April 17, 2025 • 48 mins
“Health care is finally ready to operate at information speed,” says Jonathan Bush, co-founder and CEO of Zus Health. Bush joins Bloomberg Intelligence analyst Jonathan Palmer to explain why he believes health care is poised for a digital transformation. He unpacks how Zus uses AI and FHIR-native tools to pull patient data from fragmented sources, clean it and serve it back to providers in actionable form. From uncovering the “fire in the trash” to helping doctors identify high-risk patients before costs spike, Bush shares what it means to be a modern health-tech platform and why he came out of retirement to build it. They also discuss the early customers driving growth, lessons from Athenahealth and why gross margin, not buzz, is the new benchmark for digital health.
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Episode Transcript
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Speaker 1 (00:17):
Welcome to another episode of Boomberg Intelligence's Vanguards of Healthcare podcast,
where we speak with the leaders at the forefront of
change in the healthcare industry. My name is Jonathan Palmer
and I'm a healthcare analyst at Boomberg Intelligence, the in
house research arm of Boomberg. I'm excited to welcome today's guests,
Jonathan Bush. Many in the healthcare and investor communities know
him from his time as the co founder and CEO
(00:37):
of Athena Health, but today he's joining us to talk
about his latest ventures, Zeus Health, which he co founded
in twenty twenty and serves as the CEO. Welcome to the.
Speaker 2 (00:46):
Podcast, Thanks Jonathan, I'm glad to be here.
Speaker 1 (00:48):
So why don't we dive right in. I've got probably
a million things I could ask you about, But why
don't we start with the mission statement of Zeus and
maybe in a couple sentence, what problem you guys are
trying to solve?
Speaker 2 (00:57):
Yeah, the truth in all the places in one clear voice,
and that's on the idea that our vision is that
healthcare has reached a time where it is ready to
operate at information speed. Okay, where everything is information speed.
In our lives. We watch our groceries move in real
(01:21):
time from you know, whole foods to the house. We
can see everything. Are We wake up and look at
our screen to know what time we were in light
sleep versus deep sleep. We are so plugged in, and
healthcare is still very much an analog. You know, information
must only be exchanged when asses are co located. You know,
(01:46):
it's like it's like the storyteller tradition is still living
very antiquated.
Speaker 1 (01:51):
Yeah, I mean, I think we're moving away from facts machines,
but not entirely of healthcare.
Speaker 2 (01:56):
Clinical transactions today are traveling by facts, and nobody has
a fax machine. I mean the fact servers of the
various EMR systems. You know, when I got fired, uh sorry,
I left Athena for family reasons. After being fired, I was,
you know, complaining to my then girlfriend now wife. You know,
(02:19):
these things they said aren't true. She said, yeah, but
there's a lot of things they didn't say that are
And one of them was two and a half million
factxes moved between Athena customers like one Atha customer to
another every month, so Athena couldn't even talk to itself
clinically financially it was a little better, but so it's
(02:40):
still pretty bad.
Speaker 1 (02:42):
So maybe unpack that. How does zeus solve the problem?
You know, where do you fit into the ecosystem? And
I guess maybe maybe rewind a little bit. So, you know,
you left Athena Health, why did you want to start
another couple?
Speaker 2 (02:57):
Well, I had a wonderful venture capitalist kind of into
my metaphorical you know, drunken bedroom and throw the curtains
open and get out of bed. Shave You're going to work, yes,
And I was like, I like the coach, you know.
So there was that, and I'm very grateful to Julie
you Of and Treason Horowitz for kicking me out of
(03:19):
couch mode. But I think I watched during COVID all
of these digital health companies all shoot out of the gate,
but then kind of plane off due to their inability
to generate gross margins doing something that was clearly clinically superior.
Costs went down during COVID, not up. Health status did
(03:39):
not go down. Well, costs did go down. So I thought, geez,
this may be the signal, the signs of that sign
we're ready, the bat sign that healthcare is ready for
really its first platform company. My fantasy was that it.
Speaker 1 (03:54):
Was going to be the platform company.
