1 00:00:15,276 --> 00:00:21,796 Speaker 1: Pushkin. The first time I since we all had a 2 00:00:21,836 --> 00:00:25,036 Speaker 1: serious problem that might one day lead to our doom 3 00:00:25,196 --> 00:00:32,276 Speaker 1: was when I was working on Wall Street. The problem 4 00:00:32,316 --> 00:00:36,436 Speaker 1: had to do with experts. People making important decisions had 5 00:00:36,556 --> 00:00:39,756 Speaker 1: no idea who they should listen to or who they shouldn't, 6 00:00:40,396 --> 00:00:43,636 Speaker 1: even when millions of dollars were at stake. I was 7 00:00:43,676 --> 00:00:46,596 Speaker 1: a twenty five year old art history major with zero 8 00:00:46,716 --> 00:00:49,596 Speaker 1: training in finance. Then I got hired to work on 9 00:00:49,636 --> 00:00:52,716 Speaker 1: Wall Street, where I got paid hundreds of thousands of 10 00:00:52,716 --> 00:00:55,836 Speaker 1: dollars to persuade professional money managers to do things with 11 00:00:55,956 --> 00:00:59,556 Speaker 1: millions of dollars. Obviously, I had no real idea what 12 00:00:59,596 --> 00:01:03,996 Speaker 1: to do with money, yet I was taken as the expert. Hello, 13 00:01:03,996 --> 00:01:06,596 Speaker 1: and welcome once again to this is Wall Street here 14 00:01:06,676 --> 00:01:10,956 Speaker 1: on wmi N Radio. Today's special guest is Michael Lewis. 15 00:01:11,116 --> 00:01:13,356 Speaker 1: He's the author of The Money Culture and former bond 16 00:01:13,396 --> 00:01:15,796 Speaker 1: trader for Solomon Brother. What's in the future for yourself? 17 00:01:15,836 --> 00:01:18,316 Speaker 1: I know you're a pretty young man, aren't you. I 18 00:01:18,476 --> 00:01:21,836 Speaker 1: just turned thirty one. That young well feel and all 19 00:01:21,916 --> 00:01:26,596 Speaker 1: would say so it feels old. In nineteen eighty nine, 20 00:01:26,636 --> 00:01:29,596 Speaker 1: I wrote a book called Liars Poker, in which I 21 00:01:29,676 --> 00:01:32,076 Speaker 1: explained how I and a lot of other people on 22 00:01:32,116 --> 00:01:34,716 Speaker 1: Wall Street got paid a bunch of money to give 23 00:01:34,756 --> 00:01:38,796 Speaker 1: advice that was either wrong or pointless. In this book, 24 00:01:39,076 --> 00:01:41,676 Speaker 1: I proved beyond a shadow of a doubt that I 25 00:01:41,756 --> 00:01:44,956 Speaker 1: was not a financial expert. And yet when I hit 26 00:01:44,996 --> 00:01:48,196 Speaker 1: the road to sell liars poker, people still ask me 27 00:01:49,116 --> 00:01:53,116 Speaker 1: what should I do with my money? From the Midwest, 28 00:01:53,316 --> 00:01:56,276 Speaker 1: especially for some reason, from Ohio, I am inundated with 29 00:01:56,356 --> 00:01:59,996 Speaker 1: letters from young people who have treated everything I've written 30 00:02:00,076 --> 00:02:03,756 Speaker 1: is sort of a how to manual, and it's almost 31 00:02:03,796 --> 00:02:05,796 Speaker 1: that they can't conceive as a book as anything but 32 00:02:05,876 --> 00:02:11,436 Speaker 1: advice and self help. All my books are the same 33 00:02:11,476 --> 00:02:15,476 Speaker 1: in one crude way. I start out knowing very little 34 00:02:15,516 --> 00:02:20,076 Speaker 1: about the subject. I go find actual experts, people who 35 00:02:20,156 --> 00:02:24,476 Speaker 1: know stuff, and write stories about them. To my mind, 36 00:02:24,716 --> 00:02:27,676 Speaker 1: all I'm doing is describing great characters in some interesting 37 00:02:27,756 --> 00:02:33,716 Speaker 1: situation a financial crisis, a professional sport and turmoil, a pandemic. Yeah. 38 00:02:33,756 --> 00:02:37,156 Speaker 1: I learn some things about those situations, but pretty much 39 00:02:37,196 --> 00:02:39,836 Speaker 1: everything I know about, say, the origins of the two 40 00:02:39,876 --> 00:02:43,156 Speaker 1: thousand and eight financial crisis, I know from the people 41 00:02:43,196 --> 00:02:47,316 Speaker 1: I've written about. They are the experts. I'm just a 42 00:02:47,356 --> 00:02:51,036 Speaker 1: guy who writes books about them. Still, the pressure from 43 00:02:51,076 --> 00:02:53,876 Speaker 1: me to swan around as the true expert is incredible. 44 00:02:54,436 --> 00:02:58,396 Speaker 1: Do you think that's what they believe? Well, that's not 45 00:02:58,556 --> 00:03:01,076 Speaker 1: true right now, but I think do I think they 46 00:03:01,076 --> 00:03:04,676 Speaker 1: believe that after they pass this legislation that will be true? Yes, 47 00:03:04,796 --> 00:03:07,396 Speaker 1: I do think that. I do believe that. I think 48 00:03:07,396 --> 00:03:10,196 Speaker 1: that it's flattering to be treated as the guy with 49 00:03:10,276 --> 00:03:15,076 Speaker 1: the answers, more than flattering, seductive. But still, after a 50 00:03:15,156 --> 00:03:19,436 Speaker 1: book comes out, I usually find myself thinking, why on 51 00:03:19,476 --> 00:03:22,876 Speaker 1: earth are you asking me? Ask the people who told 52 00:03:22,916 --> 00:03:25,596 Speaker 1: me everything I know. I pick him because I thought 53 00:03:25,636 --> 00:03:28,356 Speaker 1: we should all be listening to them. They're the ones 54 00:03:28,396 --> 00:03:31,556 Speaker 1: you should ask why were they unable to convince those 55 00:03:31,596 --> 00:03:36,116 Speaker 1: in power to do something sooner? And I think the 56 00:03:36,156 --> 00:03:42,756 Speaker 1: answer is that this particular threat, when you're on TV, 57 00:03:42,956 --> 00:03:46,116 Speaker 1: you can never just say I don't know. But but 58 00:03:46,716 --> 00:03:49,316 Speaker 1: beyond that, I mean, with a threat like this, he 59 00:03:49,436 --> 00:03:52,636 Speaker 1: almost requires you can't say I don't know because you're 60 00:03:52,676 --> 00:03:55,676 Speaker 1: the expert, and you're the expert because you're on TV 61 00:03:55,876 --> 00:03:59,836 Speaker 1: that you're dealing with You're dealing with an invisible enemy 62 00:03:59,916 --> 00:04:12,196 Speaker 1: that replicates exponentially, and by the time I'm Michael Lewis. 63 00:04:12,636 --> 00:04:16,356 Speaker 1: Welcome back to season three of Against the Rules, where 64 00:04:16,356 --> 00:04:20,356 Speaker 1: we explore unfairness in American life by looking at what's 65 00:04:20,356 --> 00:04:24,516 Speaker 1: happened to various characters in American life. Our first season 66 00:04:24,596 --> 00:04:29,556 Speaker 1: was about referees, Our second was about coaches. This season's 67 00:04:29,596 --> 00:04:34,436 Speaker 1: about experts. We're going to tell seven stories about them. 68 00:04:34,556 --> 00:04:36,836 Speaker 1: Each contains a clue to a mystery at the heart 69 00:04:36,836 --> 00:04:40,476 Speaker 1: of American life. How come a society so great at 70 00:04:40,476 --> 00:04:45,876 Speaker 1: creating knowledge is so bad at using it. How can 71 00:04:45,916 --> 00:04:48,476 Speaker 1: we know more and more yet behave as if we 72 00:04:48,556 --> 00:04:52,476 Speaker 1: know less and less. How can one people be so 73 00:04:52,556 --> 00:05:00,236 Speaker 1: incredibly smart and so breathtakingly moronic? The experts are terrible. 74 00:05:00,956 --> 00:05:04,036 Speaker 1: The Pandemics taught us a bunch of things. That bosses 75 00:05:04,036 --> 00:05:06,676 Speaker 1: missed the office more than their employees, That our centers 76 00:05:06,716 --> 00:05:09,636 Speaker 1: for disease control aren't very good at controlling disease. That 77 00:05:09,716 --> 00:05:12,836 Speaker 1: these United States aren't all that interested in being united 78 00:05:12,956 --> 00:05:17,196 Speaker 1: even in a crisis. Mister President, Please listen to your 79 00:05:17,196 --> 00:05:22,156 Speaker 1: public health experts instead of denigrating them. But the Pandemics 80 00:05:22,196 --> 00:05:26,476 Speaker 1: also taught us something about experts. How fraught our relationship 81 00:05:26,476 --> 00:05:29,556 Speaker 1: with him has become, how hard it is for us 82 00:05:29,556 --> 00:05:31,956 Speaker 1: to decide who they are and how to use them, 83 00:05:32,676 --> 00:05:35,636 Speaker 1: even when it's a matter of life and death. But 84 00:05:35,716 --> 00:05:39,036 Speaker 1: who cares what I think. I'm not an expert. I 85 00:05:39,116 --> 00:05:42,236 Speaker 1: just find the people who are. Hi. I'm Todd Park, 86 00:05:42,756 --> 00:05:46,476 Speaker 1: healthcare and tech entrepreneur and former public servant. Case in point. 