WEBVTT - Going to the Doctor Sucks. Can AI Make it Better? 0:00:15.356 --> 0:00:15.796 Pushkin. 0:00:20.476 --> 0:00:23.716 Going to the doctor sucks, and not just because you're sick, 0:00:24.556 --> 0:00:27.436 but because it's hard to make an appointment. Then you 0:00:27.516 --> 0:00:29.876 finally get an appointment, and you go in and you 0:00:29.916 --> 0:00:32.716 fill out all these forms. Then you wait for whatever 0:00:32.756 --> 0:00:35.516 an hour. Then you go in and see the doctor 0:00:35.956 --> 0:00:38.516 and she asks you all the questions you just answered 0:00:38.516 --> 0:00:39.316 on those forms. 0:00:39.836 --> 0:00:42.076 And by the way, it's not great for the doctor either. 0:00:42.356 --> 0:00:44.596 She has to see a million patients and do all 0:00:44.596 --> 0:00:46.516 this paperwork and doesn't have time to keep up with 0:00:46.596 --> 0:00:49.116 what's happening in the medical literature with all the new 0:00:49.156 --> 0:00:50.676 studies and recommendations. 0:00:51.196 --> 0:00:52.996 And everybody knows this is true. 0:00:53.276 --> 0:00:55.636 Nobody's figured out how to fix it yet, but it 0:00:55.796 --> 0:00:57.476 is a problem that people are. 0:00:57.356 --> 0:01:05.236 Trying to solve. I'm Jacob Goldstein and this. 0:01:05.276 --> 0:01:07.436 Is What's Your Problem, the show where I talk to 0:01:07.476 --> 0:01:10.756 people who are trying to make technol logical progress. My 0:01:10.796 --> 0:01:14.876 guest today is a lawn block. Alan is a serial entrepreneur. 0:01:15.036 --> 0:01:17.836 He was the co CEO of Wix, the site for 0:01:17.876 --> 0:01:21.156 building websites. He founded a company called Room that buys 0:01:21.196 --> 0:01:25.076 and sells used cars, and then in twenty sixteen Alan 0:01:25.156 --> 0:01:27.036 founded a company called k Health. 0:01:27.556 --> 0:01:30.756 Today, thousands of patients a month are treated through k Health. 0:01:31.316 --> 0:01:34.556 The company has this AI based patient interface and they 0:01:34.596 --> 0:01:36.116 employ around one hundred. 0:01:35.916 --> 0:01:39.116 And fifty doctors through an affiliate, and k help has 0:01:39.116 --> 0:01:42.356 big growth plans. They just raised another fifty million. 0:01:42.116 --> 0:01:43.236 Dollars to keep growing. 0:01:44.076 --> 0:01:46.676 The problem Alan and k help are trying to solve 0:01:47.156 --> 0:01:50.396 is this, can you use data and technology to make 0:01:50.436 --> 0:01:54.236 going to the doctor better? Better for patients and for doctors. 0:01:56.756 --> 0:02:00.156 We built essentially a machine that can engage with you. 0:02:00.836 --> 0:02:03.956 It's a predictive mention that is trying to figure out 0:02:03.956 --> 0:02:06.876 the next best question to ask Jacob. Jacob comes in 0:02:07.916 --> 0:02:12.356 and he's got a headache, and and and you know, 0:02:12.436 --> 0:02:14.396 if we don't know anything about you, we asked for 0:02:14.876 --> 0:02:17.716 your age and your gender, and we have a series 0:02:17.796 --> 0:02:21.476 of conversations given what we know, you know, you know, 0:02:21.756 --> 0:02:23.836 what is the next best question to us to get 0:02:23.876 --> 0:02:25.716 to the differential diagnosis? 0:02:25.916 --> 0:02:29.996 I will say, uh, this is in fact some some 0:02:30.116 --> 0:02:32.756 part of your product as it exists now is is 0:02:32.796 --> 0:02:36.116 what you're describing. And I know this because I tried 0:02:36.116 --> 0:02:39.236 it out before this interview, and as it happens, true story, 0:02:40.036 --> 0:02:44.916 I have COVID right now. Despite my chipper demeanor, I 0:02:44.916 --> 0:02:49.596 feel like asks. And so yesterday I loved Indo K 0:02:49.756 --> 0:02:52.556 Health And the one thing I didn't tell it, I 0:02:52.596 --> 0:02:53.636 didn't I have had. 0:02:53.516 --> 0:02:55.156 A positive COVID test. But I thought it would be 0:02:55.196 --> 0:02:56.756 too easy to tell it that I had a positive 0:02:56.756 --> 0:03:01.276 COVID test. But I said I have. I'm feeling tired? 