, using our product. We think that’s fantastic. Our engagement stats are about 7X the normal doctor’s office.
LG: So they go ... Use it like a ...
But here’s the cool thing, if I told you you had to come in once a week, personally I’d love it, but you’re not going to do it. You’d get fatigue. So I need to make it really, really easy for you. That’s where the app comes in and that 24/7 team. They’re just constantly sending you little pings, “Hey, by the way, we haven’t seen your ...” In my case, “We haven’t seen your vitamin D level in a while.” Or, “Hey, we’re a little worried about your cholesterol. Are you keeping up on this thing? On this diet change? Or this exercise? Or maybe you should swing by and get that quick blood test.” We try to really integrate it into your daily life, as opposed to having it be this foreign concept, where once every six months I need to magically remember that I’m supposed to go to the doctor.
LG: We’re going to take a quick break for an ad read and get back to more questions for Adrian, and then after that we’re going to go to even more questions from our readers and listeners.
KS: Yeah, we want to talk about America’s larger health care problems right now.
LG: Should I do the first ka-ching? I get to do two ka-chings this episode.
KS: Alright, okay, fantastic.
KS: That means we’re making more money than ever.
LG: Yes, and it’s largely because of me, though they haven’t told you that yet.
KS: Do I stress you out, Lauren?
LG: No, you really don’t. It’s fun working with you.
KS: Stress has worked for me, quite well in my life, I feel.
LG: I feel like a little bit of stress is ... From a working perspective, can be good. A little bit.
KS: Me, too.
LG: We can talk about fear and stress and all kinds of things.
KS: Yes, all kinds of health care stuff. All right, we’re going to take a quick break now for a word from our sponsor. We’ll be back in a minute with Adrian Aoun, the CEO of Forward.
KS: Thank you. You could do that a little more enthusiastically.
KS: Thank you.
LG: [ZipRecruiter], used by Uber in its recent search for the CEO.
KS: Did they?
LG: No, I don’t know, but, you know, it seems like they ended up with a good candidate.
KS: They did, he’s a ... Once again ... We’re back with Adrian Aoun from Forward.
KS: Sorry, Adrian, that’s the way it’s going to be the rest of your life.
LG: I have a question about health care at a macro level.
KS: Explain what he does first for the people who are just tuning in.
LG: For the people just tuning in, Forward is a concierge health service here in San Francisco that charges $149 per month for state-of-the-art care, any time you need it. But that is on top of other services that you might need, more sort of ... I don’t know, bigger diagnostic issues or chronic health care coverage.
KS: But they can add dental and stuff like that.
LG: But we’re talking about Silicon Valley’s, I guess obsession, for lack of a better word, with trying to solve health care issues through technology and through services.
LG: And I wanted to ask you a question that applies, I guess sort of broadly, to health care in general in the U.S. around the time that you first revealed Forward to the public. It was earlier this year, I believe it was in January. That was around the time the Congressional Budget Office first put out a report saying, “Here’s a number of people who are going to lose insurance.” And it was many millions of people, if the Affordable Care Act, which was introduced by President Obama during his tenure, was repealed.
Now ultimately we know that recently the Senate voted down to roll back Obamacare. So as it exists right now, things are still in this tenuous place, but the truth of the matter is that you were launching a sort of boutique health care service for people who could afford $149 a month on top of existing health care, at a time when millions of people were about to lose their insurance. How do you think about Forward in the broader landscape of health care in this country and do you want to address that in any way with your business?
Yeah, I mean first off, would love to address it. That’s what gets us up every morning. The first thing to say is, we get super caught up in what our maybe broken government happens to be doing on any given day, but the truth is that when you zoom out a little and you just look at the magnitude of the problem, all of what’s occurred in the last year is roughly noise. If I look at health care costs in this country over the last, I don’t know, order of 50 years, we’ve gone from 6 percent of GDP to 16 percent of GDP. I mean, it’s just non-tenable.
To say that this little bill that’s passing or not is the biggest issue that we should focus on just doesn’t seem to make sense, we need to get at the root of the problem. Now, I’ll be the first person to say there’s a reason that Forward didn’t partner with an insurance company from Day One or work with the government. That’s not our expertise. And there’s a lot of people that are working on that, and I’m really happy that they’re doing that, because hopefully we can partner with them.
There’s some really good and there’s some really bad. The really bad part is that there’s tons and tons of people in this country that are disenfranchised. If we can be a little less myopic, it’s not just this country, it’s all over the planet. And anyways ...
LG: Right, but in this country, life expectancy for certain groups of people has actually gone down in recent years. Our maternal deaths have gone up more than in other developed countries. This is sad.