87 00:05:46,516 --> 00:05:52,596 Speaker 1: I've been in the succession of situations of great opportunity 88 00:05:53,276 --> 00:05:58,196 Speaker 1: or great crisis and had to help figure out what 89 00:05:58,276 --> 00:06:03,596 Speaker 1: to do very quickly. Todd Parks created three different billion 90 00:06:03,596 --> 00:06:07,916 Speaker 1: dollar companies. He solved some very big problems on behalf 91 00:06:07,956 --> 00:06:11,276 Speaker 1: of the American government. But he built his career on 92 00:06:11,316 --> 00:06:15,276 Speaker 1: a single insight that the experts you most need are 93 00:06:15,356 --> 00:06:19,156 Speaker 1: often not who you think they are. Just finding the 94 00:06:19,236 --> 00:06:23,276 Speaker 1: expert can be incredibly difficult, especially when all hell is 95 00:06:23,276 --> 00:06:29,876 Speaker 1: breaking loose called blue back. In nineteen ninety seven, Todd 96 00:06:29,956 --> 00:06:32,396 Speaker 1: was a consultant fresh out of the Harvard Business School. 97 00:06:33,436 --> 00:06:34,876 Speaker 1: Like a lot of people who go by the name 98 00:06:34,916 --> 00:06:37,716 Speaker 1: of consultant, he didn't really want to be a consultant, 99 00:06:38,676 --> 00:06:41,556 Speaker 1: so he went looking for a business idea, a problem 100 00:06:41,596 --> 00:06:45,116 Speaker 1: to solve. He and another consultant, who was married to 101 00:06:45,156 --> 00:06:49,916 Speaker 1: a midwife, nurse and training settled on a really big idea. 102 00:06:50,076 --> 00:06:55,836 Speaker 1: The beginning of life, specifically pregnancy. To the eyes of 103 00:06:55,876 --> 00:06:59,596 Speaker 1: a male management consultant in nineteen ninety seven, pregnancy is 104 00:06:59,636 --> 00:07:04,796 Speaker 1: conducted in the United States seemed wildly inefficient. Women and 105 00:07:04,836 --> 00:07:07,796 Speaker 1: their babies were having all kinds of expensive medical problems 106 00:07:08,076 --> 00:07:11,396 Speaker 1: that could have been avoided with better prenatal care. By 107 00:07:11,476 --> 00:07:14,876 Speaker 1: keeping women healthier during their pregnancies, you could also make 108 00:07:14,956 --> 00:07:19,316 Speaker 1: childbirth less risky and cheaper. And so these two twenty 109 00:07:19,316 --> 00:07:21,236 Speaker 1: four year old guys set out on this new mission. 110 00:07:21,756 --> 00:07:25,636 Speaker 1: It was a bit weird. They weren't doctors, they didn't 111 00:07:25,636 --> 00:07:29,676 Speaker 1: even have children. And essentially the whole idea is that 112 00:07:29,756 --> 00:07:34,276 Speaker 1: you deploy a whole team of folks, not just the doctor, 113 00:07:34,316 --> 00:07:39,556 Speaker 1: but surfinder's midwife, social worker, educator, case manager, nutritionist to 114 00:07:39,956 --> 00:07:43,556 Speaker 1: love on a mom to be and get her the 115 00:07:43,716 --> 00:07:47,876 Speaker 1: right care, including very importantly non clinical support. Todd and 116 00:07:47,956 --> 00:07:51,956 Speaker 1: his partner named their company Athena Health. They hired a 117 00:07:51,956 --> 00:07:56,036 Speaker 1: few more people much like themselves, smart young guys. They 118 00:07:56,116 --> 00:07:58,676 Speaker 1: raised millions of dollars and used some of the money 119 00:07:58,676 --> 00:08:02,116 Speaker 1: to buy a childbirth clinic in San Diego. It mainly 120 00:08:02,156 --> 00:08:07,236 Speaker 1: served women especially prone to bad outcomes during pregnancy. Undocumented immigrants, 121 00:08:07,236 --> 00:08:11,116 Speaker 1: for instance, The clinic was the test case for Athene 122 00:08:11,116 --> 00:08:14,956 Speaker 1: of Health. If it worked, the company would create a 123 00:08:15,036 --> 00:08:18,236 Speaker 1: lot more of them. So you know, now, all of 124 00:08:18,276 --> 00:08:23,236 Speaker 1: a literally overnight, we are now on the hook for payroll, rent, 125 00:08:23,276 --> 00:08:27,076 Speaker 1: all of this stuff and the revenue. That's Bob Gatewood. 126 00:08:27,516 --> 00:08:30,956 Speaker 1: Todd had hired him to help. So almost immediately we 127 00:08:30,996 --> 00:08:34,716 Speaker 1: started hemorrhaging money. You know, claims were going out, but 128 00:08:34,756 --> 00:08:37,676 Speaker 1: no money was coming in. The first pregnancy clinic was 129 00:08:37,716 --> 00:08:41,116 Speaker 1: supposed to be like the first McDonald's or Starbucks proof 130 00:08:41,156 --> 00:08:44,876 Speaker 1: of concept. The concept never had a chance because they 131 00:08:44,916 --> 00:08:47,756 Speaker 1: couldn't get insurance companies to pay them to make pregnancy 132 00:08:47,876 --> 00:08:51,756 Speaker 1: cheaper and better. In fact, they couldn't really get anyone 133 00:08:51,796 --> 00:08:54,236 Speaker 1: to pay them for anything. Did you have any sense 134 00:08:54,276 --> 00:08:56,796 Speaker 1: that was going to be a problem when you started. No, 135 00:08:57,196 --> 00:08:59,956 Speaker 1: we thought, oh, billing is a solved problem. Everybody knows 136 00:08:59,956 --> 00:09:01,796 Speaker 1: how to do that. The interesting thing is that electronic 137 00:09:01,836 --> 00:09:04,756 Speaker 1: health records, the young entrepreneurs had thought they'd bought a 138 00:09:04,796 --> 00:09:08,916 Speaker 1: business with they'd really bought was a crisis and a cause. 139 00:09:09,556 --> 00:09:13,036 Speaker 1: We then said, okay, this is a very special practice. 140 00:09:13,356 --> 00:09:16,316 Speaker 1: It's the public health safety net for so many women 141 00:09:16,316 --> 00:09:19,876 Speaker 1: in San Diego County. We must save this practice. We 142 00:09:19,956 --> 00:09:22,996 Speaker 1: cannot allow this practice to sink beneath the surface of 143 00:09:22,996 --> 00:09:25,676 Speaker 1: the sea. And so we got plug all the stops 144 00:09:25,676 --> 00:09:28,676 Speaker 1: and fight and figure out how to keep this thing afloat. 145 00:09:28,836 --> 00:09:32,356 Speaker 1: So you go from like whiz bang entrepreneur who's going 146 00:09:32,356 --> 00:09:36,076 Speaker 1: to build a huge company on the basis of an idea, 147 00:09:36,196 --> 00:09:40,556 Speaker 1: to being philanthropist trying to save the safety net for 148 00:09:40,676 --> 00:09:43,716 Speaker 1: San Diego County. That's exactly right. But in order to 149 00:09:43,756 --> 00:09:46,236 Speaker 1: save the safety net, Todd Park realized he and his 150 00:09:46,316 --> 00:09:48,796 Speaker 1: partners had to solve the problem that hadn't even occurred 151 00:09:48,796 --> 00:09:51,956 Speaker 1: to them, the problem of not getting paid by the 152 00:09:51,996 --> 00:09:55,036 Speaker 1: health insurance system. Those system is maybe too kind a 153 00:09:55,076 --> 00:09:58,676 Speaker 1: word for it. Essentially, what's happened in the United States 154 00:09:58,876 --> 00:10:00,436 Speaker 1: is that you've got a lot of different health insurance 155 00:10:00,476 --> 00:10:03,316 Speaker 1: companies and they have invented a lot of different kinds 156 00:10:03,356 --> 00:10:08,116 Speaker 1: of health insurance products HMO Ppo pos m bas pos 157 00:10:08,236 --> 00:10:11,636 Speaker 1: pos pos, all right, and then like employers like to 158 00:10:11,756 --> 00:10:14,676 Speaker 1: customize those just for them. So there's like the ge 159 00:10:14,916 --> 00:10:19,796 Speaker 1: version of the HMO based pos product for Wisconsin. There's 160 00:10:19,836 --> 00:10:22,636 Speaker 1: not even an alternate universe. With the design of the 161 00:10:22,716 --> 00:10:26,676 Speaker 1: US health insurance system makes sense, you could not build 162 00:10:26,716 --> 00:10:29,876 Speaker 1: it to be more confusing. But now that system was 163 00:10:29,916 --> 00:10:34,916 Speaker 1: Todd's problem. There are countless called them insurance packages, like 164 00:10:35,036 --> 00:10:37,996 