0:03:01.636 --> 0:03:02.716 Was my ask you? 0:03:02.716 --> 0:03:04.596 You log in and ask you first, like you know 0:03:04.716 --> 0:03:07.276 you're presenting complain, asked like why are you here today? 0:03:07.316 --> 0:03:09.476 What seems to be the trouble? And I started with tired. 0:03:09.516 --> 0:03:13.716 And it has a specific list of possible answers. Right, 0:03:13.756 --> 0:03:16.876 it's not like it's not like chat GPT, it's not 0:03:16.996 --> 0:03:20.236 free form, right, it's very it's clearly categorized, and it 0:03:20.316 --> 0:03:22.156 puts your answer into keating. And so once I said 0:03:22.156 --> 0:03:24.676 I was tired, it asked me a lot of other 0:03:24.716 --> 0:03:27.556 things that said, when did you start a fatigue? Right, 0:03:27.556 --> 0:03:29.156 it called it fatigue, and then it's how long have 0:03:29.236 --> 0:03:32.716 you been feeling fatigue? Lots of questions about fatigue any, 0:03:32.836 --> 0:03:35.596 did your fatigue start after eating, after sun exposure? 0:03:36.316 --> 0:03:37.836 Are you more or less fatigued at the time of day? 0:03:37.836 --> 0:03:40.236 And then it asked me other symptoms that I said, 0:03:40.236 --> 0:03:42.796 I had a fever and It asked me lots of 0:03:42.796 --> 0:03:45.196 specific questions including have you been in close contact with 0:03:45.236 --> 0:03:48.636 anyone who has COVID? Lots of other symptoms, you know, 0:03:48.836 --> 0:03:52.996 loss of smell, no malaise, yes, lots of general questions, 0:03:53.036 --> 0:03:55.476 and then it said the results I'm about to show 0:03:55.516 --> 0:03:58.636 you are not a diagnosis or medical advice, which I 0:03:59.236 --> 0:04:01.156 get that. And then and then it gave me an 0:04:01.196 --> 0:04:05.956 interesting It gave me a probabilistic answer, right, which was 0:04:06.036 --> 0:04:08.316 quite interesting to me. The sort of final screen, and 0:04:08.356 --> 0:04:09.996 I got a screen of I'll just read it to 0:04:09.996 --> 0:04:10.316 you now. 0:04:10.676 --> 0:04:13.516 It says what your symptoms may mean, and then it says, 0:04:13.556 --> 0:04:17.236 here's how eleven thousand, eight hundred and eighty one people 0:04:17.316 --> 0:04:21.196 with cases like yours were diagnosed sixty percent COVID, nineteen 0:04:21.836 --> 0:04:25.316 forty percent upper respiratory infection. And then it said think 0:04:25.356 --> 0:04:27.276 you needed doctor, says it get better from home today, 0:04:27.476 --> 0:04:29.836 chat with a clinician now, and that's we can talk 0:04:29.876 --> 0:04:32.396 about that part later, but let's just talk about I'm 0:04:32.396 --> 0:04:37.796 really interested in that, the specific quantitative nature the eleven thousand, 0:04:37.916 --> 0:04:40.756 eight hundred and eighty one people with cases like yours, 0:04:40.996 --> 0:04:44.676 and then the probabilistic outcome. That's really interesting to me 0:04:44.756 --> 0:04:46.756 because it's sort of like what would. 0:04:46.596 --> 0:04:48.916 Happen if you go to the doctor, but also sort 0:04:48.916 --> 0:04:50.356 of different. So tell me about that. 0:04:51.316 --> 0:04:53.596 So first of all, that makes me ready happy and 0:04:53.636 --> 0:04:56.436 we should have started there. I'm so happy you used it. 0:04:56.476 --> 0:04:58.836 And by the way, coming in with the fatigue case 0:04:59.356 --> 0:05:01.956 is not trivial. You go to your primary care or 0:05:02.156 --> 0:05:05.996 good care and say I have fatigue. Okay, there's many 0:05:06.036 --> 0:05:08.396 many things that can lead to fatigue. It can be temporary, 0:05:08.476 --> 0:05:11.156 can be long term term. It could it could it 0:05:11.156 --> 0:05:13.956 can be related to a serious health condition, or it 0:05:13.956 --> 0:05:17.916 can be something transitory. So that's great. You came there 0:05:18.356 --> 0:05:21.436 and you acted all down. Apologies, but you didn't say 0:05:21.476 --> 0:05:24.116 I have COVID door I think I have COVID dours effected. 