I totally, totally agree, but let’s focus on the good part for a second. The good part is that this is creating a national conversation, and that’s awesome, because you’re starting to see people really, really, really care in a way that they didn’t 20 or 30 years ago. People are riled up. N
ow, what’s the next step? What do we need to do to harness that energy? Because, at least folks I know, and this certainly isn’t fully representative, folks I know say, “I have a lot of opinions, I have a lot of passion, I want this solved, but what do I do? Really? Calling my Congressman? That’s the solution to the problem? Really?” And so, we wanted to basically say, “Maybe there’s another way. Maybe we should create a conversation in which you’re partnering with folks that are actually building the products that you want.”
We see this in tons of industries today. When Facebook changes some features, everybody yells, “I want the old Facebook! I want the old Facebook!” And you actually get change. Facebook, you’re being creepy. Uber, stop tracking my location. All of a sudden, Uber’s like, “Fine, fine, fine, we’re not tracking ...” There’s a really great connection from the people using the service to the people providing the service, and you get that immediate feedback loop.
But think of what your experience is like today. You go to the doctor, and you’re like, “You know what? I didn’t like that experience. I didn’t like that he used the little hammer on my knee or I didn’t like that the chair was cold.” Whatever it happens to be. How do you get that change? You don’t have an outlet. What are you going to do, you going to call your ...
LG: But those don’t seem like huge problems to solve.
KS: Yeah, but the experience he’s talking about, the idea ... It’s really interesting, you talking to this. Nobody likes the doctor experience. I don’t think anybody likes it, particularly likes it. It reminds me a little bit of, remember, the taxi experience, it was always bad. Always dirty, always hard to find, and always too expensive. What Uber and Lyft did is they attacked a problem we didn’t know was there until ... You just put up with it, which I think is interesting.
I agree. Let me push further when you say that’s not the problem to solve. I think that’s the ballgame, because you have to start somewhere. You have to get people understanding, “Oh, when I actually engage this, it gets better.” And you start with something like, “Well, let’s not use a cold chair.” But all those tiny little steps lead up to massive change. And it’s not going to be us alone. I don’t think we are the solution to health care’s problems. Everybody that says, “Oh, are you going to solve health care?” I think is a little ridiculous and doesn’t understand the magnitude of the problem.
But I think that when you start to empower people in this country with an ability to actually affect the outcomes, over time all of us working together, the 335 million Americans that care about this, will actually have massive outcomes. You can look at the first version of Facebook and say, “Yeah, but did it matter how the ‘Like’ button worked?” Well, now look at what they’ve accomplished, and I think health care has to be on that same long-term trajectory of engaging the population.
KS: It is a broken experience so it is kinda perfect for tech people, or people who are thinking in consumer delivery of services. From the appointments, to the outcome, to hearing ... It’s utterly confusing. I was just doing my kids’ medical records for school for sports and I cannot figure it out.
LG: Records have been the thing for me that ... Very quickly, but anecdotally, I went to grad school long after I graduated from undergrad. During that decade-long period, everything changed technologically, electronically, and whatever it was and when I actually had to find medical records for vaccines and stuff, things that I’d had before, years and years ago, and ...
KS: That should be in the system, a button push.
LG: I needed to find them. I had my mom helping me out, and calling doctors from back home that I hadn’t seen in years ...
KS: It literally should be ... Vaccines should be in the system. Buttons, a button push.
Here’s my records. Right on my phone, right here in a format that makes sense to me, not a format that makes sense to some insurance company somewhere. That’s the ballgame, right? I would never underestimate the amount to which, if you empower people with their own information and you give them the tools to make the right choices, that people will move the industry forward.
KS: Which Silicon Valley has been trying to do for a long ... This goes back. Google had been at it, now they’ve got Verily, you’ve got all kinds of things. Let’s talk about this idea of Silicon Valley and their obsession with solving health, and they have not, it goes back 10, 15 years I remember, with the guy, what’s his name at Google. Microsoft had a vault, a health vault one. They’ve all tried to come at it, then they’ve all come out of it pretty quickly. Now they are moving on to death, like they’re interested in the food, stuff, and longevity and body hacking with the eating and things like that. Why is that?
Let’s analyze this in terms of ... Let’s try and be objective. What has Silicon Valley done well and what haven’t we done well? And I will personally put myself as both part of the first bucket and the second bucket.
The first thing is, there were a lot of industries when tech was booming, 10, 15 years ago, and really, really kind of getting its sea legs, the first thing that you saw was there were tons of industries where tech was, “Screw it, we don’t need to partner with people in that industry.” Google didn’t hire a bunch of librarians, even though it kind of replaced that whole industry. They’re like, “Ah, screw it, we’ll figure it out with some algorithms, leave us alone.” And what you see is the first attempts at going after this health stuff. Most of them failed, it’s unfair to say that all of them failed.