Speaker 1: different flavors of insurance that have probleagate across the country, 165 00:10:38,436 --> 00:10:42,916 Speaker 1: each of which has different rules associated with it with 166 00:10:43,076 --> 00:10:48,356 Speaker 1: respect to how to build them. And these rules are 167 00:10:48,796 --> 00:10:54,196 Speaker 1: really poorly documented. They're very opaque, they're changing all the time, 168 00:10:54,956 --> 00:10:57,996 Speaker 1: and medical doctors and medical officers have no idea what 169 00:10:58,116 --> 00:11:01,916 Speaker 1: they are right, so they'll basically put together a claim 170 00:11:02,356 --> 00:11:05,876 Speaker 1: to bill for their medical office visit. They'll send in 171 00:11:05,956 --> 00:11:11,276 Speaker 1: the claim and it will get rejected. No one insurance 172 00:11:11,316 --> 00:11:14,316 Speaker 1: company set out to create the confusion, but no one 173 00:11:14,436 --> 00:11:16,796 Speaker 1: had any incentive to clear it up. I mean, the 174 00:11:16,876 --> 00:11:18,716 Speaker 1: harder it was for doctors to figure out how to 175 00:11:18,716 --> 00:11:21,596 Speaker 1: get insurance companies to pay them, the less the insurance 176 00:11:21,636 --> 00:11:24,836 Speaker 1: companies ultimately paid out to the doctors. Todd Park now 177 00:11:24,956 --> 00:11:27,836 Speaker 1: knows this because his last resort clinic full of pregnant women, 178 00:11:28,356 --> 00:11:32,436 Speaker 1: is getting buried under unpaid bills. The payers send back 179 00:11:32,516 --> 00:11:35,316 Speaker 1: this thing called explanation of benefits, which is really kind 180 00:11:35,316 --> 00:11:37,996 Speaker 1: of misstormers doesn't really explain anything, says, here's your claim. 181 00:11:38,156 --> 00:11:40,756 Speaker 1: It was denied for denial code zero five B and 182 00:11:40,996 --> 00:11:43,316 Speaker 1: you look at the code at in the legend at 183 00:11:43,316 --> 00:11:45,356 Speaker 1: the bottom of the EOB and you know it says 184 00:11:45,396 --> 00:11:48,356 Speaker 1: something like, you know, insufficient documentation or something like something 185 00:11:48,396 --> 00:11:51,276 Speaker 1: incredibly vague and not helpful. So then you pick up 186 00:11:51,316 --> 00:11:53,716 Speaker 1: the phone and you call the health insurance company and 187 00:11:53,716 --> 00:11:55,756 Speaker 1: get some port animals who also has no idea what 188 00:11:55,916 --> 00:11:59,116 Speaker 1: that code means. Right as a super frustrating Right. But 189 00:11:59,196 --> 00:12:01,676 Speaker 1: the problem is there is a knowledge base of rules 190 00:12:01,716 --> 00:12:04,756 Speaker 1: at the payer that's totally opaque to the doctor and 191 00:12:04,836 --> 00:12:07,596 Speaker 1: frankly pretty opaque to the payer, so they don't even 192 00:12:07,636 --> 00:12:12,836 Speaker 1: know their own rules exactly. Todd and his fellow company 193 00:12:12,876 --> 00:12:16,436 Speaker 1: founders needed an expert, someone who had mastered all the 194 00:12:16,516 --> 00:12:20,596 Speaker 1: rules created by America's health insurance companies, someone who knew 195 00:12:20,596 --> 00:12:24,636 Speaker 1: how to get those companies to pay a bill. Bob 196 00:12:24,756 --> 00:12:28,756 Speaker 1: Gatewood kept seeing artifacts of this expertise. Every one of 197 00:12:28,756 --> 00:12:32,956 Speaker 1: these doing offices we walked into. Every single screen monitor 198 00:12:33,156 --> 00:12:36,596 Speaker 1: was covered in sticky nose like the whole margin of 199 00:12:36,676 --> 00:12:39,796 Speaker 1: the monitor, and so we would always point at the 200 00:12:39,916 --> 00:12:43,076 Speaker 1: sticky notes and ask the person what's that, and she 201 00:12:43,156 --> 00:12:45,876 Speaker 1: would say, and most often a sheet she would say, Oh, 202 00:12:46,036 --> 00:12:48,596 Speaker 1: that's you know that reminds me that if a midwife 203 00:12:48,676 --> 00:12:50,636 Speaker 1: does the delivery, I have to put a c Z 204 00:12:50,876 --> 00:12:54,956 Speaker 1: modifier on the code or you know. Here, This one 205 00:12:55,036 --> 00:12:59,076 Speaker 1: reminds me that ETNA only reimburses for a gim visit 206 00:12:59,116 --> 00:13:01,636 Speaker 1: every eighteen months, not twelve months. So I got to 207 00:13:01,676 --> 00:13:04,996 Speaker 1: remember not to schedule an ETNA patient too soon. And 208 00:13:05,116 --> 00:13:07,836 Speaker 1: there were thousands and thousands and thousands of these things. 209 00:13:10,796 --> 00:13:14,996 Speaker 1: Medical billing had become so complicated that hospitals were now 210 00:13:15,076 --> 00:13:19,476 Speaker 1: employing a medical biller for each and every doctor. Todd 211 00:13:19,556 --> 00:13:22,556 Speaker 1: and Bob noticed the successful medical billers were all of 212 00:13:22,596 --> 00:13:27,196 Speaker 1: a type. Gladys they called her super type, a you know, 213 00:13:27,556 --> 00:13:31,316 Speaker 1: won't let anything pass her, likes to hold people accountable 214 00:13:31,596 --> 00:13:34,556 Speaker 1: for their mistakes, and it's just kind of pissed all 215 00:13:34,596 --> 00:13:37,636 Speaker 1: the time, like angry that they're not getting paid what 216 00:13:37,756 --> 00:13:41,636 Speaker 1: they should. So at that moment, given what you're you've 217 00:13:41,756 --> 00:13:46,116 Speaker 1: just learned about just how critical Gladys is and how 218 00:13:46,196 --> 00:13:50,716 Speaker 1: important like the business succeeds or fails on whether Gladys 219 00:13:50,836 --> 00:13:53,996 Speaker 1: is on vacation or Gladys is. This strike you how 220 00:13:54,196 --> 00:14:02,036 Speaker 1: odd it is that Gladdis isn't valued. Well, that's part 221 00:14:02,036 --> 00:14:06,196 Speaker 1: of why she's pissed probably unless you know, sometimes Gladys 222 00:14:06,356 --> 00:14:10,316 Speaker 1: was the wife of the surgeon, right right, they were 223 00:14:10,356 --> 00:14:14,516 Speaker 1: all women. I'm not but I'm not being sexist. No, No, 224 00:14:14,676 --> 00:14:17,916 Speaker 1: every single one we met was a woman. But yeah, 225 00:14:17,956 --> 00:14:20,396 Speaker 1: there were a lot of pissed off Gladyses who felt undervalued. 226 00:14:21,276 --> 00:14:24,076 Speaker 1: By the late nineteen nineties, the financial fate of entire 227 00:14:24,196 --> 00:14:28,476 Speaker 1: hospitals turned on Gladys. It occurred to Bob and Todd 228 00:14:28,556 --> 00:14:32,636 Speaker 1: Park that they stumbled under a better business idea, find 229 00:14:32,716 --> 00:14:36,076 Speaker 1: the best Gladdys in the world. If she actually existed. 230 00:14:39,636 --> 00:14:42,316 Speaker 1: If I had found you when you were I don't know, 231 00:14:42,676 --> 00:14:45,396 Speaker 1: twelve years old and asked you what you were going 232 00:14:45,476 --> 00:14:47,676 Speaker 1: to be when you grew up, what might you have said? 233 00:14:47,836 --> 00:14:50,716 Speaker 1: I was going to be an accountant. This is Sue 234 00:14:50,756 --> 00:14:57,636 Speaker 1: Henderson medical biller. Seriously, it's very very, very very exciting. 235 00:14:58,596 --> 00:15:01,796 Speaker 1: And the reason was math was just so simple for me. 236 00:15:02,196 --> 00:15:05,756 Speaker 1: Everything about it was so incredibly logical, and it just 237 00:15:05,916 --> 00:15:10,196 Speaker 1: seemed a great path for me. You killed your dreams early. 238 00:15:11,556 --> 00:15:15,636 Speaker 1: I was very practical and I'm an very very organized individual, 239 00:15:16,236 --> 00:15:19,876 Speaker 1: probably leaning a little bit on the OCD side, and 240 00:15:20,156 --> 00:15:23,796 Speaker 1: so in accounting there isn't any gray. So if you're 241 00:15:23,836 --> 00:15:27,556 Speaker 1: doing the books, then it's a penny off. It's wrong someplace. 