0:05:24.316 --> 0:05:26.796 You gave it was a broad based thing. Fatigue can 0:05:26.836 --> 0:05:29.236 also be related to cancer. It can be related to 0:05:29.396 --> 0:05:33.516 thyroid issues, insomnia. So so what what we're trying to 0:05:33.556 --> 0:05:37.036 do just to tile the pieces together. It builds a 0:05:37.116 --> 0:05:42.276 dynamic cluster of people like you, of this, of this, 0:05:42.556 --> 0:05:45.356 of these people that have the same gender, age, medical 0:05:45.436 --> 0:05:47.996 history and symptoms that are relevant to what you're having, 0:05:48.396 --> 0:05:51.636 and it's trying to figure out what it has it 0:05:51.676 --> 0:05:55.996 gives you a statistical output because it's a probabilistic nature 0:05:55.996 --> 0:06:00.116 of what you might have. And it's and as as 0:06:00.156 --> 0:06:02.556 as we say very clearly we don't diagnose you, but 0:06:02.676 --> 0:06:05.796 compare it to doctor Google or any other system out there, 0:06:06.236 --> 0:06:08.516 you won't get that rigger. And every one of the 0:06:08.636 --> 0:06:13.076 questions we ask in our clinical AI is a is 0:06:13.116 --> 0:06:16.556 a very specific question. Is in medicine, this is not 0:06:16.596 --> 0:06:19.876 a hallucinating let me just try and guess what you have. 0:06:20.436 --> 0:06:25.156 It's not chat ept, it's not trying to predict some 0:06:25.396 --> 0:06:28.516 set of sentences. It's trying to predict your diagnosis. We 0:06:28.676 --> 0:06:33.596 generate a diagnosis in treatment, right, but because you know 0:06:33.676 --> 0:06:36.276 this is not regulated, we tell people this is what 0:06:36.316 --> 0:06:38.076 you might have, and if you want to, you can 0:06:38.116 --> 0:06:39.636 press about it and be in front of a doctor 0:06:39.716 --> 0:06:41.716 twenty for seven and deal if not. 0:06:41.836 --> 0:06:44.156 In fact, it says it is not a diagnosis. You're 0:06:44.156 --> 0:06:45.116 saying it's a diagnosis. 0:06:47.716 --> 0:06:49.516 Trying to make Jesus to be clear, this is not 0:06:49.556 --> 0:06:53.516 a diagnosis. Is trying to mimic a diagnosis. What we're 0:06:53.596 --> 0:06:57.356 trying to generate is trying to mimic a really high 0:06:57.436 --> 0:07:01.436 quality physician by having this medical conversation, this medical chat 0:07:01.836 --> 0:07:06.556 and having showing the differential because maybe if you didn't 0:07:06.556 --> 0:07:10.316 have a positive laptist, maybe it's maybe it's an opera 0:07:10.356 --> 0:07:13.996 respiratory infection, maybe it's something else going on here. And 0:07:14.956 --> 0:07:17.316 our goal was not to say, Okay, this is what 0:07:17.356 --> 0:07:20.236 you have and it's impossible that it's something else, because 0:07:20.236 --> 0:07:22.716 that's not how medicine works. The goal is to consider 0:07:22.756 --> 0:07:25.916 the diagnosis. But that's a tricky part of medicine. There 0:07:26.116 --> 0:07:28.676 is a science and art here about how to do it, 0:07:28.716 --> 0:07:32.316 and we're trying to mimic that capability. But in it 0:07:32.436 --> 0:07:35.356 I think it's quite magical that you can engage with 0:07:35.436 --> 0:07:39.316 a machine, have an understanding what you might have and 0:07:40.476 --> 0:07:43.276 which is not some kind of guess, work on doctor Google, 0:07:43.316 --> 0:07:44.916 and then press a button and was in a matter 0:07:44.956 --> 0:07:47.516 of minutes and be in front of a doctor and 0:07:47.596 --> 0:07:51.036 get medical advice and get prescription, get anything else, anything 0:07:51.036 --> 0:07:52.316 else you need twenty four to seven. 