KS: But, they started early, for sure.
Yeah, they started early and they were like, “Eh, we’re not going to partner with the health care industry. We’re not going to work with these doctors. You’re just an algorithm.” Turns out, that was a bad idea. In retrospect, it’s like, “Yeah, no crap.” It’s pretty obvious that was a bad idea. This is super, super complex. Now today you see companies like ours — and we’re not the only one. You can look at tons of companies, whether it’s my buddy Sami at Virta who has tons of doctors on staff, helping build diabetes management programs.
KS: All these ... Color.
Color. All these people. As an industry, we’ve wisened up a little.
KS: That’s true.
Now, let’s look forward and say, “Why is there such an obsession with health care?” What’s funny is, whenever people say that, it sounds like a negative thing. To me, it actually sounds like a great thing. I actually want more obsession with health care.
KS: I think what they are saying the obsession is the weird life-extension ... You’re right.
LG: It’s not just the subject matter but it’s also sort of a genial myopia when it comes to the approach for some of these things.
KS: You know, you’re right. And actually, why do we care that so-and-so, like Peter Thiel, is obsessed with the blood thing.
Oh yeah. I mean, some of that stuff’s weird for sure.
KS: At the same time, what if he solved it? “Oh, all right.” What if a rich guy ended up ...
We would all do it.
LG: And not only solved it, but solved it for the masses?
KS: Yes, what if he developed it for himself? So what if he’s selfish? Or whatever, he wants to live forever. Any of these people.
I think all that stuff is noise. What somebody happens to be doing in their house, I don’t really think ...
KS: But if they solve it ... You’re right. You’re 100 percent right. What’s the difference? It’s not like they are doing something bad.
Here’s the thing, I want more people ... Whether it’s biohacking, doing startups, experimenting with ... Innovation is inherently good. That doesn’t mean it’s all going to work. I think we should celebrate the fact that these people are trying. So, when I look at HealthVault from Microsoft, I think it was?
LG: Mm-hmm, yeah.
I say, “Man, bummer it didn’t work out, but thank you for trying it, because now we’ve learned.” We’ve learned how to do ... How to do things right and how to do things wrong from that. But I think that’s super, super valuable. And I just keep looking back at, when you think of the magnitude of the problems, when you think of the world’s largest problems, health care has gotta be in what, the top three? It’s up there with education, it’s up there with ... Who knows what the exact list is, but it’s important. I actually ask the opposite question, which is, “Why the hell did it take so long for our industry to start waking up to this?” Where were we?
KS: It’s hard.
Yeah, you know what? Tons of what we do in this town is hard.
KS: I know, but this one is ...
I agree, but here’s the deal, the fact that it’s hard doesn’t scare me. The fact that, look, companies like ours, super high probability of failure doesn’t scare me, because my objective function is not that I want to get rich. My objective function is I want to help people. And when you want to help people, you say, “Yeah, but I know I’m contributing to moving the industry forward, moving health care forward, even if we’re not successful.” Because we’ll have learned. Some of what we do will be great and others will do it as well, and some of we do will be stupid and others will say, “We’ve learned.” And that’s fine.
KS: Okay, so before we get to the reader’s questions, two more things. You raised a bunch of money, how much have you raised so far?
We don’t comment on the amount.
KS: You’re raising more money, presumably?
No, we’re not raising right now.
KS: But you raised certain amounts of money?
We have raised money.
KS: And you have how many storefronts? Just the one?
Yeah, we have ... one will be ...
KS: But you’re planning others right?
KS: Because you have to be located ...
And we’ll talk with you about that soon.
KS: All right, okay. But you’ve got to be places, because you’ve got to have people working.
LG: How do you scale so that people don’t look at this and say, “Oh it’s the fancy Apple Store doctor’s office in San Francisco that costs a hundred ...” How do you actually impact the people you want to help?
You scale in three ways. The first way you scale is horizontally. I just want more locations, because it turns out that not everybody lives in San Francisco, despite what your listeners might think.
The second way that you scale is you scale vertically. And by that what I mean is you’re just continuing to offer more and more services to eventually ... And years from now, and it might be a hundred, you’ve rebuilt the entire health care system on top of a modern platform.
Then the third way that you scale is actually a business model innovation. Yeah, we’re direct-to-consumer, but it turns out we also have a bunch of companies that have paid for Forward on behalf of all their employees and that makes it a little more accessible.
LG: What kinds of companies?