242 00:15:27,636 --> 00:15:30,636 Speaker 1: You have to figure out where that penny is, and 243 00:15:30,756 --> 00:15:32,756 Speaker 1: you can't just take it and tape it into the 244 00:15:32,836 --> 00:15:40,436 Speaker 1: books and then close them. Sue Henderson discovered medical billing 245 00:15:40,716 --> 00:15:45,196 Speaker 1: almost by accident back in the nineteen eighties. Accounting had 246 00:15:45,236 --> 00:15:49,596 Speaker 1: captured her imagination. Medical billing she found even more thrilling, 247 00:15:50,236 --> 00:15:53,836 Speaker 1: which was in and of itself kind of amazing. You know, 248 00:15:54,156 --> 00:16:00,916 Speaker 1: medical billers generally are housed in basements I'm not exaggerating 249 00:16:01,436 --> 00:16:07,836 Speaker 1: of hospitals or practices without a window, and they're not appreciated. 250 00:16:08,276 --> 00:16:11,676 Speaker 1: And it's kind of fascinating because if you didn't have 251 00:16:11,796 --> 00:16:14,716 Speaker 1: medical billers, you can render all the services you want, 252 00:16:14,876 --> 00:16:17,116 Speaker 1: and if you're never going to get paid, you're gonna 253 00:16:17,116 --> 00:16:20,996 Speaker 1: go out of business. They're definitely unappreciated across the board. 254 00:16:21,636 --> 00:16:23,916 Speaker 1: How do you explain that, given what you just said, 255 00:16:24,156 --> 00:16:25,516 Speaker 1: that you're going to go out of business if your 256 00:16:25,556 --> 00:16:29,636 Speaker 1: medical biller is no good? Because I don't think that 257 00:16:30,316 --> 00:16:33,796 Speaker 1: I shouldn't say I don't think. I know. Doctors are 258 00:16:33,876 --> 00:16:38,156 Speaker 1: not financial people. They care about patients. That's what they 259 00:16:38,236 --> 00:16:41,196 Speaker 1: care about. The doctor. Sue works for it don't really 260 00:16:41,316 --> 00:16:45,156 Speaker 1: get what she does or how she does it. They 261 00:16:45,236 --> 00:16:47,156 Speaker 1: just leave her alone to play what is about to 262 00:16:47,236 --> 00:16:50,876 Speaker 1: become a very high stakes game. So when you first 263 00:16:50,956 --> 00:16:54,516 Speaker 1: get into medical billing, medical billing isn't anything like as 264 00:16:54,556 --> 00:16:58,396 Speaker 1: complicated as is going to become correct. A lot of 265 00:16:58,476 --> 00:17:02,756 Speaker 1: medical billers were overwhelmed by the complexity, but Sue kind 266 00:17:02,796 --> 00:17:05,836 Speaker 1: of liked it. She sat in the basement of a 267 00:17:05,916 --> 00:17:11,756 Speaker 1: hospital in northern Massachusetts, but is ready to fly. When 268 00:17:11,836 --> 00:17:13,916 Speaker 1: would have been the first time where you walked into 269 00:17:14,156 --> 00:17:18,636 Speaker 1: a job and you increased the receipts because you were 270 00:17:18,716 --> 00:17:23,596 Speaker 1: billing better. Well, that definitely would have been Holy Family Hospital. 271 00:17:23,636 --> 00:17:26,036 Speaker 1: And with when and when would that have been? That 272 00:17:26,116 --> 00:17:28,876 Speaker 1: would be in the middle of my career nineteen eighties, 273 00:17:29,796 --> 00:17:32,396 Speaker 1: in the eighties, Ye, in the eighties. Yeah, And so 274 00:17:33,316 --> 00:17:36,156 Speaker 1: that's a moment where you walk in and just by 275 00:17:36,356 --> 00:17:41,756 Speaker 1: virtue of your command of the complexity, you're able to 276 00:17:41,876 --> 00:17:45,836 Speaker 1: generate more payment to the hospital. It was a combination 277 00:17:45,916 --> 00:17:48,796 Speaker 1: of complexity, and it was a combination of looking at 278 00:17:49,756 --> 00:17:59,116 Speaker 1: a department that was just so unbelievably mismanaged. They had 279 00:17:59,956 --> 00:18:05,316 Speaker 1: a quarter of a million dollars in unapplied payments from 280 00:18:05,716 --> 00:18:11,276 Speaker 1: the Medicaid system sitting. What does that mean? What does 281 00:18:11,316 --> 00:18:14,116 Speaker 1: that mean? The moment I asked the question, I knew 282 00:18:14,116 --> 00:18:17,236 Speaker 1: I didn't actually want to know the answer. Well, okay, 283 00:18:17,356 --> 00:18:21,236 Speaker 1: so what happens is Medicaid is sending you all of 284 00:18:21,276 --> 00:18:25,156 Speaker 1: these payments and you don't have a claim to which 285 00:18:25,236 --> 00:18:28,876 Speaker 1: they can to be applied. So either you didn't send 286 00:18:28,956 --> 00:18:34,196 Speaker 1: that claim out. The details of what Sue Henderson does, well, 287 00:18:34,236 --> 00:18:37,756 Speaker 1: even she has trouble making it sound interesting, and she's 288 00:18:37,796 --> 00:18:40,276 Speaker 1: more interested in the details than perhaps anyone in the world. 289 00:18:40,836 --> 00:18:43,476 Speaker 1: What's the secret to getting the revenue getting the money 290 00:18:43,516 --> 00:18:46,996 Speaker 1: out of the insurance? Unfortunately, is playing by their rules. 291 00:18:47,956 --> 00:18:51,516 Speaker 1: That's the unfortunate part. There's simply now no way around that. 292 00:18:52,196 --> 00:18:56,196 Speaker 1: And so if they're saying you need a modifier fifty five, 293 00:18:56,556 --> 00:18:59,436 Speaker 1: you need a modifier fifty five period, end of sentence, 294 00:18:59,516 --> 00:19:02,276 Speaker 1: there's no way around it, and it's just playing by 295 00:19:02,316 --> 00:19:07,436 Speaker 1: their rules. What's a modifier fifty five? I don't actually 296 00:19:07,516 --> 00:19:11,476 Speaker 1: care about a modifier fifty five. The modifier fifty five 297 00:19:11,596 --> 00:19:16,596 Speaker 1: would be a second I won't describe it exactly, but 298 00:19:16,876 --> 00:19:21,556 Speaker 1: it would be a second procedure code that is appropriate 299 00:19:21,676 --> 00:19:25,156 Speaker 1: with the initial procedure code. So it's there. They are 300 00:19:25,276 --> 00:19:28,196 Speaker 1: hundreds of versions of this problem with medical billing where 301 00:19:28,236 --> 00:19:32,756 Speaker 1: there's some nitty detail that if you leave it off, 302 00:19:32,876 --> 00:19:35,276 Speaker 1: you just don't get paid. There are thousands of them, 303 00:19:35,956 --> 00:19:40,236 Speaker 1: and over time they were basically in your head. There 304 00:19:40,276 --> 00:19:42,396 Speaker 1: were a lot of them in my head. Did you 305 00:19:42,596 --> 00:19:48,476 Speaker 1: have you run across anybody, any medical billers who who 306 00:19:48,556 --> 00:19:52,716 Speaker 1: felt like you're equal? Oh, that's a very I can't 307 00:19:52,716 --> 00:19:57,956 Speaker 1: answer that question because because I'm I'm quite sure there are. 308 00:19:58,116 --> 00:20:00,516 Speaker 1: I'm quite sure there are there are other people is 309 00:20:00,596 --> 00:20:06,796 Speaker 1: equally knowledgeable. Absolutely, I don't know. You just haven't met them. 310 00:20:07,476 --> 00:20:13,796 Speaker 1: I haven't met them. Over two decades in windowless rooms 311 00:20:14,236 --> 00:20:17,596 Speaker 1: in clinics and hospitals in the Greater Boston area, Sue 312 00:20:17,636 --> 00:20:23,556 Speaker 1: Henderson makes herself not just valuable, but close to irreplaceable. Then, 313 00:20:23,676 --> 00:20:26,036 Speaker 1: in the summer of nineteen ninety nine, she sees a 314 00:20:26,116 --> 00:20:30,076 Speaker 1: want ad on monster dot Com for a medical biller 315 00:20:30,916 --> 00:20:34,676 Speaker 1: from a startup called Athena Health, based in San Diego 316 00:20:34,796 --> 00:20:38,636 Speaker 1: but with an office in Boston. It's Todd Park, struggling startup. 317 00:20:39,676 --> 00:20:44,676 Speaker 1: Sue applies, She gets an interview, they reject her, but 318 00:20:44,756 --> 00:20:47,356 Speaker 1: a few weeks later they call her back with a 319 00:20:47,476 --> 00:20:52,156 Speaker 1: bizarre request. He wasn't offering me a job. He was 320 00:20:52,396 --> 00:20:56,276 Speaker 1: asking me, could I come for lunch to meet with 321 00:20:57,636 --> 00:21:03,596 Speaker 1: some potential investors that were coming, so that they could 322 00:21:03,676 --> 00:21:06,476 Speaker 1: kind of convince these investors that they had somebody who 323 00:21:06,556 --> 00:21:10,036 Speaker 1: knew what he or she was doing and convinced them 324 00:21:10,076 --> 00:21:12,276 Speaker 1: that this was a good idea to invest in the company. 