0:07:53.236 --> 0:07:57.276 So to build this thing, this machine that's trying to 0:07:57.516 --> 0:08:00.316 come up with, you know, something like a differential diagnosis, 0:08:00.796 --> 0:08:03.676 obviously you need a ton of data. And I know 0:08:03.756 --> 0:08:06.196 there's this key moment early in the life of the 0:08:06.236 --> 0:08:10.356 company when you got access to this like big beautiful 0:08:10.516 --> 0:08:13.596 data set. Tell me about that, Okay, So. 0:08:15.156 --> 0:08:17.396 People pointed me all over the world to try and 0:08:17.436 --> 0:08:20.756 find data. At the time people spoke to me about Estonia, Denmark. 0:08:22.596 --> 0:08:25.996 Any conversation I try to have with a with a 0:08:26.076 --> 0:08:29.716 large hospital group in America at the time was completely stonewalled. 0:08:29.716 --> 0:08:33.236 I can get anywhere because of hip et cetera. And 0:08:33.396 --> 0:08:36.276 we ended up licensing a data set from an HMO 0:08:36.356 --> 0:08:39.356 in Israel called Maccabi. And I'll explained specifically what we 0:08:39.476 --> 0:08:42.196 have there. At the time, we didn't realize just how 0:08:43.076 --> 0:08:44.876 what do you call it? Big and beautiful? The data 0:08:44.876 --> 0:08:50.836 set is Maccabi is structured similar to Kaiser Permanenta. So 0:08:50.876 --> 0:08:54.516 it's an insurance company that also has its own captive providers, 0:08:54.556 --> 0:08:56.876 but they also have their own drugstore, their own lab, 0:08:57.236 --> 0:08:59.236 a single EMR, their own hospital. 0:08:59.436 --> 0:09:02.236 If providers means doctors who work for the company. Just 0:09:02.276 --> 0:09:06.836 to be right, okay. So it's a complete integrated health system, right. 0:09:06.876 --> 0:09:09.956 People who are in this system, they get their prescriptions there, 0:09:09.996 --> 0:09:11.516 they go see the doctor there, they go to the 0:09:11.516 --> 0:09:15.956 hospital there. So this Macabi, this Israel, is going to 0:09:16.036 --> 0:09:18.916 have all of the data for the patients there. 0:09:18.716 --> 0:09:23.076 And then one more big step. People don't switch HMOs 0:09:23.076 --> 0:09:26.196 in Israel. So we essentially got access to two and 0:09:26.236 --> 0:09:30.036 a quarter million people for a data set over twenty years, 0:09:30.036 --> 0:09:32.036 and we essentially were a fly on the wall for 0:09:32.076 --> 0:09:34.356 all these people. Did they go to a doctor, did 0:09:34.356 --> 0:09:36.396 they get a prescription? We know also if they picked 0:09:36.396 --> 0:09:38.956 it up, we know, if they had labs, we know. 0:09:39.076 --> 0:09:41.316 We could put together a time series of all of that, 0:09:41.676 --> 0:09:45.796 and of course postilizations as procedures, surgery's outcomes. So just 0:09:45.876 --> 0:09:48.356 to give you a sense, we got access to about 0:09:48.396 --> 0:09:52.476 four hundred million medical charts, over a billion labs, half 0:09:52.476 --> 0:09:58.156 a billion prescriptions, two million hospitalizations. 0:09:57.196 --> 0:09:58.756 And I presume it's anonymized. 0:09:59.236 --> 0:10:01.436 We built an anonymizer. 0:10:02.076 --> 0:10:06.116 So you have this very large, very robust, very complete, 0:10:06.356 --> 0:10:07.756 longitudinal data set. 0:10:08.396 --> 0:10:09.996 Great, what do you do with it? 0:10:10.316 --> 0:10:13.916 We wanted to focus on these things are both what 0:10:13.996 --> 0:10:16.196 you go to your doctor, your primary care physician, and 0:10:16.236 --> 0:10:19.716 to urgent care. My head hurts, my stomach hurts, I've 0:10:19.756 --> 0:10:23.076 got a rash, I've got an upper rest with our infection, 0:10:23.116 --> 0:10:28.196 I've got a fever. All these different things. 0:10:26.596 --> 0:10:29.236 And some kind of problem that just started. It's not 0:10:29.276 --> 0:10:30.276 a chronic disease. 0:10:30.356 --> 0:10:32.876 It's not a physical it's something that like, oh, my 0:10:32.956 --> 0:10:34.996 head just started hurting, I better go to the doctor. 