November 11, 2025 • 33 mins
Emergency room doctors Kevin Biese and Daniel Arteaga saw a familiar pattern: when older adults were taken into emergency departments, more often than not, they were left waiting. On stretchers, in hallways, or in overcrowded waiting rooms. For many, the longer they waited, the more agitated they got, often leaving in worse condition than when they arrived. So the doctors decided to take on this issue and change the way we treat geriatric patients across the country in the process.
In this episode, Ben Walter and Kathleen Griffith talk with Kevin and Daniel about rethinking emergency care, pitching investors (after forgetting to ask for money), and building trust within one of the most complex systems in the U.S. They share lessons on going deep versus wide, integrating AI into a human-first model, and the power of co-founder dynamics when the mission is personal. These are The Unshakeables.
For more on how technology is transforming healthcare, check out the newest episode of JPMorgan's Making Sense: “It’s not just innovation, it’s impact”: How AI is revolutionizing healthcare
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Speaker 1 (00:11):
Ruby.
Speaker 2 (00:23):
The emergency room is the last place any of us
want to find ourselves, but the reality is you or
your loved one may end up there at some point,
and if you're dealing with an aging parent, things can
get even more complicated.
Speaker 1 (00:36):
They're easily tens of thousands of older adults who are
lining the hallways of the emergency department.
Speaker 2 (00:42):
And they're not always taken there due to emergencies.
Speaker 3 (00:46):
The patients are neither straightforward nor clearly emergent. Their vital
signs are okay, they don't look like they need an
operation right away. They don't need to get whisked off somewhere,
so they wait.
Speaker 2 (00:59):
They sit in crowded waiting rooms, or on cots in hallways, every single day. Drs. Kevin Biese and Daniel Arteaga are both physicians working in emergency medicine and specializing in geriatric patients.
They've seen it time and time again.
Speaker 3 (01:15):
There was an older lady on a cot in the corner and I don't think about it except I come back 12 hours later same corner, same cot, same lady. I got pissed.
Speaker 1 (01:25):
That is a crisis, medical humanitarian. It's a problem to
be solved.
Speaker 2 (01:39):
Welcome to the Unshakeables from Chase for Business and Ruby
Studio from iHeartMedia. I'm Ben Walter, CEO of Chase for Business.
On the Unshakeables, we're sharing the daring moments of small
business owners facing their crisis points and telling the stories
of how they got through it. And joining me today
is Kathleen Griffith. Kathleen, Let's dig in.
Speaker 4 (02:01):
I had a sneaking suspicion that you were going to
nerd out on this one, and you did.
Speaker 2 (02:05):
You didn't help it. Yeah.
Speaker 4 (02:06):
I thought this one was great because this is a
true startup ground zero zero to one. We usually see
businesses that are a bit further along. They're grappling with
very early stage issues, but in a very complicated regulated
industry that's got lots of headwinds.
Speaker 2 (02:25):
That complicated regulated industry, unsurprisingly, is healthcare. Daniel and Kevin are combining excellent patient care with the latest in tech to change emergency departments across the country. On today's episode, Apogee Care from Chapel Hill, North Carolina. I was really excited to talk to them. I'm super interested in healthcare economics, more on that later, but I also love an Unshakable story. This one is different though because not only are Kevin and Daniel, small business owners, they're doctors, practicing doctors. Both Kevin and Daniel specialize in the care of older or geriatric adults. Both came to care for this population in different ways. For Daniel, it started early.
Speaker 1 (03:12):
My first job in high school was actually serving tables
at a retirement home. That group of people, that part
of life started mattering to me more.
Speaker 2 (03:21):
And Kevin ran headfirst into the issue as a young physician.
He was a third year resident. When he saw that
older woman on a cot.
Speaker 3 (03:29):
Same corner, same cot, same lady. I got pissed. I
think it's not hard to look around at the US
healthcare system and say this is not working for older adults.
Speaker 2 (03:41):
And Who exactly are those patients. Let's imagine Mrs. Smith. She's 82 years old living in the memory care unit of an assisted living facility. One day, Mrs. Smith is taken to the ER.
Speaker 3 (03:54):
She goes to the Er because they found her sitting
beside the bed and are afraid they might have hit
her head.
Speaker 2 (04:00):
She's confused, maybe a little disoriented, but it's not apparent
that anything is wrong. When she gets to the er,
it's overwhelming.
Speaker 3 (04:08):
That ER is running around with the stroke and the heart attack and everything. They're not going to know why she's there. Mrs. Smith has dementia. She's not going to tell them why she's there. They're going to run some tests. If they find something that looks weird, they're going to put her in the hospital and move on.
Speaker 2 (04:21):
If you're a big fan of medical dramas, and Kevin
loves some of them, by the way, you'll know exactly
why the doctors have to move on quickly.
Speaker 3 (04:28):
Because like a stroke just came in and like I have 20 minutes to take care of that stroke, so I know what to do there. I'm going to go in that direction. You stubbed your toe or you twisted your ankle or you broke your wrist playing pickleball. It's like, got it. Get an x-ray, put a cast on you, out you go, we're cool. These patients that were describing are neither straightforward nor clearly emergent, and it's going to take a long time to figure out what's going on and you're still not exactly sure what to do.
Speaker 2 (04:54):
And the more Mrs. Smith waits, the worse she gets.
Speaker 3 (04:58):
If you have dementia and you're waiting in an ER
hallway for six hours. At the end of that six hours,
you have something called delirium, which is to say, now
you're completely agitated. They're not better, they're not at home,
and the hospital's more full than it was the day before,
so they can't get the next person in who does
need a surgery or whatever.
Speaker 2 (05:17):
It's an enormous problem because Daniel and Kevin are asking
how we change the care for millions of people across
the country. But solving that problem is what Kevin and
Daniel were obsessed with.
Speaker 1 (05:29):
Initially, it started as this idea of let's help you
take care of the older adults in your emergency room better.
Speaker 2 (05:35):
So they tried what doctors are familiar with, new courses, new training, new protocols. They rolled out an accreditation program to 600 hospitals.
Speaker 3 (05:44):
Five of them took the next step and said, what
if we got expert consultation for these patients when they're
in the air. What if we got the right expertise
on them. Could we get them home? Could we get
them somewhere else? Could we get them out of the hallway?
Speaker 2 (05:58):
But consultations take manpower. Someone has to triage the patients
that need help. Someone then has to see them specifically,
and then someone has to follow up to make sure
they're doing well. A few weeks later, they turned to
where so many of us do in a pickle chat GPT.
Just kidding, but they did use AI.
Speaker 3 (06:13):
A service oriented company, but it's made possible by the
technology that's now on this scene.
Speaker 2 (06:22):
Daniel, when you first pitched this business, did you pitch
it as healthcare? Did you pitch it as tech?
Speaker 1 (06:28):
Initially we were pitching this as more of a technology solution,
and then just as we learn more and we talked
to more people, we started to understand better all the
pain points that the different stakeholders experience, especially the patients
and families, we realized exactly how much the human touch,
the compassionate human touch, really really mattered. That's what we
bring to the table now, and it's up to us
(06:49):
to leverage the technology to deliver it in a way
that is efficient, that is scalable, that improves the quality
of care.
Speaker 3 (06:58):
We bring in the technology round the service model. We
don't start with the technology and then figure out how
the service fits into it. What service is required to
get Mrs. Smith home safely and in better shape than
she would have been before, saving the payer money and
creating space in the hospital for the next patient. You
define that service and then you bring the tech in
to make that service more efficient, more expeditious, more scalable,
(07:19):
and drive the workforce around it.
Speaker 2 (07:23):
And that's how they arrived at what Apogee Care is today. You see, their company's services can be contracted by hospitals. So the emergency departments can offer a consultation to patients who are a good fit for Apogee. An ideal patient for them is typically 65 years or older, not needing obvious emergency medical attention, and usually they have some sort of cognitive impairment. If it's a good fit, the patient gets a virtual consultation with a nurse or doctor who's an expert in geriatrics, and that leads to either a comprehensive care plan or a discharge plan where the patient will be monitored at home. Okay, you get all that? So now imagine trying to pitch that to investors. I've been told you pitched for the money, but you never actually asked for it.