325 00:21:13,836 --> 00:21:17,156 Speaker 1: So they were bringing you on as an expert in 326 00:21:17,276 --> 00:21:21,956 Speaker 1: medical billing to demonstrate to investors they knew about medical billing. Yep. 327 00:21:22,356 --> 00:21:27,036 Speaker 1: So I said, okay, you don't burn your bridges. So 328 00:21:27,276 --> 00:21:29,916 Speaker 1: I went over and we had lunch in the little 329 00:21:29,996 --> 00:21:33,956 Speaker 1: restaurant and I sat there for an hour and a half, 330 00:21:34,676 --> 00:21:38,676 Speaker 1: having lunch and being grilled by these investors about what 331 00:21:38,796 --> 00:21:43,316 Speaker 1: I knew about medical billing, as though I had already 332 00:21:43,356 --> 00:21:49,076 Speaker 1: been hired. And I did this three times. I didn't 333 00:21:49,116 --> 00:21:52,236 Speaker 1: get paid for anything except I had a lovely free lunch, 334 00:21:53,396 --> 00:21:56,476 Speaker 1: And finally, at the end of the three lunch process, 335 00:21:56,956 --> 00:21:59,436 Speaker 1: Bob Gatewood called and said, we'd really like to hire you. 336 00:22:00,356 --> 00:22:02,836 Speaker 1: Apparently I had convinced everybody I knew what the heck 337 00:22:02,876 --> 00:22:08,276 Speaker 1: I was doing. Of course she knew, and of course 338 00:22:08,396 --> 00:22:11,036 Speaker 1: Todd and Bob could see that they needed her, and 339 00:22:11,156 --> 00:22:14,236 Speaker 1: if they could just bottle her expertise, she might make 340 00:22:14,316 --> 00:22:31,236 Speaker 1: everyone rich. Welcome back to against the rules, we shall, 341 00:22:31,276 --> 00:22:34,236 Speaker 1: I take it without the storm. There's no reason why 342 00:22:34,316 --> 00:22:42,396 Speaker 1: we shall unless the dance blob. There's a strange British 343 00:22:42,476 --> 00:22:47,036 Speaker 1: play written in the early nineteen hundreds called The Admirable Creighton. 344 00:22:47,556 --> 00:22:49,996 Speaker 1: It was written by jam Barry, who's more famous for 345 00:22:50,076 --> 00:22:53,236 Speaker 1: Peter Pan. I only saw it once, but I've never 346 00:22:53,276 --> 00:22:55,116 Speaker 1: been able to get it out of my head. In 347 00:22:55,196 --> 00:22:58,876 Speaker 1: The Admirable Creighton, an upper class British family is shipwrecked. 348 00:22:59,236 --> 00:23:01,916 Speaker 1: They all wash up on a deserted island, along with 349 00:23:01,996 --> 00:23:09,716 Speaker 1: their butler named Creighton h Okay, then town a transport 350 00:23:09,836 --> 00:23:12,556 Speaker 1: and bring it back with him. Good my Lord. After 351 00:23:12,636 --> 00:23:15,476 Speaker 1: the shipwreck, the butler, Crichton, behaves at first as he 352 00:23:15,556 --> 00:23:18,876 Speaker 1: always has. He bows and scrapes and speaks only when 353 00:23:18,956 --> 00:23:22,756 Speaker 1: spoken to. But on the island he's the only one 354 00:23:22,836 --> 00:23:26,636 Speaker 1: who has any idea how to survive. The nobility or 355 00:23:26,676 --> 00:23:29,436 Speaker 1: forced to admit it and defer to him lest they starve, 356 00:23:30,436 --> 00:23:32,996 Speaker 1: and by the end he's king of the island. The 357 00:23:33,076 --> 00:23:36,796 Speaker 1: British Lord is Crichton's slave, and his daughters are the 358 00:23:36,876 --> 00:23:40,996 Speaker 1: Butler's harem in waiting, and the Lord is freaking out. 359 00:23:41,476 --> 00:23:43,716 Speaker 1: I should give the honors, and you want abate them 360 00:23:45,716 --> 00:23:55,116 Speaker 1: with the deepest respect, my lord. The reason I can't 361 00:23:55,116 --> 00:23:57,196 Speaker 1: get the admirable Crichton out of my head is because 362 00:23:57,236 --> 00:24:01,356 Speaker 1: it's about the arbitrariness of social status and the way 363 00:24:01,436 --> 00:24:05,676 Speaker 1: that status can disguise people's value. Athena Health is his 364 00:24:05,756 --> 00:24:08,756 Speaker 1: own little island. Todd parks washed up on it with 365 00:24:08,836 --> 00:24:11,996 Speaker 1: Sue Anderson. But he's a first a bit unclear about 366 00:24:11,996 --> 00:24:15,836 Speaker 1: how to maximize her value. So he called his brother. 367 00:24:16,756 --> 00:24:18,916 Speaker 1: Tyd called me up and said, can you we need 368 00:24:19,036 --> 00:24:21,356 Speaker 1: some help? Can you help me? And so I said, 369 00:24:21,476 --> 00:24:25,436 Speaker 1: of course, because when your older brother calls you, you 370 00:24:25,636 --> 00:24:29,196 Speaker 1: basically say yes. This is Ed Park. He was just 371 00:24:29,396 --> 00:24:32,116 Speaker 1: then a twenty two year old graduate of Harvard, where 372 00:24:32,116 --> 00:24:35,316 Speaker 1: he'd run the computer science club. And so I packed 373 00:24:35,396 --> 00:24:39,476 Speaker 1: up all my things and no drove in my ten 374 00:24:39,556 --> 00:24:42,796 Speaker 1: year old Taylor camera in a three day sprint out 375 00:24:42,836 --> 00:24:45,356 Speaker 1: west to join him in San Diego. It wouldn't have 376 00:24:45,356 --> 00:24:47,036 Speaker 1: been a startup if there wasn't a story about an 377 00:24:47,076 --> 00:24:51,156 Speaker 1: old Toyota camera. Once Ed stopped driving, he took a long, 378 00:24:51,396 --> 00:24:54,996 Speaker 1: hard look at the health insurance industry. We went through 379 00:24:55,116 --> 00:24:58,876 Speaker 1: and we tried to figure out what are all these rules, 380 00:24:58,956 --> 00:25:02,916 Speaker 1: and then we pretty quickly figured out that the rules 381 00:25:02,996 --> 00:25:06,756 Speaker 1: weren't written down anywhere. The only people who knew the 382 00:25:06,916 --> 00:25:10,156 Speaker 1: rules were people who would actually worked in the industry 383 00:25:10,516 --> 00:25:14,996 Speaker 1: and had been incredibly observant for the last five years, 384 00:25:16,516 --> 00:25:22,116 Speaker 1: people like Sue Henderson, or perhaps no one but Sue Henderson. Anyway, 385 00:25:22,436 --> 00:25:24,476 Speaker 1: Todd ned figured out that what Ed needed to do 386 00:25:24,716 --> 00:25:27,436 Speaker 1: was go into a room with Sue to see if 387 00:25:27,436 --> 00:25:30,876 Speaker 1: he could replicate her brain in computer code. And so 388 00:25:31,196 --> 00:25:34,316 Speaker 1: Ed drove his camera back to the Boston suburbs. I 389 00:25:34,796 --> 00:25:37,556 Speaker 1: still remember the offices that we were working in. There 390 00:25:37,596 --> 00:25:41,876 Speaker 1: were these tiny little offices, I think, with the requisite 391 00:25:42,036 --> 00:25:43,956 Speaker 1: three or four people to an office. She's sort of 392 00:25:43,996 --> 00:25:46,876 Speaker 1: the next office over, and I was heads down coding, 393 00:25:46,996 --> 00:25:48,436 Speaker 1: and that was like, what do I need to code 394 00:25:48,476 --> 00:25:52,316 Speaker 1: to make this thing work? And so her job was 395 00:25:52,356 --> 00:25:54,316 Speaker 1: to basically help us get paid, and my job was 396 00:25:54,356 --> 00:25:56,236 Speaker 1: to try and figure out how to write a bunch 397 00:25:56,236 --> 00:25:59,196 Speaker 1: of code to make it so that we could start 398 00:25:59,316 --> 00:26:04,356 Speaker 1: doing it in a way that was semi replicable. For 399 00:26:04,516 --> 00:26:06,676 Speaker 1: her part, Sue was struck by just how much was 400 00:26:06,756 --> 00:26:09,676 Speaker 1: in her head that was not in theirs. Yeah, I think, 401 00:26:10,236 --> 00:26:13,796 Speaker 1: and probably Eddie would, and he's going to kill me 402 00:26:13,796 --> 00:26:16,236 Speaker 1: because I call him Eddie all the time. I think 403 00:26:16,316 --> 00:26:20,316 Speaker 1: that Eddie probably understood the fact that they had all 404 00:26:20,396 --> 00:26:26,356 Speaker 1: his complexities. But I think that he thought, with all 405 00:26:26,436 --> 00:26:29,236 Speaker 1: of these brilliant programmers, that they could figure it out 406 00:26:30,116 --> 00:26:32,196 Speaker 1: all by themselves, that they could just figure it out. 407 00:26:32,596 --> 00:26:34,796 Speaker 1: It was a few days into it when Sue realized 408 00:26:34,836 --> 00:26:36,596 Speaker 1: that Ed and I really had no idea what we 409 00:26:36,676 --> 00:26:41,556 Speaker 1: were doing. So she sets astounished, just like boys, shut up, 410 00:26:41,956 --> 00:26:43,836 Speaker 1: I'm gonna give you a little lesson, and she taught 411 00:26:43,876 --> 00:26:49,596 Speaker 1: us about like how the accounting works. Bob Gatewood is 412 00:26:49,636 --> 00:26:52,076 Speaker 1: remembering the day on the island when it became clear 413 00:26:52,436 --> 00:26:55,236 Speaker 1: who was the admirable Crichton. Well after she gave us 414 00:26:55,276 --> 00:26:57,596 Speaker 1: that lesson, and we're like, oh, yes, we will follow you. 415 00:26:57,716 --> 00:27:01,116 Speaker 1: We are your grasshoppers. And so, you know, she was 416 00:27:01,156 --> 00:27:03,516 Speaker 1: basically the product manager at that point, so she, you know, 417 00:27:03,596 --> 00:27:05,396 Speaker 1: she would tell us what the system needed to do 418 00:27:05,556 --> 00:27:08,836 Speaker 1: and we would go do it. And we bought her 419 00:27:08,876 --> 00:27:10,836 Speaker 1: hay hold, did you tell you about Hazel the big print? 