0:10:35.076 --> 0:10:38.836 It's that, yes, And now it could be my head 0:10:38.876 --> 0:10:41.876 started hurting and I've got a history of migrains a synoscientists, 0:10:41.876 --> 0:10:43.316 and I think I know what it is, or it 0:10:43.396 --> 0:10:45.196 might be something completely out of the blue. 0:10:45.596 --> 0:10:49.316 What's one thing you tried at k Health over the 0:10:49.316 --> 0:10:51.396 course of the company that didn't work. 0:10:52.956 --> 0:10:55.636 We tried in the beginning as we were building through 0:10:55.676 --> 0:10:59.156 as we're learning healthcare, we're trying to send people. When 0:10:59.196 --> 0:11:02.756 we built the information, we said, okay, here's the information 0:11:02.876 --> 0:11:05.356 and we'll connect you to physical doctors in person in 0:11:05.396 --> 0:11:08.996 Manhattan and Brooklyn because we're basing the arc and then 0:11:09.156 --> 0:11:10.716 work at all. 0:11:10.716 --> 0:11:11.796 Why not? So why not? 0:11:12.276 --> 0:11:15.716 Because people wanted immediate solutions of their problems right now, 0:11:15.876 --> 0:11:19.476 that's a scientist or UTI or migraine. And you know 0:11:19.516 --> 0:11:21.636 the whole beauty was it twenty four to seven service? 0:11:21.956 --> 0:11:23.756 So was that when you realized that you had to 0:11:23.836 --> 0:11:24.636 hire doctors. 0:11:25.116 --> 0:11:27.996 We needed to hire doctors and build our own solution, 0:11:28.116 --> 0:11:29.556 own the resolution. 0:11:29.196 --> 0:11:31.796 Which is a huge that's a huge leap right there. 0:11:31.836 --> 0:11:34.916 You're going from being a software company to being like 0:11:35.876 --> 0:11:39.276 a much more complicated, much more expensive to build company 0:11:39.276 --> 0:11:39.956 at that moment. 0:11:40.036 --> 0:11:44.596 Right, Yeah, but you we didn't go in here, timid. 0:11:44.636 --> 0:11:47.476 We went in here. We want to make real changes. 0:11:47.516 --> 0:11:50.196 We don't want to be some yet another cute digital 0:11:50.356 --> 0:11:53.876 health company that does cute things and sells usself. We 0:11:53.916 --> 0:11:55.876 want to build a big, independent company, and we want 0:11:55.916 --> 0:11:59.076 to build a company that will make a difference in 0:11:59.116 --> 0:12:03.636 care delivery in people's lives, starting was primary care. So yeah, 0:12:03.876 --> 0:12:05.516 you have to you have to pick your battles. 0:12:05.716 --> 0:12:06.036 Yeah. 0:12:06.196 --> 0:12:08.436 Well, so let me ask since that came up, I mean, so, 0:12:08.676 --> 0:12:13.956 I know you're just raised another fifty million dollars, which congratulations. 0:12:13.956 --> 0:12:15.796 Hard to do at this moment from what I've heard 0:12:15.836 --> 0:12:18.556 for a lot of companies, and you've raised what three 0:12:18.676 --> 0:12:23.076 hundred million or so so far? Is there some Well, 0:12:23.156 --> 0:12:24.996 do you have a sense of when you'll be profitable? 0:12:26.196 --> 0:12:28.636 I think we'll be profitable in the second half of 0:12:28.716 --> 0:12:29.116 next year. 0:12:30.356 --> 0:12:36.556 Great, So let's let's talk more more fully about how 0:12:36.596 --> 0:12:40.036 your business works at this point, right, I have I 0:12:40.116 --> 0:12:43.716 tried out this sort of consumer facing first step, I 0:12:43.756 --> 0:12:47.916 didn't click through to talk with a clinician, but what like, 0:12:48.636 --> 0:12:49.996 how does the business work now? 0:12:51.036 --> 0:12:55.716 So our business is wet. We have both a direct 0:12:55.756 --> 0:13:01.076 to consumer relationships and we work with payers, and we 0:13:01.116 --> 0:13:06.396 work with large health system providers. 0:13:04.116 --> 0:13:07.436 And payers means insurance companies. Payers is what people are 0:13:07.476 --> 0:13:09.396 in healthcare call insurance companies. 0:13:09.476 --> 0:13:13.756 So we essentially offer our services and we get paid 0:13:13.796 --> 0:13:16.156 as a provider to take care of patients. So if 0:13:16.196 --> 0:13:19.956 it's direct to consumer, we have an offer for consumers 0:13:19.956 --> 0:13:22.236 and you can just sign up and pay out of pocket. 