Speaker 2 (03:56):
But when we built our medical record, it wasn't federated,
you know. You know, the Jonathan Bush in one practice
was a totally different chart from the Jonathan Bush in
another practice, even though it was the same guy. So
we were still we were doing a cloud based online
version of the same blind men and the elephant problem.
And so I thought, she's all these companies that actually
make money knowing the whole truth about a patient. That
(04:20):
may be the thing that will that will not this
over for the first time. And then of course, you know,
we watched AI come up, which is critical when you're
going through old data to find new insights. The cooking down.
You know, when we were building Athena that was called India.
You know, AI was anonymous Indians, you know, big rooms
(04:43):
of keyboards, you know, doing streamlined work. All of a sudden,
we could have ten thousand you know, offshore worker type
of energy with a tremendous degree of precision going through.
And essentially, when you get medical records out of the
back of an EMR, it's a little bit like taking
out the trash, you know, in those police detective movies
(05:03):
and going through the records. It's really bad stuff in
terms of its format and usability. So the ability to
actually have an AI agent read it all and say, hey,
this is fire. You know, this is medicine, this is
ICD ten. Go look for this in these charts. If
you find it, build a link, add it to our
graph so that a doctor or anyone else could see
(05:26):
the provenance of your decision. Yea, and help us build
a ticker tape like the Facebook wall of just always
on truth. And that just wasn't around before. So you
had a business case, you know, you had a technology
toolkit that wasn't there before, and you had a regulatory
environment where suddenly hospitals were actually we passed the twenty
(05:48):
sixteen Cures Acting in twenty sixteen, but it wasn't under
enforcement until twenty nineteen, twenty twenty, so suddenly you could
get in trouble if you didn't respond to another provider.
And we spiked up in the number of records exchanged.
So yet all these it was just like flight of
the concords. Conditions are perfect.
Speaker 3 (06:08):
So that got me off the couch.
Speaker 2 (06:10):
You know, it was Wednesday, it was time.
Speaker 1 (06:13):
So if I think about that, maybe unpacking that and
not being a technologist myself.
Speaker 2 (06:17):
Yeah, me neither.
Speaker 1 (06:19):
So Zeus is gonna help package the longitude longitudinal journey
from all these Sparre places Zeus. So it's gonna look
at Jonathan Palmer's health record from maybe not nineteen ninety nine.
Speaker 2 (06:30):
But we averaged a half years of his Okay, Yeah,
So Zeus goes through the trash. First of all, here's
my here's my like podcast tagline for like. Zeus is
an always on fire native API first longitudinal record for
every American. That's what it's plugs in to do. In
(06:52):
order to do that, there's three functions. Function one we
call fresh making. Go find Jonathan, where has he been?
Look for breadcrumbs that have Jonathan's signature. Follow the bread crumbs,
get the data. We go through the prescription traffic. Come
here's a prescription that was written for Jonathan last year
by doctor Schwartz. Go to doctor Schwartz's practice. Hit the
(07:14):
database for that date, range get the record that led
to that prescription. Now you've got more data. Go look
in that. Find another clue. Go hit that constantly looking
for evidence, admission discharge transfer pings out of emergency rooms.
Grab that, Go pull the discharge summary, Go pull the
chart other specialists were seen at the hospital, Go to
(07:34):
their record systems. So that's the first piece. The second
thing is in Richmond, read the trash, find the fire
in the trash fhir not burning fire.
Speaker 1 (07:45):
Well, maybe for the way person, can you explain a
little bit about.
Speaker 2 (07:48):
Structured, machine readable consistent medical truth. Everybody formats their data
in a different way. So this is a national shared
format and we graph every to that. Okay, So it
goes from being like text to being more like a
Rosetta stone, like a grappable logical object as opposed to
(08:09):
just a text block. Then the third thing is value making,
Like it doesn't matter if somebody doesn't make some more
money right now this month. You can understand the abstract
value of actually having one version of yourself because you've
been given a clipboard two hundred times in the last
five years asking the same freaking questions. Right, But to
make it be cash, it has to do something. It
has to do your risk adjustment, which is sort of
(08:30):
your actuarial work as a doctor with a risk contract
or check the quality of the patient based on the
ncqa's quality measures, identify patients who are about to become
expensive before they do. There's things you can do that
turn into cash. And that's the third thing Zeus is
doing is constantly adding. Just like when you go into
the wonderful Stripe Developer kit, you know, this week you
(08:53):
can collect a visa card with an Apple. Next week
you can get venmo on a iPad or whatever it is.