So far tech companies, because we’re in SF. Maybe not all tech, but a bunch of Silicon Valley companies. Yeah. But you want to get to the masses and there’s multiple ways to get to the masses. You get there via the employers, you can get there via the insurance system, you can get there via the government, like CMS, like Medicare, Medicaid. You want to go after all those.
The trick is you gotta walk before you run, because here’s one of the mistakes a lot of people do make in health care, especially tech folks. They say, “Oh well, YouTube went from zero to a billion users overnight. So, we’ll just do that in ...” Turns out, that’s not the case. The largest private health care system in the United States is Kaiser. We all know it, we all think of them as enormous. Well, it turns out they have 11.7 million members.
LG: That’s all?
That’s it. 335 million Americans, they have 11.7 million. And how many years have they been at it? More than half a century. When you look at this, it’s not an overnight thing.
KS: How many members do you have?
It’s going to go through phases. We don’t comment on that.
KS: Okay, fine.
And you know that, stop asking.
KS: It doesn’t hurt to ask. What do you mean, “Stop asking”? Are you kidding? How much investment have you gotten?
When you are thinking of the consumer health movement, this is Lauren’s big issue, about the ...
LG: Yeah, I mean, I guess I ...
KS: You guys have them in the ...
LG: Kara and I talk about unwearables a lot. She calls them unwearables, I call them wearables. I’ve tested every one, but I’ve also tested a lot of health apps and food-logging apps and that sort of thing. And watch them get absorbed into big brands.
KS: And there’s biohacking and Googling your systems.
LG: As everyone buys your data, right. But what do you think about the movement, the trend toward quantification and ... I was just talking to some doctors this week about apnea, because apnea is a thing that Fitbit has come out and said that it’s researching in its labs. And a couple of doctors said, “We’re starting to see more of a movement to home tracking of apnea.” But it’s still a class two or a class three FDA approved devices. It’s not consumer stuff yet. When you think about that movement, how does that impact what you do?
KS: Cardio is another.
This is a great, great example of what we’ve been talking about. A good buddy of mine that I really respect is Robbie Pearl, he was CEO of the Kaiser Medical Group for the last 20 years or so. And he said it better than I could. He said, “All these tech people, they’re just making technologies in search of problems.” You gotta ask yourself what all these health things that’s tracking this metric or that metric, what problem was it solving? But here’s the cool thing, when you start to take these technologies and you mix them in with a doctor, now all of a sudden the technologies can actually solve the problem the doctor has.
At Forward, we use sensors, we send our customers home with sensors, if appropriate. But the doctor’s on the other end. If the doctor comes in and says, “You know what, Lauren, we’re pretty concerned about your heart. We want to watch it. Turns out the blood pressure reading that we happened to get on the day you were in the exam room might be high, might be low, for all sorts of reasons. We want to monitor that.” So now, this doctor’s sending you home with a blood pressure cuff that’s monitoring you over the course of the next few weeks.
If you go up to any one of our doctors, or frankly any doctor in industry, they’d say, “That’s helpful. That’s game-changing. That’s really wonderful.” But when you start with the, “Hey, I think this would be awesome, it’s your steps.” Everybody’s like, “Yeah, but what do I do with that?” So I think that this innovation needs to come a little more from the other side, let’s start with the actual practice of care, let’s start with the actual medicine we’re providing, medical practice that we’re providing, and say, “How can technology support it?” That’s why from the beginning, we had doctors. We said, “We don’t know what technologies to build. You tell us what technologies to build and we’ll go ahead and build them.”
KS: What about all the stuff on the web? You can just google things, now you have so much information.
Has that worked out well?
KS: Actually, kinda good. Like on stupid little stuff, like, “My arm is twitching today, I don’t know why.”
I love my girlfriend to death, she comes up to me three times a week telling me she’s got some rare virus.
KS: No, I don’t ever do that.
LG: Yeah, it’s six clicks to death. Your fingernail hurts and then six clicks later you are dead.
KS: I actually find it useful for small ... Like “Oh, should I do this ... Or should I put this.”
I agree, the reason it’s tough to do that ...
KS: If you’re not a hypochondriac, it’s useful.
Yeah, medicine is nuanced. Medicine’s not the most concrete science, because it’s so nascent. Think of a lot of what a doctor is doing as being the interpreter, just kind of helping you out, saying, “Don’t worry, the probability of that one’s insanely low. Sometimes we can’t even tell you the number, but we know. Look, you haven’t been anywhere, you don’t have Zika. I’m pretty damn sure of it.” Whereas WebMD or whatever, Google, just can’t give you that context. And again, pairing with a doctor is really, really valuable.