0:13:22.916 --> 0:13:23.956 We announced that a. 0:13:23.876 --> 0:13:25.716 Few weeks ago that we're. 0:13:25.396 --> 0:13:28.156 Working with Cedar Sinai. We're working with other health systems. 0:13:28.156 --> 0:13:31.036 Theesar sign up a big hospital system in Los Angeles. 0:13:31.596 --> 0:13:35.356 Yeah, the largest hospital system in California. We see thousands 0:13:35.356 --> 0:13:39.036 of patients every day, which would be the size of 0:13:39.076 --> 0:13:43.476 a large health system with multiple hospitals and multiple art 0:13:43.516 --> 0:13:44.356 patient centers. 0:13:44.436 --> 0:13:48.716 So large, and how often do you end up referring 0:13:48.796 --> 0:13:53.036 people to see a doctor in the physical world, or 0:13:53.076 --> 0:13:55.476 get a test in the physical world, to do something 0:13:55.596 --> 0:13:58.116 in real life, to do something in meat space. 0:13:58.716 --> 0:14:04.436 So we refer people to in person physician about eight 0:14:04.436 --> 0:14:06.756 percent of the time. That could be to the er, 0:14:07.116 --> 0:14:09.516 it could be to specialty care or to an person 0:14:09.556 --> 0:14:12.516 primary care. Okay, so I was going to say that, 0:14:13.036 --> 0:14:18.396 Just to be clear, there is many times a physical interaction. 0:14:18.516 --> 0:14:22.196 For example, our doctors will send a patient to do ELEB. Yeah, 0:14:22.316 --> 0:14:24.996 but ninety two percent of the time we can resolve 0:14:24.996 --> 0:14:29.236 it without a bricks and marker doctor reviewing that lab. 0:14:29.996 --> 0:14:32.436 A portion of the time we need to we need 0:14:32.436 --> 0:14:34.716 to refer the patient to an in person visit in 0:14:34.796 --> 0:14:40.276 primary care, or to specialty care or to er. But again, 0:14:40.356 --> 0:14:42.636 the vast majority of stuff we can do online. So 0:14:42.676 --> 0:14:47.476 it completely changes the paradigm on access because if it's 0:14:47.476 --> 0:14:48.796 ten pm, what are your choices? 0:14:51.396 --> 0:14:53.716 In a minute, Alan talks about the problems that k 0:14:53.916 --> 0:15:06.636 Health is still trying to solve. It's interesting to think 0:15:06.636 --> 0:15:11.276 about to compare k help Health versus a traditional doctor. 0:15:11.316 --> 0:15:14.396 Say good, you know, seventieth percentile a good but not 0:15:14.476 --> 0:15:15.836 amazing traditional doctor. 0:15:17.076 --> 0:15:21.436 And I'm curious. I would imagine there are some settings 0:15:21.436 --> 0:15:23.276 where KA health is better and some settings where a 0:15:23.316 --> 0:15:25.316 traditional doctor might be better. Some things that are just 0:15:25.476 --> 0:15:30.316 easier to detect in person, say, and I'm curious, like, 0:15:31.076 --> 0:15:35.996 are there particular kinds of cases that worry you? Are 0:15:35.996 --> 0:15:39.596 there particular kinds of patients who you think KA health 0:15:39.636 --> 0:15:41.796 may not be well well suited for. 0:15:42.956 --> 0:15:46.836 I think the same things that doctors will struggle with 0:15:47.636 --> 0:15:51.476 online are things that they will struggle with in person. 0:15:52.236 --> 0:15:56.876 Patients that are not compliant with their medications or with 0:15:56.916 --> 0:16:01.236 their care protocols. Patients that have are just very fragile, 0:16:01.916 --> 0:16:08.356 they're very old, they have you know, they have pneumonia, 0:16:08.556 --> 0:16:12.116 but they also to have multiple other background diseases. Remember 0:16:12.156 --> 0:16:14.756 that when you go into a primary care doctor or 0:16:14.916 --> 0:16:18.716 clinic and you walk out you're ass it's very difficult 0:16:18.756 --> 0:16:20.956 for the doctor to interact with you and follow up 0:16:20.996 --> 0:16:24.356 with you. So there's multiple advantages actually to build a 0:16:24.396 --> 0:16:28.716 system online. People can come back very easily to our platform. 