We add new little jobs to do with this record
so that it's useful to people.
Speaker 1 (09:06):
So it would have been sort of the key milestones
in that journey, because it sounds like you maybe started
with the connectivity and then now you've been ext It's
almost like I hate to use the land and expand strategy,
but it sounds a little bit like that.
Speaker 2 (09:18):
It's it is. Although I would say Zeus compared to Athena,
Zeus was really a cold start. There was nobody, there
was nothing. There was not one line of code, and
there was not one dollar of revenue, whereas Athena. We
actually took over a women's health clinic and ran it
on its old systems, and then little by little by little,
took off pieces and put on pieces, and after a
couple of years it looks like athena thing, but we
(09:41):
had something to work with this time. It's just cold.
So the bickering because nobody knows there's no data to study,
so it's everybody's it's going to be a build a
bear studio where you can build your own EMR front end.
We had all of these arguments, all of them relatively
data life intuition driven, let's just say, okay, from some
pretty intuitive people. So it was a good argument. But
(10:03):
it wasn't until so's that was years, like not many years,
but two years of really swirling pointlessly.
Speaker 1 (10:11):
And you're doing this all during the pandemic.
Speaker 2 (10:13):
During the pandemic, so you can't go sit over someone's shoulder,
you know, can we zoom surf while you work? Just
sit here and be on zoom with you while you work,
but not talk to you, like it's a weird ask.
And so it wasn't until we got a few customers
to stick with and generate results, and then we could
sort of say, oh, let's iterate, well, that's.
Speaker 1 (10:34):
A good question. There's what was the proof of concept
with some of those first customers.
Speaker 2 (10:40):
Interestingly, one of the first proof of concept sort of
money makers for customers was who do I focus on,
which patient should I call today? And how many times
should I call them before I move on to the
next one. Right, So, in traditional medicine, it doesn't matter
they come to you. In fact, they're supposed to say, oh,
(11:03):
thanks for fitting me in, you know. But in these country,
companies with risk contracts. So there was this incredible company,
Imagine Pediatrics. They take care of the very sickest Medicaid
children in Texas and Florida. I mean these cases are
just rip your heart out cases. And the kids have
nine doctors and parents with literacy or language or financial currency.
Speaker 1 (11:26):
And huge, huge everything.
Speaker 2 (11:30):
Yeah, and they got feeding tubes and wheelchairs and I
mean it's really hard cases. Which ones will move the needle?
What do we do? You could spend forty hours with
every single one of them. Which ones are going to
move the needle today? And what is the best way
to reach whoever is the most influential with that child.
So that was an early job to do, and we
(11:51):
found other companies. Firsthand takes care of acute mental illness patients.
How do we find them? How do we prioritize who
do we need to do our magic with? There's Mike
Bloomberg celebrity sighting. I mean, I guess when you're at Bloomberg's.
Speaker 1 (12:06):
We are in the building. Yeah, and he does in
the company.
Speaker 2 (12:09):
Yes, there's reasons, but yet still and to think I
almost crashed that coffee stand with the anyway. Sorry, we'll
cut back to the anyway. So these companies, their first
problem was who do we focus on and how do
we reach them. One of the things that was interesting
that the data that the state medicaid plan gave you
on how to reach somebody wasn't very good. But the specialists,
(12:31):
you know, had gotten a cell phone number. And when
we get the specialist record and we get the cell
phone number, so there's all kinds of improvements in where
to focus and how to improve your efficiency of focus.
That were the first thing. The next thing was just
get up to speed. Who is this person? I've got
the patient? What are we dealing with here? What has
gone on so far? So guts was our first.