KS: Stop googling? All right, we’re going to take one more break and then we’re going to get to our readers and listeners and Adrian’s going to answer all of them, including how many employees they have, how many patients they have, and what kinds of money he’s raised. No, I’m kidding.
Yes, ma’am, whatever you tell me to, ma’am.
KS: First, we’re going to take a quick break for a word from one of other sponsors.
KS: Again ... Not ...
LG: Ka-ch... Adrian, would you like to say ka-ching?
KS: Nice, well done.
LG: There you go.
We’re back with Adrian Aoun, the CEO of Forward. And now we’re going to take some questions about the company and the future of healthcare from our readers and listeners. We’ve got some good ones. Lauren, wanna read the first question?
LG: Absolutely. The first question is from Christine Jackman, @ChrisEJay on Twitter, “I don’t see why patients foot the bill. What is the real challenge this is solving for patients? This seems to only be solving issues for physicians.”
KS: Oh, Christine’s pissed.
Interesting. Great question. It is kind of broken today, that you’re footing the bill twice, and that’s really annoying. Because we’ve been kind of ... We’ve got our hands tied behind our back in this country, where most of the time, you get your health care via your employer, which I just think is a broken model, because it reduces our choice, it reduces your ability to say, “I don’t want to go with this service. I want to choose a different service.” In some cases, yeah, it’s double paying. What a lot of our members do, which works super well because it just gets around this problem is — and there’s just a big movement towards this is — choose a high-deductible plan. If you’re on a high-deductible plan and then you’ve got an HSA or an FSA, you can use that towards Forward, it’s cost neutral to you, sometimes you save money.
KS: Oh, you can use a HSA.
Yeah, and a lot of people do that. And it’s really, really helpful to them. I’d encourage her to look at that. The second thing is saying it’s only solving problems for doctors, well first off, I’m very happy to be solving problems for doctors, because that is an important problem, but I don’t think it’s just doing that, and I would encourage her to swing by and check it out. And I think you’d be pretty surprised at how much of a difference it is for our members. Or just ask Kara.
KS: It’s very enjoyable.
LG: Let’s say that Christine does not live in San Francisco, what cities are you going to next?
We’re not commenting on that yet.
KS: Not commenting on everything.
LG: He’s telling Christine to swing by.
KS: New York, probably New York.
LG: What if she doesn’t live in the area?
KS: Christine, I’ll answer that.
LG: This is $400 for a plane ticket.
KS: This is Kara’s guessing ... New York.
I just presumed all your listeners were in San Francisco.
LG: No, we’re famous worldwide.
KS: I’m gonna guess.
You’re famous worldwide.
KS: You’re not letting me guess where they are going.
LG: Oh, go ahead.
KS: New York, they’ll go to Chicago, they’ll go to Boston ...
Chicago? I don’t like the snow.
KS: You don’t have to go.
Oh, okay that’s ... Clearly, clearly you know what it’s like to operate ...
KS: You can go for the opening and come back. All the big cities, and maybe a Palo Alto thrown in there or something like that. That’s what I see.
KS: Thank you, see. Very easy, I can do this internet thing. Anyway ...
Though, I don’t think we can afford you.
KS: No, you cannot.
LG: A little ... Headspace wants to hire Kara.
KS: No they don’t.
LG: For her meditative qualities.
KS: They do. Do you want to know what my meditation was like? “Hi.”
Oh. Dear God.
KS: See, I know. It would be so good.
LG: I think my heart rate just went ... According to my Apple Watch, my heart rate just went up.
KS: I think he was super interested in my meditative ...
LG: He really was.
KS: He was, it was weird.
LG: Watch out, Andy Puddicombe ...
LG: Whatever your name is, because Kara is taking over.
KS: Kara Puddicombe, my new name. It’s going on.
Okay, Carrie Watkins, @CarrieJWatkins: “How do they see this changing how insurance looks and what is covered?” That’s ... Because for big things you have to ... Which you do have to do in your regular medical thing?
So, one of the coolest things about starting Forward has been starting to learn — and I will absolutely tell you, I’m naïve to this world, but just the world of health care is not ... It’s kind of the opposite of the world of taxicabs. When Uber came out, everybody in the taxi world apparently wanted to kill them. At least that’s what I read on your blog, but in health care, every single player comes up to us and just says, “Great, let’s work together.” They’re smart, they actually do understand that investing more in preventative care and investing more in primary care is tons ...
KS: Because I don’t have to pay as much.
Yeah, exactly. As there has been a shift from fee-for-service, where your doctor bills out every service, to value-based medicine, where your doctor just gets a flat rate for taking care of you, all of them are like, “Oh God, we need to really invest in primary care.” That’s been neglected for a long time.