0:16:28.796 --> 0:16:31.116 I mean, I've asked, is there somewhere where KA health 0:16:31.156 --> 0:16:33.076 is worse? And you've given me somewhere where KA health 0:16:33.156 --> 0:16:38.836 is better. But I am curious within the universe where 0:16:38.836 --> 0:16:42.556 you were treating people, are there places where for whatever 0:16:42.596 --> 0:16:45.396 then maybe there's a smell, maybe there's some you know, 0:16:45.716 --> 0:16:48.476 truly right, like there are things that can be perceived 0:16:48.516 --> 0:16:49.436 in the physical world. 0:16:51.236 --> 0:16:52.316 It's a genuine question. 0:16:52.516 --> 0:16:55.476 No, No, I understand the question. I think the areas 0:16:55.516 --> 0:16:58.036 that we're less strong and now is areas that we've 0:16:58.076 --> 0:17:01.756 seen for your patients. It's stuff a little bit different 0:17:01.756 --> 0:17:04.356 from what your intuition is. Your intuition was similar to mine, 0:17:04.436 --> 0:17:07.196 you know, six seven years ago. But it's stuff around 0:17:07.356 --> 0:17:14.156 or simpedic huh, back pain, extremity, medicine, you know. Uh, 0:17:14.316 --> 0:17:17.836 the trauma. We don't do trauma, you know, so so 0:17:18.276 --> 0:17:19.196 stuff around. 0:17:18.956 --> 0:17:22.036 That trauma trauma like did I break my wrist when 0:17:22.036 --> 0:17:23.036 I fell that? 0:17:23.276 --> 0:17:25.916 Or you've got a pain in your in your in 0:17:25.996 --> 0:17:30.476 your foot for a few days. Maybe it's planter fasciaetus 0:17:30.556 --> 0:17:34.596 if you've ever had it, it's pretty painful and appears 0:17:34.596 --> 0:17:37.156 out of the blue. But you know, maybe maybe you 0:17:37.236 --> 0:17:39.636 broke a bone or maybe you've got you know, you know. 0:17:41.116 --> 0:17:43.156 Is the reason is the reason you don't do that, 0:17:43.196 --> 0:17:45.876 because the doctor needs to touch the patient in short 0:17:45.996 --> 0:17:46.996 to make that diagnosi. 0:17:47.116 --> 0:17:50.676 I think we can build systems for orthopedics as well. Uh, 0:17:51.156 --> 0:17:53.556 it's just not it hasn't been an error focus about 0:17:53.716 --> 0:17:56.876 for us, and and over time, I think the whole 0:17:57.196 --> 0:18:00.316 online versus in person is going to be mute. It's 0:18:00.396 --> 0:18:02.556 kind of like going to the ATM to get out 0:18:02.636 --> 0:18:07.356 cash versus venmo. Both are utilities of of getting cash 0:18:07.436 --> 0:18:12.156 or transferring cash. You will use both interchangeably in different 0:18:12.196 --> 0:18:15.396 reasons for different settings. I think that's how medicine's gonna 0:18:15.956 --> 0:18:19.116 go to. If you can resolve your problem right now 0:18:19.116 --> 0:18:22.156 from home in a high quality, high confidence environment, and 0:18:22.196 --> 0:18:24.316 I can follow up with you wherever you are. Maybe 0:18:24.316 --> 0:18:29.076 you need a prescription, maybe not. It's typically better than 0:18:29.156 --> 0:18:31.116 going in in person. Sometimes you need to go in 0:18:31.116 --> 0:18:34.836 person for various things. Medicine is really tricky. It's really 0:18:34.876 --> 0:18:38.276 tough to I'm still at all of how doctors make 0:18:38.356 --> 0:18:41.996 decisions because they don't always have all the facts, but 0:18:42.076 --> 0:18:43.876 yet they need to act. They need to decide should 0:18:43.876 --> 0:18:45.796 I send the patient to the R do I tell 0:18:45.836 --> 0:18:48.596 them to rest at home? I would just jacb I'm 0:18:48.676 --> 0:18:51.756 jumping into something to me is ready burning and important 0:18:51.756 --> 0:18:55.156 for us. We built k to give people access to 0:18:55.556 --> 0:19:00.596 high quality medicine. I think we have uneven quality medicine. Yes, 0:19:00.636 --> 0:19:05.116 there's Mayo Clinic and Cleveland Clinic and top academic institutions 0:19:05.116 --> 0:19:08.276 that act as lost results or solving complex care Cedar 0:19:08.356 --> 0:19:11.716 