Speaker 3 (08:07):
That's important. You probably know more about finances than I do.
I'm guessing and based on our background. But everybody was like,
that's so cool, that's awesome, and I was like, thanks
for your support, and then the conversation would end. And
so I went to one of my really good friends
who fundraises for the university I work at, and I'm like, Tim,
what am I doing wrong? Man? And he listens the
whole thing. He goes, well, do you ask him for money?
(08:27):
And I'm like, oh, not really.
Speaker 2 (08:30):
He's like, you gotta ask him.
Speaker 3 (08:31):
You got it at the end of it, be like,
if you believe in this, you want to put in
fifty thousand or one hundred thousand or whatever number. And
that same day I got to the end of a
conversation with a venture capital an angel. He's like, I
love this and I got my courage to get I'm like, okay,
then are you in for a hundred? And he's like yes,
and I'm like.
Speaker 5 (08:49):
Oh, that works. It's funny how that works.
All right, Kathleen, You're right. I was fascinated with this story,
and it's for a couple of reasons. I was an
economics major in college, and what always fascinates me about
healthcare is that there's a fundamental piece of classic economics
that breaks down, which is in regular economics they teach
(09:10):
you supply demand and the price goes up and demand
goes down, and vice versa and the whole thing. Except
here demand is completely inelastic. Right, So when is the
heart surgery too expensive? If the TV gets too expensive,
you just say, you know what, I'm not going to
buy the TV. Right, But if you need the surgery,
you need the surgery or whatever the thing is, or
the drug or the procedure or the whatever. We've tried
(09:31):
to apply classic economics to a lot of these healthcare situations.
But when what is classically called price inelasticity is infinite,
that becomes really hard.
Speaker 4 (09:40):
That's so interesting. And you don't have the perception of
choice either as a patient. It's just you go as directed.
Speaker 2 (09:49):
I liken it to when you go to the mechanic
and he's like, you need a new gasket. What are
you gonna be like? No, I think this gasket's great.
Speaker 4 (09:55):
Right, let me get into the fuselage, right.
Speaker 5 (09:57):
Like I what?
Speaker 2 (09:58):
And so when they say like you need a whatever
other than a second opinion, and someone else is an expert,
there's complete information asymmetry.
Speaker 4 (10:03):
Yeah, it's so true.
Speaker 2 (10:05):
I took away another lesson that I've learned from other entrepreneurs.
You only get what you ask for. And that's when
you're fundraising, that's when you're hiring people, that's when you
are looking for advisors or connections or anything else. If
you don't ask, you should not expect to receive.
Speaker 4 (10:20):
Yeah, can we talk about pitching?
Speaker 2 (10:21):
Please? Please?
Speaker 4 (10:22):
Okay, I eat, sleep, breathe, pitches. I get pitched all
the time. I feel like I'm constantly pitching for my life.
So there's five steps. There's identifying the macro problem that
you're solving for in the world. All good stories start
from a broader place and they do not start with you.
So that's step one. Step two is key trends or
stats that kind of substantiate that broader problem. Step three
(10:44):
is you want to introduce the macro opportunity that is
being solved for. And then step four is really where
you're introducing your solution for the first time. So this
is why you're unique or different. And then kind of
wrapping with those proof points and dun...dun... da... the ask, like
the actual investment that was wild that they talked about,
not actually even making an ask at the end.
Speaker 2 (11:07):
And how much do you think you have to get
the balance between an emotional hook in your pitch versus cold,
hard fact.
Speaker 4 (11:14):
I love this question for me. You always need to
start at an emotional evocative place and then you want
to land the plane with those facts and figures and
the data points to substantiate the broader argument that you're making.
I think what people really get wrong is they focus
too much on the middle. It's like a very pragmatic,
practical pitch that is neither here nor there. So I say,
(11:35):
go super high and super low.
Speaker 2 (11:38):
Okay, So now you know how Kathleen approaches a pitch,
and Kevin figured out that he needed to actually ask
for money when he did so. But when fundraising you
also need to know how much money you actually need
before you start. Kevin and Daniel were looking for a
few million dollars, small potatoes in the healthcare world.
Speaker 3 (11:56):
We raised our first million off of select angel investors,
and that was like keep the lights on, explore the idea,
continue talking to stakeholders, figure out what this is actually
going to be. We were kind of floating the idea
by different hospital leaders. Eventually we started selling the idea
to hospital leaders, which was a big jump for us.
Speaker 1 (12:17):
And then when you didn't have anything to sell, I
assume more.
Speaker 3 (12:20):
Or less visions, dreams, aspirations.
Speaker 2 (12:23):
Right.
Speaker 1 (12:24):
We were very fortunate to find the hospital that saw
the same thing we did and wanted to do it
with us, and that's when the rubber hit the road.
Speaker 3 (12:30):
But the story is we had raised like half the
money and our first customer, we had signed them up
and they're like, aren't you going to start? And we're like,
oh shit, because because we had to tell them.
Speaker 2 (12:41):
We could to chicken an egg problem right, Like right,
we can't get the money unless we have customers. But
when you get a customer, you need to already have
the money seeming to go build it exactly.
Speaker 3 (12:48):
And so Daniel and I just looked at each other
and said, we're telling them that we're going to start
on this day. It's going to happen. It's just going
to happen. We picked like the last week in March,
it was like early February, and we are going to
do it. And the next of investors rewarded us by saying,
now we see the conviction we're on too, Like they
needed to see us be like, yep, we're jumping in
the pool, and I imagine you're going to throw us
a life raft.
Speaker 1 (13:08):
Our first hospital customer, fantastic partner, Luminous Healthcare and Rundo
Medical Center. So it's the busiest hospital in the state
of Maryland. On a really busy day, they've got about
three hundred patients that go through that er.
Speaker 2 (13:20):
The hospital was thrilled to have extra help, but that
also meant Kevin and Daniel were going in whether they
were ready or not.
Speaker 1 (13:27):
The first patient that we saw was an older woman who came in with vague neurologic complaints. I remember being terrified that the technology wouldn't work, the sound wouldn't work, the video would be bad. A lot of those things did happen. And then I remember I took the call down the hall from the emergency room, so I'm actually on site. It'd probably be more efficient for me to just walk down the hallway and see the patient in person, But where we're trying to prove the systems exactly,
(13:51):
We're rehearsing a telemedicine model. And so I remember we completed the consult. I sent my findings, my recommendations to the ER doc, and then I walked down the hall to go meet them and I was like, "Hey, was that useful?" They were like, "I don't know who you are." It was a little bit jarring. It was a formative moment for us as a company. It was just like, oh, this is the relationship that we have to foster. It's our team with this ER docs at these ER nurses. And it wasn't smooth right out of the gate and it's really been based off the repetition, the weeks and months of getting to know each other.
Speaker 2 (14:23):
And that allowed both hospital staff and patients to get
to know what Apogee was and the quality of the
care they were able to provide.
Speaker 1 (14:31):
We're probably four or five weeks in. Still very, very new. I'm seeing a patient, it's a patient who's in a stretcher bed in the hallway, and the way that these interactions, I'll start with the patient is we introduce ourselves and we say, "Hey, would you like this service? We'd like to help you out." The adult daughter says, "Thank you very much, but we don't need another cook in the kitchen." And an ER nurse who's overhearing this conversation, she steps in and she goes, "I'm really sorry. I just have to say I think that this team is really helpful. I think you should meet with them." And I was like, "Oh my God, they like us. They think we're useful." And that patient and their family agreed to talk to us. We did a full consult. We helped sort out a discharge plan for them to get back to their assisted living. And that was the moment for me where it's just like, "Oh my gosh, this is actually working. Now they're chasing our nurse down the hallway, asking her questions, asking her to see patients."