KS: Yeah, it has.
So I actually think that companies like Forward, and we’re not the only one, but companies like Forward that are investing in primary care are actually really great to partner with the transition and the shift to value-based.
KS: They don’t want you to be sick. Put that donut down. Diagnostic tools.
Well, you know what? If that’s what it takes. Stop eating donuts.
KS: No, but it is interesting. Just so we have everyone ... Carrie is clear, they do not bill insurance ...
We don’t bill your insurance.
KS: So you just go in and pay your fee, like you’re going to a gym, essentially.
KS: The gym you’re not going to that you’re paying $149 for this, this is probably money that ...
It turns out that Equinox is twice our price, so you know.
KS: Yeah, no, but then you don’t go. And then if you have something that they don’t cover, like an MRI or some serious cancer issue, or ...
We still want you to have insurance.
KS: But a rash, you can do?
Oh yeah. All your primary care stuff. We’re a super expansive version of primary care. We do women’s health, we do men’s health, we do a lot of this stuff. But the stuff that if you do need to get referred out, you should have insurance. And just generally, we just think people should have insurance.
KS: How is it different from, in that regard, from One Medical? I mean, it’s fancier, I’ve been to One Medical, so the chairs are fantastic, the outfits are fantastic, the design ... It does look like the Apple Store of medical things. How do you compare it to that?
There’s two big differences, from traditional care. First difference ...
KS: One Medical is different from traditional care, too though.
In some regards, the first thing that’s really important is that we really want to empower both our doctors and our members with information. Today, when you want to understand what’s going on with your body, it’s kind of a black box, you beg somebody to tell you ... Have you ever been in a doctor’s office and they’re typing up notes about you? I always try to look around and look at the notes. And they’re like, “No, don’t look.” And they’ve got a privacy filter. It’s like, “Wait, that’s about me.”
KS: They’re on Facebook.
LG: They’re sliding into someone’s DM’s.
So the key for us is, let’s use technology and let’s be thorough and let’s get as much information as possible. And that’s both when you’re onsite, but also when you’re offsite. When you’re at home, this is where the sensors actually come into play.
And then the second thing is, to not just be this repair shop, like, “Oh, let’s wait for you to have the rash, see you for seven minutes and send you on your way.” But to really focus on more the long-term, chronic issues, the preventative issues, the things that actually kill us.
KS: It was disconcerting how much she talked to me, I have to say. It was disconcerting.
LG: Next question.
KS: She was doctor talking to me a lot. I was like,”"Stop being so interested in me.” And she goes, “Well, this is your checkup.” And I’m like, “Cut it out.”
Go ahead, next question.
LG: Next question. We got a lot of fantastic questions via email from our frequent listener Liz Weeks and unfortunately we do not have time to get to them all, but here are a few of them.
KS: It’s two, one or two.
LG: Yeah. So her first question is about, “What about dental or oral health? I noticed the emphasis on focusing on systemic root causes for health issues, but Pew has noted the increased need for preventative oral care, especially in rural areas lacking water, etc.” And I don’t know if some of you may remember a story that ran in the Washington Post not long ago. It was a pretty heartbreaking story about thousands of people who were lining up at a gymnasium in Virginia to receive free dental treatments. Just some of their stories, it’s really sad, how people don’t have access to basic dental care in this country.
First off, awesome question, I love it. The reason that we haven’t gotten into dental yet is not that we don’t want to, we think it’s super, super awesome, there’s two things. One, we haven’t developed game-changing technologies there, and it doesn’t make sense for us to go into something if we don’t have some kind of true novel thing. Turns out there’s some pretty decent dental technologies out there.
The second thing is that ... And with all due respect, because it is a big issue for a lot of people, I don’t know that many people that are dying of dental issues. I know a lot of people are dying of cardiovascular issues, of diabetes, this, that and the other, and so we’d prefer to focus on those things much, much more. A lot of the dental issues in the Unites States at least, and I say this with only a cursory understanding, are a lot of cosmetic issues, and those are important and we should deal with those, but on my stack rank, I’d rather solve the heart attack.
KS: You could specialize.
We absolutely can, and we will over time. It’s just a question of what order do we go to things.
KS: I just had a filling right now. My mouth is ...
You have a feeling?
KS: A filling. That’s why I just said filling because I just had a filling.
LG: I would argue that even if it’s not life threatening, that someone needing a root canal or having a cavity, or not being able to do their job effectively, or hold down a job effectively. Some people can’t get jobs because they’re missing teeth or whatever it may be. So that’s why I think it’s pretty important.
That’s why it’s important, I agree, I totally agree, which is why we want to get to it. We’re not going to ignore it, but in our stack rank it ...