420 00:27:11,516 --> 00:27:13,836 Speaker 1: So we got her a big claims print and she 421 00:27:13,996 --> 00:27:16,836 Speaker 1: named it after her mother. So we have a gladys 422 00:27:16,876 --> 00:27:21,796 Speaker 1: a Hazel in the suit. So I was sitting in 423 00:27:21,876 --> 00:27:24,356 Speaker 1: one room, Sue was sitting out over in the next room. 424 00:27:24,436 --> 00:27:28,116 Speaker 1: And every day I would code something and put it 425 00:27:28,196 --> 00:27:31,036 Speaker 1: out there, and then you know that evening Sue would 426 00:27:31,116 --> 00:27:34,076 Speaker 1: yell at me and so about something or other. I 427 00:27:34,116 --> 00:27:36,556 Speaker 1: did in sort of say like, you can't, like I 428 00:27:36,596 --> 00:27:38,316 Speaker 1: don't understand what you're doing. You can't do that, And 429 00:27:38,316 --> 00:27:39,876 Speaker 1: I'm like, what do you mean. Then she would basically 430 00:27:39,876 --> 00:27:42,596 Speaker 1: explain to me that, like, you need to make sure 431 00:27:42,836 --> 00:27:46,596 Speaker 1: that the procedure code with the highest charge amount is 432 00:27:46,756 --> 00:27:49,996 Speaker 1: put first on the claim because the insurance companies will 433 00:27:50,236 --> 00:27:52,076 Speaker 1: like sometimes pay the first line in the claim and 434 00:27:52,156 --> 00:27:53,796 Speaker 1: not the second, third, and fourth lines and the claim. 435 00:27:53,876 --> 00:27:56,516 Speaker 1: So I'm like, I didn't know that. Great, I'll do that, 436 00:27:56,756 --> 00:27:58,916 Speaker 1: and so then I would change it and then it 437 00:27:58,996 --> 00:28:02,596 Speaker 1: would be that way from then on. This went on 438 00:28:03,316 --> 00:28:08,516 Speaker 1: and on end on, not for weeks or months, for years. 439 00:28:11,436 --> 00:28:14,596 Speaker 1: The first three years, ed Park worked eighteen hours a day. 440 00:28:15,116 --> 00:28:17,476 Speaker 1: He had a sleeping bag and slept under his desk. 441 00:28:18,316 --> 00:28:21,076 Speaker 1: By day he had listened to Sue. By night, he 442 00:28:21,116 --> 00:28:23,956 Speaker 1: had turned what was in Sue's head into software. In 443 00:28:24,036 --> 00:28:26,956 Speaker 1: the morning. I would kind of wake up at six 444 00:28:27,156 --> 00:28:29,076 Speaker 1: or so, go to the bathroom. You know that. Do 445 00:28:29,156 --> 00:28:31,476 Speaker 1: you remember that pink soap, that the clear pink soap 446 00:28:31,516 --> 00:28:35,236 Speaker 1: that you sometimes get from from those dispensers from a 447 00:28:35,276 --> 00:28:38,116 Speaker 1: long time ago. I basically take that stuff runs from 448 00:28:38,156 --> 00:28:41,276 Speaker 1: my hair like you know, shampoo and the sink, and 449 00:28:41,476 --> 00:28:43,436 Speaker 1: go back to my desk and keep programming. So that 450 00:28:43,756 --> 00:28:48,156 Speaker 1: was That's the kind of life I led. This weird 451 00:28:48,236 --> 00:28:51,276 Speaker 1: new version of a theme of health now totally depends 452 00:28:51,316 --> 00:28:54,876 Speaker 1: on the value of one woman's expertise, even though no 453 00:28:54,996 --> 00:28:57,876 Speaker 1: one else had ever seen special value in Sue Henderson 454 00:28:58,556 --> 00:29:02,596 Speaker 1: or considered the stuff in her head and expertise in 455 00:29:02,676 --> 00:29:04,796 Speaker 1: a funny way, that's why there's money to be made here. 456 00:29:05,156 --> 00:29:08,596 Speaker 1: Up until now, no one, not even really Sue herself, 457 00:29:09,276 --> 00:29:12,756 Speaker 1: has figured out how valuable Sue is. If I basically 458 00:29:12,916 --> 00:29:14,436 Speaker 1: had asked her to go into the middle of a 459 00:29:14,516 --> 00:29:17,836 Speaker 1: room and basically gave her a stack of paper and said, 460 00:29:18,076 --> 00:29:21,116 Speaker 1: please write out everything you know about billing, she would 461 00:29:21,316 --> 00:29:24,796 Speaker 1: not have produced the things that were necessary for us 462 00:29:24,836 --> 00:29:29,436 Speaker 1: to be successful. Instead, she'd had a set of experiences 463 00:29:29,636 --> 00:29:33,636 Speaker 1: such that when she got placed into a sort of situation, 464 00:29:34,076 --> 00:29:36,236 Speaker 1: which I often did. I'd put her into a situation 465 00:29:36,476 --> 00:29:39,276 Speaker 1: where somebody didn't make sense right. Then she would basically 466 00:29:39,356 --> 00:29:42,076 Speaker 1: say she would immediately recognize that something was wrong, and 467 00:29:42,156 --> 00:29:45,716 Speaker 1: she'd basically searched her database, her head and said and 468 00:29:45,796 --> 00:29:49,156 Speaker 1: ask herself, why is this wrong? The smart young Harvard 469 00:29:49,196 --> 00:29:51,636 Speaker 1: graduates are trying to fix a big problem in the 470 00:29:51,716 --> 00:29:55,236 Speaker 1: healthcare system, but what they're really doing is exploiting the 471 00:29:55,316 --> 00:30:00,716 Speaker 1: world's inability to see the expert. It's expert blindness. Sue 472 00:30:00,796 --> 00:30:04,636 Speaker 1: had a sense of moral indignation when something was wrong, right, 473 00:30:04,716 --> 00:30:07,236 Speaker 1: And so there are some people who are essentially the 474 00:30:07,316 --> 00:30:09,836 Speaker 1: unsung experts. But you get them into a room and 475 00:30:09,916 --> 00:30:12,076 Speaker 1: you present them with something wrong and they won't tell 476 00:30:12,116 --> 00:30:15,316 Speaker 1: you right, like they're trying to read the room. They're 477 00:30:15,316 --> 00:30:17,516 Speaker 1: trying to figure out what you think the answers should be, 478 00:30:17,956 --> 00:30:21,796 Speaker 1: and they don't tell you that, like you're full of crap. Right. 479 00:30:22,396 --> 00:30:26,636 Speaker 1: Sue did not have that problem. If she thought it 480 00:30:26,756 --> 00:30:28,716 Speaker 1: was wrong, she would say, Eddie, I think you're wrong, 481 00:30:29,036 --> 00:30:32,036 Speaker 1: and she would tell me in no. In certain terms, 482 00:30:32,636 --> 00:30:35,236 Speaker 1: you get this sense that there are certain things in 483 00:30:35,316 --> 00:30:38,476 Speaker 1: the world. In particular for Sue was medical billing, for 484 00:30:38,596 --> 00:30:41,356 Speaker 1: which they have a sense of moral indignation that they 485 00:30:41,396 --> 00:30:44,556 Speaker 1: can't hide. She cared a lot, Yes, she cared a lot. 486 00:30:44,996 --> 00:30:47,556 Speaker 1: Did you at any point think or wonder if there 487 00:30:47,596 --> 00:30:50,276 Speaker 1: was someone who was even better than Sue at this 488 00:30:50,516 --> 00:30:53,156 Speaker 1: or did you think all along, Wow, we probably have 489 00:30:53,276 --> 00:30:57,076 Speaker 1: the best. I couldn't conceive of anyone who knew more 490 00:30:57,116 --> 00:30:59,436 Speaker 1: than her Like I would say, it was three or 491 00:30:59,516 --> 00:31:02,596 Speaker 1: four years until we got to the point where it 492 00:31:02,836 --> 00:31:06,716 Speaker 1: was clear that we had something that did justice to 493 00:31:06,796 --> 00:31:09,956 Speaker 1: the knowledge in her head. The content of