Speaker 3 (15:22):
The other story that comes to mind that really illuminates this, the moment I realized what a difference we were making was Daniel was seeing a patient that had come into the hospital like five times in the last year, had fallen two big falls, had been in the hospital for a week, had a hip replacement, and Daniel sees them for 10 minutes and goes, "My god, this is a variation of Parkinson's disease." But ER docs aren't great trained in Parkinson's, the orthopedic service that replaced the hip, they're not great trained in Parkinson's. So this patient had come in and out and in and out. I mean we're talking several hundred thousand dollars and more importantly like a year of misery and not that we can just wave a wand and fix Parkinson's, but Daniel was like, "Stop. We got to get this patient in the right direction." And I'm like, "Oh, that is what we are doing. We're getting the right eyes on these patients and everyone wins." Like the hospital wins, the insurance company wins, but most importantly, the patient and their family win because they're not being subjected to incredible misery without clear resolution.
Speaker 2 (16:16):
Kevin and Daniel became doctors because they believed in helping others,
but entrepreneurs need to have a slightly different goal. The
product should help people, of course, but the business still
needs to make economic sense for everyone involved. Luckily they
had thought that through.
Speaker 1 (16:31):
If we put a team in an emergency department and
they're working forty five fifty hours a week seeing patients,
they're saving and insure something in the ballpark of five
million dollars a year.
Speaker 3 (16:40):
Essentially, every time you do this type of consult for every consult, whether they end up admitted or discharged, you save the payer around $3,000. Our consults, they probably cost us like four to $500. So there's a five to six ROI just for every consult. You profoundly drive down the cost if you get patients the care they actually want in the setting, they want it
Speaker 2 (17:01):
So talk to us a little bit about what both
the sales cycle and the onboarding cycle look like. You're
selling into and onboarding into an incredibly complex ecosystem. You've
got Hospitals are big complicated places with lots of bureaucracy.
Insurance companies are big complicated places with lots of bureaucracy.
How does that work?
Speaker 3 (17:21):
Slowly but not super slowly. You're absolutely correct, and one of the advantages is it's not very capital heavy. I'm not asking to build a new hospital or buy a CAT scanner or whatever. I'm saying we're going to work in the ER that's already there and we're going to deliver a different kind of care that's already there. You got to work from the top and the bottom. Two things have to happen. One, you've got to work your way to the decision makers in a healthcare system. In a healthcare system, everybody's empowered to say no and fewer are empowered to say yes. So you've got to get to the C-suite and they either say one of two things, "That is amazing, do not leave my room because we have a capacity crisis," or they say, "That's really neat and cute. You should continue to talk to us." In which case we say thank you and go to the next hospital because hospitals are great followers, not great innovators. And so you want to catch the couple that there are and then it'll spread like wildfire
Speaker 2 (18:12):
And you've got to.
Speaker 3 (18:13):
Work really well in an integrated, supportive manner to all
the stakeholders, the doctors, the nurses, the patients, the case managers.
You've got to make the CEO happy and you got
to make the nurses happy. And if you do those
two things, you'll work your way into the system.
Speaker 1 (18:26):
And that's exactly what keeps me up at night right
It's like, how are we going to be the best
possible teammates to our emergency room colleagues and customers. It's
every little thing from who are we saying hello? To
how are we communicating with the ER docs, what are
we suggesting? What are we asking for? What are we
advocating for for individual patients? These are all things that
(18:49):
we are just laser focused on We want to make
sure that those er docs find us helpful, they want
more of our services because that gets us to the
bedside of the patient. That allows us to have a
larger clinical impact, and at the end of the day
allows Apogee Care just to make the biggest difference.
Speaker 2 (19:04):
Wow, that's not a small undertaking, it is?
Kathleen. I think one of the most interesting things about
their setup and the challenges they have is that they're
basically dealing with a multi tiered customer environment. You know,
there's a lot of people who say, well, I go
(19:26):
to my clients and I sell or I don't sell.
But here they have three layers of clients that they
have to get on board. They have to get the
hospital system, they have to get the insurance companies, and
they have to get the end patients to say yes.
They sort of have three distinct but overlapping Venn diagram-ish
customer groups they have to cater to. That's not typical.
Speaker 4 (19:46):
So what kind of biz? Is this a B2B2B to B2C business?
Speaker 2 (19:51):
It's sort of a B too many B's to C business,
I guess B to B to C Now. Fortunately, they
work in healthcare, so they understand a lot of it.
And on top of all of that, it's highly regulated
compared to selling software to corporate clients, that is a
massive amount of sort of market complexity. Yeah, for me
and for our listeners who own their own businesses in particular,
(20:13):
I think this idea of deciding who your customer is
is not a small decision. And when you have multiple
how do you think about rank ordering them? Or if
you can't rank order them, how do you think about
how you divide your time, attention focus to those different ones.
And it might be different at different times, it might
be different for different activities, but having a map that
(20:34):
lays that out, I think is quite important.
Speaker 4 (20:37):
And I always suggest that they have separate workstreams for
customer bases. So you should have a key stakeholder within
the company that is wholly responsible, for example, for the
hospital experience or the insurer experience, or the patient experience,
as well as the customer feedback that's coming in from
each of those different cohorts, and then you try to
(20:57):
find common ground. So I think for anyone who's running
a more complicated business like we're talking about, it's important
to be serving all of your quote unquote customer bases uniquely,
and then you've.
Speaker 2 (21:09):
Got to duke get out. They are really clear on
the two things that matter, which is what is the
problem they are trying to solve and how much passion
do they have for solving that problem, And that sort
of clarifies everything else around it. So, yeah, it might
be complicated that if to deal with a nurse and
a doctor and an insurance company and a patient and
probably an orderly and everything else in between. But they
know the problem they're trying to solve, and they're enormously
(21:32):
passionate about solving it, and that clarity is probably pretty helpful.
One thing we talk about for business owners is scale,
but scaling here means something totally different than what we
see for other B two C or B to B companies.
For Kevin and Daniel, it's not about having Apogee in
every single hospital in the US.
Speaker 3 (21:50):
We do best in certain markets. We're not best in 30 hospitals in 30 states. We're best in 10 hospitals in a geographic region because then we know Alzheimer's Association, Meals on Wheels, what are the best clinics because these patients still need help after they leave the hospital. So scale for us is going deep in markets, not just across every hospital that there can possibly be. The other thing that's really important is we need technology. So we started talking to technology firms and I had no idea what they were talking about because part of the answer to your question is you have to leverage AI to help us work differently. Most of the information we need is somewhere in these people's medical records. The computer can pull that out for us, organize it in a new way, tell our workstream because we can't afford to have Daniel seeing every one of these patients. There's not enough Daniels in the world, but we can get great providers and then use the computer to help tell them which patients to see, and then use the computer to help figure out what are the right care pathways that are most efficacious for those patients.
Speaker 2 (22:45):
Yeah, this is the same place in financial services where
we see the biggest leverage for AI. It's not that
AI is going to do everything for us, but the
efficiency and the productivity that it can add to the
existing workforce is tremendous. And that goes back to this
what is a service tech enabled service? Service enabled tech
that's really interesting and just out of curiosity. How many
patients a year do you think you're seeing now?
Speaker 1 (23:03):
It's in the ballpark of one hundred and twenty patients
a month, one thousand four hundred and forty patients a year.
Speaker 3 (23:08):
And we have a bunch of healthcare systems circling right now.
I mean, like getting a contract as per our prior
conversation with healthcare system isn't a super quick process. And
so we have several in four different markets. We really
can't go to more than three markets in eighteen months.
We have several and four different markets that I think
we'll start to engage with us very soon and so
that number will go up relatively quickly.
Speaker 2 (23:30):
Okay.
Speaker 3 (23:30):
And one health insurance plan there's one large health insurance
plan that we're also talking with about how would you
do this across their population, not just in one hospital,
but like all the places their members go.
Speaker 2 (23:40):
Interesting. So I want to talk a little bit about
both of you as individuals. So first of all, you've
both said Kevin's the forest and Daniel's trees. Say more
you need both.