KS: And in this same question she’s asking about AI machine learning: “Learning is coming to the fore regarding how biased, inappropriate, or flat-out incorrect inputs can completely throw off outputs. How is Forward dealing with this since you have an AI background and how does it intend to deal with issues like liability and malpractice?”
The way we think about the problem is, all we’re trying to do is learn from our doctors, we’re not trying to bypass the doctors, we’re just trying to make them more efficient. It’s a little like when you are sending a text message on your phone and it kind of fixes your typos or it just fills in the work for you and it just makes you a little more efficient. It didn’t send the text message without you being involved, it just made it a little easier for you.
The key in our system is, our doctors are always in control of the care. We don’t bypass the doctors, we don’t overrule the doctors, that’s not how it works. You’ve seen what self-driving cars do when they go wrong, can you imagine what it would be like if your doctor went down that path? We don’t want to go down that any time soon. Maybe in 30 years, come back to me and we’ll have a different conversation about that.
But basically, the cool thing about using machine learning and AI is now instead of just seeing one doctor at Forward, think of it as you’re getting a second opinion for free every time, because our technology is basically looking at what all of our doctors have done and say, “Oh, this is the part that has worked the best.” And so now our doctors can very easily learn from each other, because the system is saying, “Hey, hint hint, this kind of treatment usually works better than this treatment.” And that’s really good.
KS: And that is one thing in terms of your files being on paper, there’s so many patterns that should be able to be seen. All right, so next question, Lauren.
LG: Next question, two questions again from Andrew Porter, @AJMPorter on Twitter: “With an increasing number of people in favor of a quote unquote universal care, how does a service like this square with that?”
First off, I love the idea of universal care. That being said, I also don’t think we’re going to get there any time soon in the United States. We’re not trying to build our business for that model, but should that model come out in the United States, we’d be absolutely happy to work within the constraints of that model. It’s a little hard for me to give specifics because it doesn’t exist and there’s not really a serious plan for it to exist. I don’t know if Andrew Porter is working on it, but if he is, God bless him, because I think we should move towards that.
LG: The next question, you answered already. An email question from Paul Hippmann: “Where can laymen access helpful info on new help for heart failure patients, when neither cardiologist nor the media inform them as they do of cancer breakthroughs?” Like a lot of the FitBits, they tried to have more content I know, all of them did. Do you do that?
We always try and pair something with the doctor. It’s really a key notion for us, is don’t try to bypass doctors, it turns out they’re pretty smart people. They went to school for a lot of years, they mean really well, so let them be your guide. You don’t ever want them to be in control of your health, you want them to almost be your guide or your sherpa through your health. We’re constantly looking at all the latest research.
Then what our doctors are doing, which is really awesome, they are going to our relevant members and saying, “Hey, FYI Adrian, this just came out. This actually affects your treatment.” Me, in particular, without getting too much into my medical files, I do have high risk for heart issues. Fairly obvious, probably what I’m going to die from. My 23andMe was like, “BTdubs, you’re going to die of a heart attack, everything else you can ignore.” I spent a lot of time being on top of that research. The truth is, I’m not a doctor, what do I know? I’m reading this stuff ...
LG: Which one is good and, which one is bad.
Exactly, and all of a sudden I think I have Zika virus, it’s like the WebMD problem. My doctor at Forward, who’s awesome, is just constantly telling me, and sometimes I ask him, “Hey, should I care about this or not?” But honestly, he’s coming to me saying, “Hey, Adrian, you know that medication that you’ve been on for a few years, I know you were on it. I know your prior doctor was awesome but it turns out, that’s now outdated. We shouldn’t keep you on that. So we’re going to switch you from this to this.” He explains it, he explains both the research but also what do we know, but here’s the key, what do we not know. Which traditional care, because you don’t have more than seven minutes, they don’t take the time to tell you, “Hey, we know this thing for sure,” versus, “We might know this, this one’s a little of a crapshoot.” The truth is, again, we’re really early in the science.
KS: The only thing, of course, is that it’s all subjective. Because I’ve seen doctors ... My brother, all argue about the same study. It would be helpful if there was some way AI or some other computing technique could ... because I would love to get the latest information about strokes. And my doctor doesn’t think about it.
I agree, and I’d love to work on that problem, over time. It’s a really hard problem, it’s one that’s definitely worth working on. We have the beginnings of this ...
KS: It just seems like it would supplement what you’re doing. Here you are, it could pop in a go, “Oh, this person had this, therefore, they must be ...”
You’ll actually, I don’t want to pre-announce anything, you’ll see the beginnings of us doing a little of that in the coming weeks.