Sue Henderson's 494 00:31:09,996 --> 00:31:13,516 Speaker 1: mind became a five billion dollars software company. It has 495 00:31:13,596 --> 00:31:16,796 Speaker 1: been one month since Athena Health announced the deal to 496 00:31:16,836 --> 00:31:19,436 Speaker 1: be acquired by Veritas Capital, and Sue got a bit rich. 497 00:31:19,916 --> 00:31:22,316 Speaker 1: But in the bargain, she saved the US economy a 498 00:31:22,436 --> 00:31:26,876 Speaker 1: small fortune. By selling medical billing software to doctor's offices, 499 00:31:27,316 --> 00:31:31,796 Speaker 1: Athena Health changed the US healthcare system. Doctors would never 500 00:31:31,876 --> 00:31:35,636 Speaker 1: again need their own medical biller. A single biller can 501 00:31:35,716 --> 00:31:39,996 Speaker 1: now handle ten doctors. That biller is now in effect, 502 00:31:40,396 --> 00:31:44,556 Speaker 1: Sue Henderson, Many of our doctors basically said to us, look, 503 00:31:45,476 --> 00:31:48,596 Speaker 1: you saved my career. I would have gone out of 504 00:31:48,716 --> 00:31:51,076 Speaker 1: business if it hadn't been for you guys. But maybe 505 00:31:51,116 --> 00:31:53,756 Speaker 1: the most telling response to the power of Sue Henderson 506 00:31:54,396 --> 00:31:57,876 Speaker 1: came from a big health insurance company. Or anyway, that's 507 00:31:57,876 --> 00:32:01,916 Speaker 1: what Todd Park thought. So I get a call one 508 00:32:01,996 --> 00:32:07,276 Speaker 1: day from a very powerful, very sophisticated national health insurance company, 509 00:32:07,516 --> 00:32:09,796 Speaker 1: right way above average in terms of it technical and 510 00:32:09,876 --> 00:32:15,276 Speaker 1: operational prowess. The insurance company had a bizarre request. They said, 511 00:32:15,436 --> 00:32:19,676 Speaker 1: we'd like to license your rules engine from you. I said, 512 00:32:19,716 --> 00:32:21,676 Speaker 1: I can't do that. I can't tell you what your 513 00:32:21,676 --> 00:32:24,436 Speaker 1: competitors insurance rules are. They said, no, no, no, we 514 00:32:24,516 --> 00:32:29,156 Speaker 1: want to license our own rules from you. The insurance 515 00:32:29,196 --> 00:32:32,836 Speaker 1: company itself didn't understand why it paid some medical claims 516 00:32:33,036 --> 00:32:36,596 Speaker 1: and not others. It was relieved that someone had figured 517 00:32:36,636 --> 00:32:38,756 Speaker 1: it out. I said, well, let me get this straight. 518 00:32:38,796 --> 00:32:42,116 Speaker 1: You want to license your own billing rules from us? 519 00:32:44,116 --> 00:32:46,836 Speaker 1: They said yes. I said, okay, it's a little crazy. 520 00:32:46,916 --> 00:32:49,396 Speaker 1: Can you just explain to me why? They said, well, look, 521 00:32:49,476 --> 00:32:51,996 Speaker 1: you know, I mean, we have a bunch of different systems. 522 00:32:52,116 --> 00:32:56,276 Speaker 1: We bought a bunch of different insurers. You know, there's 523 00:32:56,276 --> 00:32:59,356 Speaker 1: a ton of spaghetti code in these disparate systems, and 524 00:32:59,596 --> 00:33:04,836 Speaker 1: we don't really know what the hell's in there. That's incredible. 525 00:33:04,876 --> 00:33:09,556 Speaker 1: It's incredible, right, it's incredible. And after that one insurance 526 00:33:09,596 --> 00:33:12,116 Speaker 1: coming to that, did you find others also wanting to 527 00:33:12,196 --> 00:33:14,196 Speaker 1: do it? Or we we said we said we was 528 00:33:14,196 --> 00:33:23,436 Speaker 1: too weird, we couldn't do it, Okay. To recap this 529 00:33:23,636 --> 00:33:26,796 Speaker 1: invisible woman becomes an expert in a subject no one 530 00:33:26,916 --> 00:33:31,916 Speaker 1: really thinks of as especially important or even really a subject, 531 00:33:33,276 --> 00:33:39,916 Speaker 1: and her expertise changes a massive industry in retrospect or 532 00:33:39,956 --> 00:33:45,316 Speaker 1: At any moment, were you surprised by your value, like 533 00:33:45,516 --> 00:33:48,956 Speaker 1: your value to this new business. I don't think most 534 00:33:48,996 --> 00:33:52,436 Speaker 1: of the time that I realized my value. I think 535 00:33:53,436 --> 00:33:56,916 Speaker 1: I was enjoying what I was doing, and I don't 536 00:33:56,956 --> 00:34:01,156 Speaker 1: think that I was thinking, Wow, I'm I'm pretty valuable 537 00:34:01,276 --> 00:34:03,476 Speaker 1: here and if I left, they'd be in big trouble. 538 00:34:08,156 --> 00:34:12,476 Speaker 1: Sue Henderson's Todd Park's first business. But if you ask 539 00:34:12,556 --> 00:34:15,356 Speaker 1: Todd Park, that was only the second most important things 540 00:34:15,396 --> 00:34:18,436 Speaker 1: she did for him. The most important thing she did 541 00:34:18,476 --> 00:34:20,796 Speaker 1: for him was to lead him to a bigger idea 542 00:34:21,596 --> 00:34:27,996 Speaker 1: about where to find experts, especially in a crisis. Sue 543 00:34:28,236 --> 00:34:31,916 Speaker 1: doesn't run the healthcare system. She doesn't run a hospital system, 544 00:34:31,996 --> 00:34:34,956 Speaker 1: but she doesn't run a physician group. She doesn't run 545 00:34:34,956 --> 00:34:38,196 Speaker 1: an insurance company, right, but she has an incredibly good 546 00:34:38,276 --> 00:34:42,476 Speaker 1: sense on the ground of what is going on and 547 00:34:42,516 --> 00:34:44,756 Speaker 1: an instinct for what to do to make things better. Right, 548 00:34:44,796 --> 00:34:48,876 Speaker 1: So in the healthcare system, she is absolutely an L 549 00:34:48,956 --> 00:34:55,556 Speaker 1: six the L six, the level six, the person six 550 00:34:55,716 --> 00:35:00,636 Speaker 1: levels down from the top, the admirable cretens. That insight 551 00:35:00,796 --> 00:35:04,036 Speaker 1: became Todd's new obsession that you might never find the 552 00:35:04,116 --> 00:35:06,996 Speaker 1: expert who knows what you badly need to know because 553 00:35:07,036 --> 00:35:11,076 Speaker 1: she's buried under some big organization or system. She has 554 00:35:11,116 --> 00:35:14,156 Speaker 1: no status. She might have a voice, but no one 555 00:35:14,276 --> 00:35:18,836 Speaker 1: hears it. After his experience with Sue Henderson, Todd Park 556 00:35:18,956 --> 00:35:21,756 Speaker 1: basically became known as the guy who could find experts 557 00:35:22,196 --> 00:35:35,596 Speaker 1: where no one else thought to look. During his first 558 00:35:35,716 --> 00:35:39,996 Speaker 1: term in office, President Obama addressed the American people. Hello, everybody, 559 00:35:40,476 --> 00:35:43,036 Speaker 1: I want to talk with you about a new consumer website, 560 00:35:43,476 --> 00:35:47,116 Speaker 1: healthcare dot gov. It's a good resource for understanding the 561 00:35:47,196 --> 00:35:50,076 Speaker 1: new law, and it offers a few simple tools to 562 00:35:50,276 --> 00:35:54,156 Speaker 1: help you take your healthcare into your own hands. Obamacare 563 00:35:54,836 --> 00:35:57,356 Speaker 1: Americans were now suddenly eligible to sign up for a 564 00:35:57,436 --> 00:36:02,156 Speaker 1: new health insurance marketplace online. On October first, twenty thirteen, 565 00:36:04,036 --> 00:36:07,636 Speaker 1: billions of uninsured Americans are going online. This is healthcare 566 00:36:07,956 --> 00:36:11,396 Speaker 1: dot Gov. Hope to enroll in the Obamacare exchanges, but 567 00:36:11,476 --> 00:36:15,116 Speaker 1: the websites have been experiencing technical glitches. Medical that's the 568 00:36:15,316 --> 00:36:20,116 Speaker 1: sound of a crisis. Healthcare dot gov has crashed. It's 569 00:36:20,156 --> 00:36:23,916 Speaker 1: not just embarrassing, it's a political disaster. After weeks of 570 00:36:24,036 --> 00:36:27,876 Speaker 1: ignoring it, the White House finally admitting what everyone already knew. 571 00:36:28,116 --> 00:36:31,636 Speaker 1: Healthcare dot gov is a mess. The White House is 572 00:36:31,676 --> 00:36:34,796 Speaker 1: scrambling to find someone, anyone who can fix this nightmare. 573 00:36:35,556 --> 00:36:38,716 Speaker 1: Obama has by now brought Todd Park in as Chief 574 00:36:38,836 --> 00:36:41,836 Speaker 1: Technology Officer for the Department of Health and Human Services. 