Speaker 1 (23:53):
Kevin is the ER doc, so he's down in the trenches, so to speak, with the constant stream of patients, right? It's a nonstop flow. I came from the background of being a geriatrician who was working in the hospital and feeling frustrated because I was seeing a lot of patients who came in through the ed, but I was seeing them on day five, day six, day seven of hospitalization. The way we operate is incredibly different in ways that are complementary, and I think it makes both of us better. I really enjoy digging into complex processes. I've got all of my flow charts, my decision matrices, figuring out how do we put all these pieces together, where are all the different stakeholders interacting, and where do we see potential frictions happening and how do we solve for that? That's what I enjoy doing. It's my happy place, so to speak. I think that would be torture for Kevin.
Speaker 3 (24:42):
I would be awful at it. I'm definitely the big picture person of like, wait, where do we need to go? What's the simplest thing? How do we communicate this? I think the important point for me from a leadership standpoint in that is that you better surround yourself with people that make you a little bit uncomfortable. Daniel and I are good friends, but he's going to say things that I'm like, I don't like that because it's not what I would say and I'm sure it's reciprocated, but if I like what everybody around me is saying, I'm not doing a very good job leading anything because I'm just getting an echo chamber. And you've got to bring in people that see things differently and bring in different skill sets and even challenge each other. Otherwise, I think we'll just collectively you know blissfully fail if we don't challenge each other.
Speaker 2 (25:24):
Well, it's a very adult way to think about it.
I Mean, one of my favorite phrases is I'm not crazy,
I'm just not you.
Speaker 3 (25:30):
I love it.
Speaker 2 (25:31):
That's always stuck with me is two people can approach
a problem completely differently, come to completely different conclusions, and
it doesn't make either of them insane. What's next for Apogee,
I guess I should look at the big picture.
Speaker 1 (25:41):
Guy.
Speaker 3 (25:42):
I think that big picture, we are going to sign up a handful more hospitals. We're going to be in three markets in 18 months, and we're going to go deep. We'll be in 10 to 20 hospitals in those three markets and we'll start to get a lot of attention. And when we do that, we will be set up with AI, the scalable workforce, the care pathways and models that allow us to deploy this even without us directly caring for the patients and other hospitals. So what's next for Apogee? It's picking those three markets, making sure that all the right components are lined up in those three markets, going deep into those spaces and nailing down our workflows and making sure we're optimizing the integration of technology so that when those three markets get attention and they want us in 20 markets, we can deliver on that scale.
Speaker 1 (26:26):
Beautifully said, no notes.
Speaker 2 (26:29):
My last question is something we ask every guest we
have on the show, so I'd like an answer from
each of you. You've both been through the joy and
pain of starting a business and running a business, So
what is the one piece of advice you have for
aspiring our current small business owners?
Speaker 3 (26:44):
Daniel usually likes when I go first because it gives him a second to get his thoughts in order. Having my thoughts in order has never been an impediment to me speaking. So my advice would be make sure that what you are creating is addressing an oh shit moment for stakeholders for the public. At the end of the day, what we are about is that moment when you realize you've got to go back to the ER either for yourself or for a loved one, and you're not sure that you're really going to get the care you need. You got to be solving something real. And so if you're going to create a small business, at least in healthcare, it better be engineered towards real pain points that your customers are already experiencing and that you can meaningfully address not what you think they should be doing because there's a cooler way to do it. And I think a lot of what we're missing, the market and integration of technology and healthcare right now is a lot of really smart people creating a lot of really cool things that aren't addressing the actual pain points that are being experienced by the care delivery system right now. So start by listening, start by understanding where you provide value and then infuse the technology and the workflows that allow you to address that.
Speaker 2 (27:49):
Okay, top that, Daniel.
Speaker 1 (27:51):
My answer I think is going to be very complimentary, which is I think that if you're going to take a leap like this, you have to be obsessed with the problem you're trying to solve. As physicians, we love solving problems, whether it's solving the problem of an individual patient in front of you or trying to solve problems for a broader health system that's struggling with their inpatient capacity. If you are obsessed with the problem that you are trying to solve and you are understanding that problem in 13 different dimensions and catering to that problem in everything that you do every day, then you're going to build something that has value.
Speaker 2 (28:30):
Kevin and Daniel, thank you very much, Thank you, Thank you.
All Right, Kathleen, we're sort of at the end here,
and I hear all this about going deep versus wide,
but I think these guys probably convinced a lot of
people to bet on them.
Speaker 4 (28:47):
Yeah, it seems like it. Also, you've got this co
founder element, which is really nice in the line share
of businesses that are backed at a venture level or
co founders. So that was great to see their dynamic
between the two of them.
Speaker 2 (29:00):
I can't tell you how many either clients or prospective clients, meaning people I talk to who ask my advice for starting a business, my number one piece of advice for many of them is find a co-founder. I think it is too hard, too consuming, too diverse, too everything to do by yourself in most of these cases. I think having a co-founder is critical. I don't care if you're venture-backed or not, and it's a few things and these guys really embody them. I think it's, one, having someone to share the load both cognitively and physically. I think it's having someone to challenge you, and I'm super impressed with how they manage that dynamic and they clearly come at problems differently and they're open to each other's viewpoints and they respect that challenge and internalize it and think it through and pay it the time it deserves. I think that's really important. And then I think specialization quickly becomes important because you have to start to go deep on things and you just run out of capacity. So I'm a huge fan of the co-founder model. It takes a ton of work upfront to find the right one, but on a personal level, I would often bet on the right two co-founders with a good idea versus one co-founder with a great idea.
Speaker 4 (30:08):
and one of the main questions is like, well, how
do I find my co founder? You know, it's like
you got to go on a bunch of dates.
Speaker 2 (30:14):
Yeah, the same way you find a spouse or a
right friend or a girlfriend or whatever you have.
Speaker 4 (30:17):
We need an app for that.
Speaker 2 (30:18):
Well, there are are they? I think there are yes,
But I would say for people who are looking for
a co founder, the most important thing is to make
a list of what you want and don't want in
a co founder and be absolutely strict about it, be
honest about if it's truly things you have to have
or can't live with, and then don't compromise on it
because you know the things that drive you crazy and
(30:40):
those aren't your fault, they're just who you are. We
all have them, So don't partner with someone who has
the trait that drives you crazy all the time. Yeah,
that's good advice.
Speaker 4 (30:48):
And I think also making sure you're not just getting
your doppelganger, because you're just you're drawn to people who
are like you. Right, But today we saw just a
great example of someone who's a total yin to his yang.
You know, their counterpoints to each other. They have really
complimentary skill sets. You made me chuckle as you were
talking about that, because I've heard recently that they're a
(31:10):
therapist and coaches now who specifically help co founders deal
with communication issues and breakdowns in the business. And it's
a growing business for good reason.
Speaker 2 (31:21):
I also know some people now who signed prenups. So
what happens if one of us decides we want.
Speaker 4 (31:25):
To leave the business walks out the door.
Speaker 2 (31:27):
It's better to agree that upfront, Yeah, especially because sometimes
the amount of money put in is an equal, or
maybe it is, or the time hasn't been. It's better
to agree upfront. If one of us goes, here's how
we'll deal with it.
Speaker 4 (31:37):
Yeah, it's interesting. I was just talking to a small
business three co founders. One decided to leave for a
full time job because they were having a bit of
a lull in the business. Now they're trying to ferret
out what happens. So there's debt in the business, but
they're also assets, right, and so it's so much better
to do it upfront, to have those tough conversations.
Speaker 2 (31:57):
Kathleen, this is a really interesting one. Thank you for joining,
thank you for coming in, and thank you as always
for your insight. It's always fascinating.
Speaker 4 (32:03):
Yeah, I enjoyed the conversation and it's fun to be
together in person.