sin I other institutions, But most of the time people 0:19:11.756 --> 0:19:14.556 need to manage their diabetes and hyppertension, or even better 0:19:14.636 --> 0:19:18.356 avoid getting diabetes talked to or high pretension. Many people 0:19:18.396 --> 0:19:21.276 who have insurance and have money do not manage their 0:19:21.316 --> 0:19:24.756 diabetes and hard conditions. Well, it's not one or two percent, 0:19:25.036 --> 0:19:30.556 it's double digit percent. Why Because it's tough, it's it's expensive, 0:19:30.596 --> 0:19:33.036 it's messy that you know who wants to deal with it? 0:19:33.516 --> 0:19:37.876 Can we build care delivery systems that are dramatically better, 0:19:38.636 --> 0:19:40.836 that are much more data driven and are tailored to 0:19:40.876 --> 0:19:45.396 you admin that take into account prevention. Everybody talks about 0:19:45.396 --> 0:19:49.436 prevention that are preventative systems are similar to for the 0:19:49.476 --> 0:19:52.036 most part, I'm not talking about oncology here to the 0:19:52.116 --> 0:19:54.396 seventies and the sixties. That's pretty awful. 0:19:54.476 --> 0:19:56.516 So let's this is interesting. 0:19:56.636 --> 0:19:58.956 Let's talk about it at a at a slightly more 0:19:58.956 --> 0:20:02.836 specific level, Like you're making a compelling kind of abstract, 0:20:02.916 --> 0:20:07.676 big picture society wide point. Tell me something specific. 0:20:07.276 --> 0:20:09.636 About what you're doing to do a better verse of 0:20:10.636 --> 0:20:13.956 helping patients manage their diabetes or high blood pressure. 0:20:14.196 --> 0:20:17.596 I'll give you one specific example. We took maoclinic data 0:20:18.116 --> 0:20:21.436 and we're able to look at mayoclinic patients in an 0:20:22.076 --> 0:20:25.356 anonymized manner over long periods of time, and look at 0:20:25.436 --> 0:20:29.516 high pertension patients and figure out the best medication or 0:20:29.596 --> 0:20:34.316 combination of medicines to stabilize high blood pressure given their 0:20:34.356 --> 0:20:39.716 current blood pressure, gender, age, comorbidity, and ethnicity, and be 0:20:39.836 --> 0:20:43.396 able to tell a doctor in that same statistical split 0:20:43.556 --> 0:20:47.956 here is potentially the best way to give this medicine, 0:20:47.956 --> 0:20:49.796 and then math medicine. 0:20:49.596 --> 0:20:51.916 And high blood pressure is presumably a good place to 0:20:51.956 --> 0:20:56.556 do that, because there are lots and lots of good, cheap, 0:20:56.716 --> 0:20:59.876 old high blood pressure medicines, but which ones to use 0:20:59.956 --> 0:21:02.996 or which combination to use for which. 0:21:02.836 --> 0:21:05.276 Patient is hard to figure out. Presumably that's why that's 0:21:05.276 --> 0:21:06.676 a good sort of target problem. 0:21:06.756 --> 0:21:09.356 I would venture to say most doctors do not in 0:21:09.436 --> 0:21:14.836 the in their head that algorithm of gender, age, medical history, ethnicity, culpabidity, 0:21:15.356 --> 0:21:17.756 and you know, the current blood pressure. So this is 0:21:17.836 --> 0:21:20.356 really helpful to our doctors. Eight percent of the time 0:21:20.396 --> 0:21:23.756 they change the patient's regimen or change change their mind 0:21:23.796 --> 0:21:25.716 around what they want to do. And it's based on 0:21:25.796 --> 0:21:30.076 male clinical mail clinics standard of care. So that's that's 0:21:30.116 --> 0:21:33.676 really powerful. Every day that you stabilize in better, you know, 0:21:33.836 --> 0:21:37.276 to reduce the risk of strokes and heart attacks. 0:21:37.716 --> 0:21:41.436 What's something you haven't figured out yet that you're still 0:21:41.436 --> 0:21:44.156 working on. What's what's the sort of frontier problem, a 0:21:44.276 --> 0:21:45.756 frontier problem that you're working on. 0:21:46.316 --> 0:21:52.476 Hmm. The stuff that we're working on integrating right now 0:21:52.796 --> 0:21:57.356