575 00:36:42,276 --> 00:36:48,436 Speaker 1: We basically went to CMS, the agency in charge of 576 00:36:48,716 --> 00:36:53,036 Speaker 1: healthcare dot gov that have been working it's heart out 577 00:36:53,916 --> 00:36:58,556 Speaker 1: since the site went live in October twenty thirteen. Todd 578 00:36:58,636 --> 00:37:01,236 Speaker 1: found that the people in charge didn't actually know why 579 00:37:01,276 --> 00:37:04,716 Speaker 1: the site had crashed or how to fix it. Neither 580 00:37:04,756 --> 00:37:07,556 Speaker 1: did the people right under the people in charge or 581 00:37:07,676 --> 00:37:10,516 Speaker 1: the people right under them. We went down another layer, 582 00:37:10,756 --> 00:37:14,156 Speaker 1: and then another layer, five layers down basically, and then 583 00:37:14,156 --> 00:37:17,476 Speaker 1: we finally got to layer six, which is where all 584 00:37:17,516 --> 00:37:20,636 Speaker 1: the contractors were who were working on the site, and 585 00:37:21,916 --> 00:37:25,916 Speaker 1: found a really really difficult and tough situation. But long 586 00:37:25,996 --> 00:37:29,316 Speaker 1: story short, at that layer and the layer beneath that layer, right, 587 00:37:29,676 --> 00:37:32,596 Speaker 1: folks working for the people in charge of the contractors, 588 00:37:33,156 --> 00:37:38,316 Speaker 1: and folks actually one layer beneath that found people who 589 00:37:39,116 --> 00:37:43,676 Speaker 1: really understood at least part of the picture right and 590 00:37:44,076 --> 00:37:47,716 Speaker 1: had deep domain expertise and had an instinct about what 591 00:37:47,916 --> 00:37:51,756 Speaker 1: to do. Why the Obama administration hadn't found the people 592 00:37:51,796 --> 00:37:53,676 Speaker 1: who knew how to fix their website on their own 593 00:37:53,796 --> 00:37:56,676 Speaker 1: is a question for another day, But this kind of 594 00:37:56,716 --> 00:38:02,396 Speaker 1: thing seems to happen over and over again. After the 595 00:38:02,516 --> 00:38:06,036 Speaker 1: healthcare dot gov debacle. Todd always sent his tech teams 596 00:38:06,076 --> 00:38:10,196 Speaker 1: into any crisis with a specific instruction find the l 597 00:38:10,316 --> 00:38:14,116 Speaker 1: six I remember actually report out from one of the teams. 598 00:38:15,036 --> 00:38:17,156 Speaker 1: They had been deployed to the State Department because I 599 00:38:17,276 --> 00:38:20,756 Speaker 1: believe it was the visa processing system of America that 600 00:38:20,876 --> 00:38:25,036 Speaker 1: had broken, and that was a huge problem obviously, And 601 00:38:25,196 --> 00:38:27,116 Speaker 1: so he said, what did you do? He said, well, 602 00:38:27,756 --> 00:38:34,836 Speaker 1: I went seven layers down and found two contractors who 603 00:38:34,956 --> 00:38:38,916 Speaker 1: actually knew what the problem was. And he said, all 604 00:38:38,956 --> 00:38:42,356 Speaker 1: I did was basically say, Okay, I'm going to take 605 00:38:42,476 --> 00:38:48,156 Speaker 1: your solution and deliver it seven layers up and basically 606 00:38:48,236 --> 00:38:50,836 Speaker 1: tell the people in charge, this technical fix needs to 607 00:38:50,876 --> 00:38:55,076 Speaker 1: be executed. And it was, and then America was able 608 00:38:55,156 --> 00:39:01,596 Speaker 1: to process visas again. Have you ever asked yourself why 609 00:39:01,756 --> 00:39:07,116 Speaker 1: you stumbled upon this pattern as opposed to someone else? Oh, 610 00:39:07,196 --> 00:39:11,316 Speaker 1: I don't think I am you in identifying the pattern. 611 00:39:13,116 --> 00:39:16,756 Speaker 1: I guarantee you there are L sixes in your space 612 00:39:16,836 --> 00:39:19,756 Speaker 1: and your organization, right. And the key to your success 613 00:39:20,396 --> 00:39:23,836 Speaker 1: in addressing a problem or tapping into an opportunity is 614 00:39:23,876 --> 00:39:27,676 Speaker 1: not you. It's not you, It is actually someone else 615 00:39:28,436 --> 00:39:30,436 Speaker 1: and L six And you have to have the wisdom 616 00:39:30,436 --> 00:39:33,476 Speaker 1: of your job is to find the L six and 617 00:39:34,036 --> 00:39:38,796 Speaker 1: let them rock and roll. Find the L six Not 618 00:39:39,036 --> 00:39:43,036 Speaker 1: the officially important person, not the public person, the person 619 00:39:43,156 --> 00:39:46,676 Speaker 1: on TV, not the person that seems like he knows 620 00:39:46,716 --> 00:39:50,516 Speaker 1: what he's talking about. No, you need to find the 621 00:39:50,596 --> 00:39:53,316 Speaker 1: person who spent the last twenty years stuffed inside some 622 00:39:53,516 --> 00:39:58,116 Speaker 1: basement without windows, quietly learning things, and who as a result, 623 00:39:58,716 --> 00:40:01,876 Speaker 1: might not be very good at advertising themselves or what 624 00:40:02,036 --> 00:40:07,876 Speaker 1: they know. There are some experts who, forever reason are 625 00:40:07,916 --> 00:40:11,836 Speaker 1: really terrible explaining what is going on and what to do, 626 00:40:12,316 --> 00:40:15,516 Speaker 1: either because they're just really terrible explaining or because they're 627 00:40:15,556 --> 00:40:17,796 Speaker 1: not clear thinkers, or because they want to keep the 628 00:40:17,876 --> 00:40:22,276 Speaker 1: secret sauce for themselves. In any given situation, you think 629 00:40:22,356 --> 00:40:26,556 Speaker 1: it will be obvious who the expert is, it won't. 630 00:40:27,876 --> 00:40:30,556 Speaker 1: We'll go right along believing that the people who happen 631 00:40:30,636 --> 00:40:34,436 Speaker 1: to be on top are the most important people until 632 00:40:34,516 --> 00:40:38,396 Speaker 1: we sense we cannot afford to believe that anymore, until say, 633 00:40:39,076 --> 00:40:43,436 Speaker 1: some crisis arises, and just to survive, you need to 634 00:40:43,516 --> 00:40:46,876 Speaker 1: find someone who actually knows the answer to your question. 635 00:40:50,756 --> 00:40:53,636 Speaker 1: Against the Rules is written and hosted by me Michael 636 00:40:53,716 --> 00:40:57,596 Speaker 1: Lewis and produced by Catherine Girardo and Lydia Jeancott. Julia 637 00:40:57,676 --> 00:41:01,036 Speaker 1: Barton is our editor, with additional editing by Audrey Dilling. 638 00:41:01,796 --> 00:41:05,956 Speaker 1: Beth Johnson is our fact checker, and Mia Lobell executive produces. 639 00:41:06,516 --> 00:41:09,956 Speaker 1: Our music is created by John Evans and Thias Bossi 640 00:41:10,396 --> 00:41:14,116 Speaker 1: of Stellwagon Symphonette. We record our show at Berkeley Advanced 641 00:41:14,156 --> 00:41:19,076 Speaker 1: Media Studios, expertly helmed by tofer Ruth, Thanks also to 642 00:41:19,196 --> 00:41:24,836 Speaker 1: Jacob Weisberg, Heather fag John Snars, Carly Migliori, Christina Sullivan, 643 00:41:25,116 --> 00:41:31,276 Speaker 1: Eric Sandler, Maggie Taylor, Nicole Morrano, Royston Beserve, Daniela La Khan, 644 00:41:32,116 --> 00:41:36,636 Speaker 1: Mary Beth Smith, and Jason Gambrel. Against the Rules is 645 00:41:36,636 --> 00:41:40,476 Speaker 1: a production of Pushkin Industries. Keep in touch, sign up 646 00:41:40,516 --> 00:41:44,116 Speaker 1: for Pushkin's newsletter at pushkin dot Fm, or follow at 647 00:41:44,196 --> 00:41:48,316 Speaker 1: Pushkin Pods. To find more Pushkin podcasts, listen on the 648 00:41:48,396 --> 00:41:52,996 Speaker 1: iHeartRadio app, Apple Podcasts, or wherever you listen to podcasts. 649 00:41:55,476 --> 00:41:57,996 Speaker 1: In case you missed it, I recently recorded a new 650 00:41:58,116 --> 00:42:02,396 Speaker 1: unabridged audiobook edition of my first book, Liars Poker. It's 651 00:42:02,396 --> 00:42:04,876 Speaker 1: about Wall Street and how it became the place it is. 652 00:42:05,436 --> 00:42:08,796 Speaker 1: You can buy the new Liars Poker audiobook at Pushkin 653 00:42:08,876 --> 00:42:12,476 Speaker 1: dot fm slash Liar's Poker. You could also buy it 654 00:42:12,516 --> 00:42:14,836 Speaker 1: at Audible or wherever audio books are sold