Speaker 2 (32:06):
Yes, it's always better. If you're like me and are interested in how technology is transforming healthcare, check out the newest episode of JPMorgan's Making Sense. Their latest episode explores how artificial intelligence is revolutionizing clinical workflows, improving patient care, and reshaping the business of healthcare. Give it a listen in the show's feed or visit the link in this episode's description. Thanks so much for listening to this episode of The Unshakeables. If you liked this episode, please rate and review it. On our next episode, we'll have two guests for you. One is from Fernandina Beach, Florida and the other is from Charlotte, North Carolina. And it'll be great because they'll be live on stage with me for a special episode. I'm Ben Walter, and this is The Unshakeables from Chase for Business and Ruby Studio from iHeartMedia. We'll see you back here soon.
Ruby.
Speaker 2 (00:23):
The emergency room is the last place any of us
want to find ourselves, but the reality is you or
your loved one may end up there at some point,
and if you're dealing with an aging parent, things can
get even more complicated.
Speaker 1 (00:36):
They're easily tens of thousands of older adults who are
lining the hallways of the emergency department.
Speaker 2 (00:42):
And they're not always taken there due to emergencies.
Speaker 3 (00:46):
The patients are neither straightforward nor clearly emergent. Their vital
signs are okay, they don't look like they need an
operation right away. They don't need to get whisked off somewhere,
so they wait.
Speaker 2 (00:59):
They sit in crowded waiting rooms, or on cots in hallways, every single day. Drs. Kevin Biese and Daniel Arteaga are both physicians working in emergency medicine and specializing in geriatric patients.
They've seen it time and time again.
Speaker 3 (01:15):
There was an older lady on a cot in the corner and I don't think about it except I come back 12 hours later same corner, same cot, same lady. I got pissed.
Speaker 1 (01:25):
That is a crisis, medical humanitarian. It's a problem to
be solved.
Speaker 2 (01:39):
Welcome to the Unshakeables from Chase for Business and Ruby
Studio from iHeartMedia. I'm Ben Walter, CEO of Chase for Business.
On the Unshakeables, we're sharing the daring moments of small
business owners facing their crisis points and telling the stories
of how they got through it. And joining me today
is Kathleen Griffith. Kathleen, Let's dig in.
Speaker 4 (02:01):
I had a sneaking suspicion that you were going to
nerd out on this one, and you did.
Speaker 2 (02:05):
You didn't help it. Yeah.
Speaker 4 (02:06):
I thought this one was great because this is a
true startup ground zero zero to one. We usually see
businesses that are a bit further along. They're grappling with
very early stage issues, but in a very complicated regulated
industry that's got lots of headwinds.
Speaker 2 (02:25):
That complicated regulated industry, unsurprisingly, is healthcare. Daniel and Kevin are combining excellent patient care with the latest in tech to change emergency departments across the country. On today's episode, Apogee Care from Chapel Hill, North Carolina. I was really excited to talk to them. I'm super interested in healthcare economics, more on that later, but I also love an Unshakable story. This one is different though because not only are Kevin and Daniel, small business owners, they're doctors, practicing doctors. Both Kevin and Daniel specialize in the care of older or geriatric adults. Both came to care for this population in different ways. For Daniel, it started early.
Speaker 1 (03:12):
My first job in high school was actually serving tables
at a retirement home. That group of people, that part
of life started mattering to me more.
Speaker 2 (03:21):
And Kevin ran headfirst into the issue as a young physician.
He was a third year resident. When he saw that
older woman on a cot.
Speaker 3 (03:29):
Same corner, same cot, same lady. I got pissed. I
think it's not hard to look around at the US
healthcare system and say this is not working for older adults.
Speaker 2 (03:41):
And Who exactly are those patients. Let's imagine Mrs. Smith. She's 82 years old living in the memory care unit of an assisted living facility. One day, Mrs. Smith is taken to the ER.
Speaker 3 (03:54):
She goes to the Er because they found her sitting
beside the bed and are afraid they might have hit
her head.
Speaker 2 (04:00):
She's confused, maybe a little disoriented, but it's not apparent
that anything is wrong. When she gets to the er,
it's overwhelming.
Speaker 3 (04:08):
That ER is running around with the stroke and the heart attack and everything. They're not going to know why she's there. Mrs. Smith has dementia. She's not going to tell them why she's there. They're going to run some tests. If they find something that looks weird, they're going to put her in the hospital and move on.
Speaker 2 (04:21):
If you're a big fan of medical dramas, and Kevin
loves some of them, by the way, you'll know exactly
why the doctors have to move on quickly.
Speaker 3 (04:28):
Because like a stroke just came in and like I have 20 minutes to take care of that stroke, so I know what to do there. I'm going to go in that direction. You stubbed your toe or you twisted your ankle or you broke your wrist playing pickleball. It's like, got it. Get an x-ray, put a cast on you, out you go, we're cool. These patients that were describing are neither straightforward nor clearly emergent, and it's going to take a long time to figure out what's going on and you're still not exactly sure what to do.
Speaker 2 (04:54):
And the more Mrs. Smith waits, the worse she gets.
Speaker 3 (04:58):
If you have dementia and you're waiting in an ER
hallway for six hours. At the end of that six hours,
you have something called delirium, which is to say, now
you're completely agitated. They're not better, they're not at home,
and the hospital's more full than it was the day before,
so they can't get the next person in who does
need a surgery or whatever.
Speaker 2 (05:17):
It's an enormous problem because Daniel and Kevin are asking
how we change the care for millions of people across
the country. But solving that problem is what Kevin and
Daniel were obsessed with.
Speaker 1 (05:29):
Initially, it started as this idea of let's help you
take care of the older adults in your emergency room better.
Speaker 2 (05:35):
So they tried what doctors are familiar with, new courses, new training, new protocols. They rolled out an accreditation program to 600 hospitals.
Speaker 3 (05:44):
Five of them took the next step and said, what
if we got expert consultation for these patients when they're
in the air. What if we got the right expertise
on them. Could we get them home? Could we get
them somewhere else? Could we get them out of the hallway?
Speaker 2 (05:58):
But consultations take manpower. Someone has to triage the patients
that need help. Someone then has to see them specifically,
and then someone has to follow up to make sure
they're doing well. A few weeks later, they turned to
where so many of us do in a pickle chat GPT.
Just kidding, but they did use AI.
Speaker 3 (06:13):
A service oriented company, but it's made possible by the
technology that's now on this scene.
Speaker 2 (06:22):
Daniel, when you first pitched this business, did you pitch
it as healthcare? Did you pitch it as tech?
Speaker 1 (06:28):
Initially we were pitching this as more of a technology solution,
and then just as we learn more and we talked
to more people, we started to understand better all the
pain points that the different stakeholders experience, especially the patients
and families, we realized exactly how much the human touch,
the compassionate human touch, really really mattered. That's what we
bring to the table now, and it's up to us
(06:49):
to leverage the technology to deliver it in a way
that is efficient, that is scalable, that improves the quality
of care.
Speaker 3 (06:58):
We bring in the technology round the service model. We
don't start with the technology and then figure out how
the service fits into it. What service is required to
get Mrs. Smith home safely and in better shape than
she would have been before, saving the payer money and
creating space in the hospital for the next patient. You
define that service and then you bring the tech in
to make that service more efficient, more expeditious, more scalable,
(07:19):
and drive the workforce around it.
Speaker 2 (07:23):
And that's how they arrived at what Apogee Care is today. You see, their company's services can be contracted by hospitals. So the emergency departments can offer a consultation to patients who are a good fit for Apogee. An ideal patient for them is typically 65 years or older, not needing obvious emergency medical attention, and usually they have some sort of cognitive impairment. If it's a good fit, the patient gets a virtual consultation with a nurse or doctor who's an expert in geriatrics, and that leads to either a comprehensive care plan or a discharge plan where the patient will be monitored at home. Okay, you get all that? So now imagine trying to pitch that to investors. I've been told you pitched for the money, but you never actually asked for it.
Speaker 3 (08:07):
That's important. You probably know more about finances than I do.
I'm guessing and based on our background. But everybody was like,
that's so cool, that's awesome, and I was like, thanks
for your support, and then the conversation would end. And
so I went to one of my really good friends
who fundraises for the university I work at, and I'm like, Tim,
what am I doing wrong? Man? And he listens the
whole thing. He goes, well, do you ask him for money?