KS: Just information, which is interesting, but they could be easily tailored.
Especially around metrics. We’re going to start really empowering you to really understand ... You get this blood test and you see these 47 different numbers and you don’t know what they mean and you don’t know what to think about them. That’s a really good place to really start demystifying things so that when that research comes out you really understand, “What am I trying to change? How does this affect my LDL, my HDL?”
KS: What’s interesting is that simplification would certainly be helpful for anyone new offering. Because that’s another area that is ... I think they keep it mystified for very good reason, to keep you away from, they don’t want people asking dumb questions. But dumb questions is precisely what they ...
Totally. I want to just address a slight nuance there, which is we don’t want to dumb it down ...
KS: No, of course not.
One of the things a lot of traditional care does, it comes down to, “I’ve got five minutes,” whatever, it’s like, “Oh, your heart’s fine.” I think, “No, no, no, don’t tell me my heart is fine. Tell me, educate me. These are the 12 things you need to understand about your heart. These ones look pretty good, these ones look pretty bad, these ones got better, these ones got worse.” A lot of people, especially tech companies have said, “Okay, can I simplify this to one number, this, that.” I actually think people are a lot smarter and care a lot more than we realize.
KS: Yeah, I do think what it is is that they get annoyed by people having been on Google or some idea ...
KS: I have a lot of doctors in my family. But at the same time, I’ve been in so many situations ... I had low white blood cells at one point, they couldn’t figure it out. And then the doctor said, “What you’re suffering from is neutropenia.” Which is, of course, low white blood cells. And I go, “You just described what I have, but not the diagnosis.” And he’s like, “No, that’s what you suffer from.” I’m like, “No, that’s a description.” I said, “I can speak English better than you, so I’m pretty certain that’s what you’re doing.” It was fascinating, because you could see the struggle of the doctor, they’ve trained for all this time, there’s sort of this god-like thing around doctors, which has gotten less so over time.
But it was interesting because I finally said, “Can you just say ‘I don’t know’? Because I would prefer ‘I don’t know.’” And he wouldn’t say “I don’t know.” I said, “But you don’t know, do you?” And he’s like, “I’m not going to say that.” I go, “Just say you don’t know.” Can you imagine me being your patient? But it was interesting because you could not dumb it down, but make it ... It seems to me there could be a lot of computer ways to do that, which I think is probably ...
LG: What I think one of the challenges, too, for startups is, they can’t necessarily ... I mean, you’re a doctor office, so it’s different, but you mentioned like other tech companies, they can’t necessarily diagnose you. They’ll say things like the CDC says or the Mayo Clinic says, or whatever it may be, but ...
KS: Yes, here are the 10 things ...
LG: They can only be so prescriptive in some of these direct-to-consumer applications of things.
KS: Okay, the very last question that I think someone did bring up was the idea of under-served communities. This shouldn’t cost $149, can you get it to a price that’s $20 a month or something like that? Is there a way to do that? Or even middle-class communities so that you can sort of take away the health care burden and get more preventative.
I agree with you. I think it sucks and it’s a travesty that it costs a lot and I’m totally with you. We absolutely can — whether it’s us or just as an industry — get this kind of modern comprehensive care to a low price. What we can’t do is we can’t do it overnight. Again, it just comes back to, it took Elon 12 years to go from 150k to 35k? Well, it’s going to take us, who knows, that amount of time, maybe longer. We don’t know.
So we’re working on it. We’re working super hard on it. A lot of our technology is all about just the efficiency of interaction. Can we make it so you don’t have to come in if you don’t need to come in? Can we make it so your doctor’s not spending hours typing up notes or fighting with insurance companies? And we’re well on our way toward that. You’ll see us do a few things.
First off, we do want to launch lower-priced options. I’m not pre-announcing that, but since I am, so you’ll see that come soon. The second thing is that, again, we want to work with the employers and even insurers to help get it out to the masses. Again, these things take time. As you know, the health care industry doesn’t move overnight, nor should it necessarily. The third thing really, really comes to what we as a company like to do and might be what this person was talking about it, we actually give away some memberships as well, to folks from the under-served community. That’s not a model that scales. I don’t think it should be the number one plan of doing so. But it also helps in the short term.
KS: Great, Adrian.
LG: Thank you.
KS: This has been great. This is Adrian Aoun, from Forward.
You have to howl it.
KS: Aoun. I like to howl. Anyway, thank you so much. It’s a really important topic and it’s ... I actually do find it nice that Silicon Valley people are working on real problems. I’m sorry, I consider these real problems as opposed to some of the things they work on.
LG: Yes, thank you for joining us, Adrian.
This article originally appeared on Recode.net.