(08:27):
And I'm like, oh, not really.
Speaker 2 (08:30):
He's like, you gotta ask him.
Speaker 3 (08:31):
You got it at the end of it, be like,
if you believe in this, you want to put in
fifty thousand or one hundred thousand or whatever number. And
that same day I got to the end of a
conversation with a venture capital an angel. He's like, I
love this and I got my courage to get I'm like, okay,
then are you in for a hundred? And he's like yes,
and I'm like.
Speaker 5 (08:49):
Oh, that works. It's funny how that works.
All right, Kathleen, You're right. I was fascinated with this story,
and it's for a couple of reasons. I was an
economics major in college, and what always fascinates me about
healthcare is that there's a fundamental piece of classic economics
that breaks down, which is in regular economics they teach
(09:10):
you supply demand and the price goes up and demand
goes down, and vice versa and the whole thing. Except
here demand is completely inelastic. Right, So when is the
heart surgery too expensive? If the TV gets too expensive,
you just say, you know what, I'm not going to
buy the TV. Right, But if you need the surgery,
you need the surgery or whatever the thing is, or
the drug or the procedure or the whatever. We've tried
(09:31):
to apply classic economics to a lot of these healthcare situations.
But when what is classically called price inelasticity is infinite,
that becomes really hard.
Speaker 4 (09:40):
That's so interesting. And you don't have the perception of
choice either as a patient. It's just you go as directed.
Speaker 2 (09:49):
I liken it to when you go to the mechanic
and he's like, you need a new gasket. What are
you gonna be like? No, I think this gasket's great.
Speaker 4 (09:55):
Right, let me get into the fuselage, right.
Speaker 5 (09:57):
Like I what?
Speaker 2 (09:58):
And so when they say like you need a whatever
other than a second opinion, and someone else is an expert,
there's complete information asymmetry.
Speaker 4 (10:03):
Yeah, it's so true.
Speaker 2 (10:05):
I took away another lesson that I've learned from other entrepreneurs.
You only get what you ask for. And that's when
you're fundraising, that's when you're hiring people, that's when you
are looking for advisors or connections or anything else. If
you don't ask, you should not expect to receive.
Speaker 4 (10:20):
Yeah, can we talk about pitching?
Speaker 2 (10:21):
Please? Please?
Speaker 4 (10:22):
Okay, I eat, sleep, breathe, pitches. I get pitched all
the time. I feel like I'm constantly pitching for my life.
So there's five steps. There's identifying the macro problem that
you're solving for in the world. All good stories start
from a broader place and they do not start with you.
So that's step one. Step two is key trends or
stats that kind of substantiate that broader problem. Step three
(10:44):
is you want to introduce the macro opportunity that is
being solved for. And then step four is really where
you're introducing your solution for the first time. So this
is why you're unique or different. And then kind of
wrapping with those proof points and dun...dun... da... the ask, like
the actual investment that was wild that they talked about,
not actually even making an ask at the end.
Speaker 2 (11:07):
And how much do you think you have to get
the balance between an emotional hook in your pitch versus cold,
hard fact.
Speaker 4 (11:14):
I love this question for me. You always need to
start at an emotional evocative place and then you want
to land the plane with those facts and figures and
the data points to substantiate the broader argument that you're making.
I think what people really get wrong is they focus
too much on the middle. It's like a very pragmatic,
practical pitch that is neither here nor there. So I say,
(11:35):
go super high and super low.
Speaker 2 (11:38):
Okay, So now you know how Kathleen approaches a pitch,
and Kevin figured out that he needed to actually ask
for money when he did so. But when fundraising you
also need to know how much money you actually need
before you start. Kevin and Daniel were looking for a
few million dollars, small potatoes in the healthcare world.
Speaker 3 (11:56):
We raised our first million off of select angel investors,
and that was like keep the lights on, explore the idea,
continue talking to stakeholders, figure out what this is actually
going to be. We were kind of floating the idea
by different hospital leaders. Eventually we started selling the idea
to hospital leaders, which was a big jump for us.
Speaker 1 (12:17):
And then when you didn't have anything to sell, I
assume more.
Speaker 3 (12:20):
Or less visions, dreams, aspirations.
Speaker 2 (12:23):
Right.
Speaker 1 (12:24):
We were very fortunate to find the hospital that saw
the same thing we did and wanted to do it
with us, and that's when the rubber hit the road.
Speaker 3 (12:30):
But the story is we had raised like half the
money and our first customer, we had signed them up
and they're like, aren't you going to start? And we're like,
oh shit, because because we had to tell them.
Speaker 2 (12:41):
We could to chicken an egg problem right, Like right,
we can't get the money unless we have customers. But
when you get a customer, you need to already have
the money seeming to go build it exactly.
Speaker 3 (12:48):
And so Daniel and I just looked at each other
and said, we're telling them that we're going to start
on this day. It's going to happen. It's just going
to happen. We picked like the last week in March,
it was like early February, and we are going to
do it. And the next of investors rewarded us by saying,
now we see the conviction we're on too, Like they
needed to see us be like, yep, we're jumping in
the pool, and I imagine you're going to throw us
a life raft.
Speaker 1 (13:08):
Our first hospital customer, fantastic partner, Luminous Healthcare and Rundo
Medical Center. So it's the busiest hospital in the state
of Maryland. On a really busy day, they've got about
three hundred patients that go through that er.
Speaker 2 (13:20):
The hospital was thrilled to have extra help, but that
also meant Kevin and Daniel were going in whether they
were ready or not.
Speaker 1 (13:27):
The first patient that we saw was an older woman who came in with vague neurologic complaints. I remember being terrified that the technology wouldn't work, the sound wouldn't work, the video would be bad. A lot of those things did happen. And then I remember I took the call down the hall from the emergency room, so I'm actually on site. It'd probably be more efficient for me to just walk down the hallway and see the patient in person, But where we're trying to prove the systems exactly,
(13:51):
We're rehearsing a telemedicine model. And so I remember we completed the consult. I sent my findings, my recommendations to the ER doc, and then I walked down the hall to go meet them and I was like, "Hey, was that useful?" They were like, "I don't know who you are." It was a little bit jarring. It was a formative moment for us as a company. It was just like, oh, this is the relationship that we have to foster. It's our team with this ER docs at these ER nurses. And it wasn't smooth right out of the gate and it's really been based off the repetition, the weeks and months of getting to know each other.
Speaker 2 (14:23):
And that allowed both hospital staff and patients to get
to know what Apogee was and the quality of the
care they were able to provide.
Speaker 1 (14:31):
We're probably four or five weeks in. Still very, very new. I'm seeing a patient, it's a patient who's in a stretcher bed in the hallway, and the way that these interactions, I'll start with the patient is we introduce ourselves and we say, "Hey, would you like this service? We'd like to help you out." The adult daughter says, "Thank you very much, but we don't need another cook in the kitchen." And an ER nurse who's overhearing this conversation, she steps in and she goes, "I'm really sorry. I just have to say I think that this team is really helpful. I think you should meet with them." And I was like, "Oh my God, they like us. They think we're useful." And that patient and their family agreed to talk to us. We did a full consult. We helped sort out a discharge plan for them to get back to their assisted living. And that was the moment for me where it's just like, "Oh my gosh, this is actually working. Now they're chasing our nurse down the hallway, asking her questions, asking her to see patients."
Speaker 3 (15:22):
The other story that comes to mind that really illuminates this, the moment I realized what a difference we were making was Daniel was seeing a patient that had come into the hospital like five times in the last year, had fallen two big falls, had been in the hospital for a week, had a hip replacement, and Daniel sees them for 10 minutes and goes, "My god, this is a variation of Parkinson's disease." But ER docs aren't great trained in Parkinson's, the orthopedic service that replaced the hip, they're not great trained in Parkinson's. So this patient had come in and out and in and out. I mean we're talking several hundred thousand dollars and more importantly like a year of misery and not that we can just wave a wand and fix Parkinson's, but Daniel was like, "Stop. We got to get this patient in the right direction." And I'm like, "Oh, that is what we are doing. We're getting the right eyes on these patients and everyone wins." Like the hospital wins, the insurance company wins, but most importantly, the patient and their family win because they're not being subjected to incredible misery without clear resolution.
Speaker 2 (16:16):
Kevin and Daniel became doctors because they believed in helping others,
but entrepreneurs need to have a slightly different goal. The
product should help people, of course, but the business still
needs to make economic sense for everyone involved. Luckily they
had thought that through.
Speaker 1 (16:31):
If we put a team in an emergency department and
they're working forty five fifty hours a week seeing patients,
they're saving and insure something in the ballpark of five
million dollars a year.
Speaker 3 (16:40):
Essentially, every time you do this type of consult for every consult, whether they end up admitted or discharged, you save the payer around $3,000. Our consults, they probably cost us like four to $500. So there's a five to six ROI just for every consult. You profoundly drive down the cost if you get patients the care they actually want in the setting, they want it
Speaker 2 (17:01):
So talk to us a little bit about what both
the sales cycle and the onboarding cycle look like. You're
selling into and onboarding into an incredibly complex ecosystem. You've
got Hospitals are big complicated places with lots of bureaucracy.
Insurance companies are big complicated places with lots of bureaucracy.
How does that work?
Speaker 3 (17:21):
Slowly but not super slowly. You're absolutely correct, and one of the advantages is it's not very capital heavy. I'm not asking to build a new hospital or buy a CAT scanner or whatever. I'm saying we're going to work in the ER that's already there and we're going to deliver a different kind of care that's already there. You got to work from the top and the bottom. Two things have to happen. One, you've got to work your way to the decision makers in a healthcare system. In a healthcare system, everybody's empowered to say no and fewer are empowered to say yes. So you've got to get to the C-suite and they either say one of two things, "That is amazing, do not leave my room because we have a capacity crisis," or they say, "That's really neat and cute. You should continue to talk to us." In which case we say thank you and go to the next hospital because hospitals are great followers, not great innovators. And so you want to catch the couple that there are and then it'll spread like wildfire
Speaker 2 (18:12):
And you've got to.
Speaker 3 (18:13):
Work really well in an integrated, supportive manner to all
the stakeholders, the doctors, the nurses, the patients, the case managers.
You've got to make the CEO happy and you got
to make the nurses happy. And if you do those
two things, you'll work your way into the system.
Speaker 1 (18:26):
And that's exactly what keeps me up at night right
It's like, how are we going to be the best
possible teammates to our emergency room colleagues and customers. It's
every little thing from who are we saying hello? To
how are we communicating with the ER docs, what are
we suggesting? What are we asking for? What are we
advocating for for individual patients? These are all things that
(18:49):
we are just laser focused on We want to make
sure that those er docs find us helpful, they want
more of our services because that gets us to the
bedside of the patient. That allows us to have a
larger clinical impact, and at the end of the day
allows Apogee Care just to make the biggest difference.
Speaker 2 (19:04):
Wow, that's not a small undertaking, it is?
Kathleen. I think one of the most interesting things about
their setup and the challenges they have is that they're
basically dealing with a multi tiered customer environment. You know,
there's a lot of people who say, well, I go
(19:26):
to my clients and I sell or I don't sell.
But here they have three layers of clients that they
have to get on board. They have to get the
hospital system, they have to get the insurance companies, and
they have to get the end patients to say yes.
They sort of have three distinct but overlapping Venn diagram-ish
customer groups they have to cater to. That's not typical.
Speaker 4 (19:46):
So what kind of biz? Is this a B2B2B to B2C business?
Speaker 2 (19:51):
It's sort of a B too many B's to C business,
I guess B to B to C Now. Fortunately, they
work in healthcare, so they understand a lot of it.
And on top of all of that, it's highly regulated
compared to selling software to corporate clients, that is a
massive amount of sort of market complexity. Yeah, for me
and for our listeners who own their own businesses in particular,
(20:13):
I think this idea of deciding who your customer is
is not a small decision. And when you have multiple
how do you think about rank ordering them? Or if
you can't rank order them, how do you think about
how you divide your time, attention focus to those different ones.
And it might be different at different times, it might
be different for different activities, but having a map that
(20:34):
lays that out, I think is quite important.
Speaker 4 (20:37):
And I always suggest that they have separate workstreams for
customer bases. So you should have a key stakeholder within
the company that is wholly responsible, for example, for the
hospital experience or the insurer experience, or the patient experience,
as well as the customer feedback that's coming in from
each of those different cohorts, and then you try to
(20:57):
find common ground. So I think for anyone who's running
a more complicated business like we're talking about, it's important
to be serving all of your quote unquote customer bases uniquely,
and then you've.
Speaker 2 (21:09):
Got to duke get out. They are really clear on
the two things that matter, which is what is the
problem they are trying to solve and how much passion
do they have for solving that problem, And that sort
of clarifies everything else around it. So, yeah, it might
be complicated that if to deal with a nurse and
a doctor and an insurance company and a patient and
probably an orderly and everything else in between. But they
know the problem they're trying to solve, and they're enormously
(21:32):
passionate about solving it, and that clarity is probably pretty helpful.
One thing we talk about for business owners is scale,
but scaling here means something totally different than what we
see for other B two C or B to B companies.
For Kevin and Daniel, it's not about having Apogee in
every single hospital in the US.
Speaker 3 (21:50):
We do best in certain markets. We're not best in 30 hospitals in 30 states. We're best in 10 hospitals in a geographic region because then we know Alzheimer's Association, Meals on Wheels, what are the best clinics because these patients still need help after they leave the hospital. So scale for us is going deep in markets, not just across every hospital that there can possibly be. The other thing that's really important is we need technology. So we started talking to technology firms and I had no idea what they were talking about because part of the answer to your question is you have to leverage AI to help us work differently. Most of the information we need is somewhere in these people's medical records. The computer can pull that out for us, organize it in a new way, tell our workstream because we can't afford to have Daniel seeing every one of these patients. There's not enough Daniels in the world, but we can get great providers and then use the computer to help tell them which patients to see, and then use the computer to help figure out what are the right care pathways that are most efficacious for those patients.
Speaker 2 (22:45):
Yeah, this is the same place in financial services where
we see the biggest leverage for AI. It's not that
AI is going to do everything for us, but the
efficiency and the productivity that it can add to the
existing workforce is tremendous. And that goes back to this
what is a service tech enabled service? Service enabled tech
that's really interesting and just out of curiosity. How many
patients a year do you think you're seeing now?
Speaker 1 (23:03):
It's in the ballpark of one hundred and twenty patients
a month, one thousand four hundred and forty patients a year.
Speaker 3 (23:08):
And we have a bunch of healthcare systems circling right now.
I mean, like getting a contract as per our prior
conversation with healthcare system isn't a super quick process. And
so we have several in four different markets. We really
can't go to more than three markets in eighteen months.
We have several and four different markets that I think
we'll start to engage with us very soon and so
that number will go up relatively quickly.
Speaker 2 (23:30):
Okay.
Speaker 3 (23:30):
And one health insurance plan there's one large health insurance
plan that we're also talking with about how would you
do this across their population, not just in one hospital,
but like all the places their members go.
Speaker 2 (23:40):
Interesting. So I want to talk a little bit about
both of you as individuals. So first of all, you've
both said Kevin's the forest and Daniel's trees. Say more
you need both.
Speaker 1 (23:53):
Kevin is the ER doc, so he's down in the trenches, so to speak, with the constant stream of patients, right? It's a nonstop flow. I came from the background of being a geriatrician who was working in the hospital and feeling frustrated because I was seeing a lot of patients who came in through the ed, but I was seeing them on day five, day six, day seven of hospitalization. The way we operate is incredibly different in ways that are complementary, and I think it makes both of us better. I really enjoy digging into complex processes. I've got all of my flow charts, my decision matrices, figuring out how do we put all these pieces together, where are all the different stakeholders interacting, and where do we see potential frictions happening and how do we solve for that? That's what I enjoy doing. It's my happy place, so to speak. I think that would be torture for Kevin.
Speaker 3 (24:42):
I would be awful at it. I'm definitely the big picture person of like, wait, where do we need to go? What's the simplest thing? How do we communicate this? I think the important point for me from a leadership standpoint in that is that you better surround yourself with people that make you a little bit uncomfortable. Daniel and I are good friends, but he's going to say things that I'm like, I don't like that because it's not what I would say and I'm sure it's reciprocated, but if I like what everybody around me is saying, I'm not doing a very good job leading anything because I'm just getting an echo chamber. And you've got to bring in people that see things differently and bring in different skill sets and even challenge each other. Otherwise, I think we'll just collectively you know blissfully fail if we don't challenge each other.
Speaker 2 (25:24):
Well, it's a very adult way to think about it.
I Mean, one of my favorite phrases is I'm not crazy,
I'm just not you.
Speaker 3 (25:30):
I love it.
Speaker 2 (25:31):
That's always stuck with me is two people can approach
a problem completely differently, come to completely different conclusions, and
it doesn't make either of them insane. What's next for Apogee,
I guess I should look at the big picture.
Speaker 1 (25:41):
Guy.
Speaker 3 (25:42):
I think that big picture, we are going to sign up a handful more hospitals. We're going to be in three markets in 18 months, and we're going to go deep. We'll be in 10 to 20 hospitals in those three markets and we'll start to get a lot of attention. And when we do that, we will be set up with AI, the scalable workforce, the care pathways and models that allow us to deploy this even without us directly caring for the patients and other hospitals. So what's next for Apogee? It's picking those three markets, making sure that all the right components are lined up in those three markets, going deep into those spaces and nailing down our workflows and making sure we're optimizing the integration of technology so that when those three markets get attention and they want us in 20 markets, we can deliver on that scale.
Speaker 1 (26:26):
Beautifully said, no notes.
Speaker 2 (26:29):
My last question is something we ask every guest we
have on the show, so I'd like an answer from
each of you. You've both been through the joy and
pain of starting a business and running a business, So
what is the one piece of advice you have for
aspiring our current small business owners?
Speaker 3 (26:44):
Daniel usually likes when I go first because it gives him a second to get his thoughts in order. Having my thoughts in order has never been an impediment to me speaking. So my advice would be make sure that what you are creating is addressing an oh shit moment for stakeholders for the public. At the end of the day, what we are about is that moment when you realize you've got to go back to the ER either for yourself or for a loved one, and you're not sure that you're really going to get the care you need. You got to be solving something real. And so if you're going to create a small business, at least in healthcare, it better be engineered towards real pain points that your customers are already experiencing and that you can meaningfully address not what you think they should be doing because there's a cooler way to do it. And I think a lot of what we're missing, the market and integration of technology and healthcare right now is a lot of really smart people creating a lot of really cool things that aren't addressing the actual pain points that are being experienced by the care delivery system right now. So start by listening, start by understanding where you provide value and then infuse the technology and the workflows that allow you to address that.
Speaker 2 (27:49):
Okay, top that, Daniel.
Speaker 1 (27:51):
My answer I think is going to be very complimentary, which is I think that if you're going to take a leap like this, you have to be obsessed with the problem you're trying to solve. As physicians, we love solving problems, whether it's solving the problem of an individual patient in front of you or trying to solve problems for a broader health system that's struggling with their inpatient capacity. If you are obsessed with the problem that you are trying to solve and you are understanding that problem in 13 different dimensions and catering to that problem in everything that you do every day, then you're going to build something that has value.
Speaker 2 (28:30):
Kevin and Daniel, thank you very much, Thank you, Thank you.
All Right, Kathleen, we're sort of at the end here,
and I hear all this about going deep versus wide,
but I think these guys probably convinced a lot of
people to bet on them.
Speaker 4 (28:47):
Yeah, it seems like it. Also, you've got this co
founder element, which is really nice in the line share
of businesses that are backed at a venture level or
co founders. So that was great to see their dynamic
between the two of them.
Speaker 2 (29:00):
I can't tell you how many either clients or prospective clients, meaning people I talk to who ask my advice for starting a business, my number one piece of advice for many of them is find a co-founder. I think it is too hard, too consuming, too diverse, too everything to do by yourself in most of these cases. I think having a co-founder is critical. I don't care if you're venture-backed or not, and it's a few things and these guys really embody them. I think it's, one, having someone to share the load both cognitively and physically. I think it's having someone to challenge you, and I'm super impressed with how they manage that dynamic and they clearly come at problems differently and they're open to each other's viewpoints and they respect that challenge and internalize it and think it through and pay it the time it deserves. I think that's really important. And then I think specialization quickly becomes important because you have to start to go deep on things and you just run out of capacity. So I'm a huge fan of the co-founder model. It takes a ton of work upfront to find the right one, but on a personal level, I would often bet on the right two co-founders with a good idea versus one co-founder with a great idea.
Speaker 4 (30:08):
and one of the main questions is like, well, how
do I find my co founder? You know, it's like
you got to go on a bunch of dates.
Speaker 2 (30:14):
Yeah, the same way you find a spouse or a
right friend or a girlfriend or whatever you have.
Speaker 4 (30:17):
We need an app for that.
Speaker 2 (30:18):
Well, there are are they? I think there are yes,
But I would say for people who are looking for
a co founder, the most important thing is to make
a list of what you want and don't want in
a co founder and be absolutely strict about it, be
honest about if it's truly things you have to have
or can't live with, and then don't compromise on it
because you know the things that drive you crazy and
(30:40):
those aren't your fault, they're just who you are. We
all have them, So don't partner with someone who has
the trait that drives you crazy all the time. Yeah,
that's good advice.
Speaker 4 (30:48):
And I think also making sure you're not just getting
your doppelganger, because you're just you're drawn to people who
are like you. Right, But today we saw just a
great example of someone who's a total yin to his yang.
You know, their counterpoints to each other. They have really
complimentary skill sets. You made me chuckle as you were
talking about that, because I've heard recently that they're a
(31:10):
therapist and coaches now who specifically help co founders deal
with communication issues and breakdowns in the business. And it's
a growing business for good reason.
Speaker 2 (31:21):
I also know some people now who signed prenups. So
what happens if one of us decides we want.
Speaker 4 (31:25):
To leave the business walks out the door.
Speaker 2 (31:27):
It's better to agree that upfront, Yeah, especially because sometimes
the amount of money put in is an equal, or
maybe it is, or the time hasn't been. It's better
to agree upfront. If one of us goes, here's how
we'll deal with it.
Speaker 4 (31:37):
Yeah, it's interesting. I was just talking to a small
business three co founders. One decided to leave for a
full time job because they were having a bit of
a lull in the business. Now they're trying to ferret
out what happens. So there's debt in the business, but
they're also assets, right, and so it's so much better
to do it upfront, to have those tough conversations.
Speaker 2 (31:57):
Kathleen, this is a really interesting one. Thank you for joining,
thank you for coming in, and thank you as always
for your insight. It's always fascinating.
Speaker 4 (32:03):
Yeah, I enjoyed the conversation and it's fun to be
together in person.
Speaker 2 (32:06):
Yes, it's always better. If you're like me and are interested in how technology is transforming healthcare, check out the newest episode of JPMorgan's Making Sense. Their latest episode explores how artificial intelligence is revolutionizing clinical workflows, improving patient care, and reshaping the business of healthcare. Give it a listen in the show's feed or visit the link in this episode's description. Thanks so much for listening to this episode of The Unshakeables. If you liked this episode, please rate and review it. On our next episode, we'll have two guests for you. One is from Fernandina Beach, Florida and the other is from Charlotte, North Carolina. And it'll be great because they'll be live on stage with me for a special episode. I'm Ben Walter, and this is The Unshakeables from Chase for Business and Ruby Studio from iHeartMedia. We'll see you back here soon.
Hosts And Creators
Ben Walter
Kathleen Griffith
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