Speaker 1 (12:53):
Real that look back finding all the information about that
patient and all these disparate systems.
Speaker 2 (12:59):
Take every that's happened and cook it down into one
kind of Matrushka doll, all one stack that I can
look at once, and then I can double click and
double click and double click and get all the way
down to Leonid Brezhnev or whatever. But how do I
quickly summarize everything that's going on so I know what
I'm dealing with? And that used to just be a
(13:20):
game with Marco Polo with a stressed out parent or child.
This allowed the caregivers to see the docs, and the
navigators and social worst to see the whole story really concisely,
really quick. These are the care teams, These are the
problem lists, These are the drugs they've been on, These
are the devices they're on. These are the procedures they've had,
(13:41):
you know, like a Facebook wall glance. So those are
the early jobs to do. And then it's like, what
are you going to do next? Well, we're going to
enroll them. Well what's that? Can we can we do
the new member questionnaire for you? We've got the answers
to probably most of the questions. Maybe we prefill it,
and little by little by little we start doing other
jobs besides just get up to speed.
Speaker 1 (14:01):
Okay, so I think I understand that evolution. So where
where's the evolution going next? So what are you excited about?
I guess if we think about the product roadmap in
the next couple of years.
Speaker 2 (14:09):
Well, our early customers right now you have the mavens,
and then you have the pit of despair, and then
you get into the mainstream connectors. You know. The mavens
are all companies where there's no CIO, there's no CMO,
there's a CPO, a chief product officer, and a CTO
and they actually write their own code as a provider.
So that crowd is a small crowd venture back, mostly
(14:34):
super sophisticated time outside of healthcare and modern tech and
now sort of possessed of an exciting mission inside healthcare,
crossing over their tech expertise. That was our early customers.
Speaker 1 (14:47):
So they're your evangelists.
Speaker 2 (14:49):
There are evangelists, but also they're pretty self sufficient as customers.
They're like, just give me the freaking API, leave me alone,
you know, or I'll take that component, you know, and
they're working with it quickly on their own h self
sufficient text acts. The next step for us is to
get over to more traditional providers who have of which
there are many, many, many many more, and frankly are
(15:10):
much less tuned in on what's missing because they're so
used to you know, their old tech environment. They don't
have software.
Speaker 1 (15:17):
What is that old tech environment? Is it just an
antiquated the HR?
Speaker 2 (15:20):
Yeah, whoever got to kiss them first? During the Obama
kissing contest, you know there was you know, obviously Epic
did incredibly well with people attached to the hospital on
my old my old friends at Athena did well in
the independent practice area, and then Epic next Gen and
all Scripts were able to hold on to some. So
(15:41):
there's there's probably ten mrs that make up ninety five
percent of traditional providers, and there's four or five that
are trying to nip away that have focused on newer,
newer age providers as their anchor, but are trying to
cross over, like we are, into the into that traditional
(16:01):
provider space. But really, you know, in the traditional provider space,
if they're already on a system, if you show them
a system that's thirty percent better, there's no way they're switching.
That's just not enough energy to not enough potential energy
to go through the kinetic chaos.
Speaker 1 (16:21):
Of doing that, we slop out.
Speaker 2 (16:22):
So there has to be either white space where there
is no system. So for example, so.
Speaker 1 (16:26):
Who's the ideal customer? Then well, so the ideal.
Speaker 2 (16:29):
Customer, of which there are very few, are these digital players,
and we love them and they're growing.
Speaker 1 (16:34):
So the companies that have been created in the last
five to ten years, yeah.
Speaker 2 (16:37):
Okay, they're exciting to watch. They grow really fast. So
our customer base grows about twenty five eight quarter just
without any new customers.
Speaker 1 (16:47):
Just because of their underlying growth.
Speaker 2 (16:49):
They're just underlying, they're just water skiing behind them. But
as we cross over to folks that are already in
the world and we're in the world long before COVID
and before soft healthcare companies, that software developers on them
that crowd. You need white space that there is no
piece of software resident and you need kind of a
(17:11):
finished product. You need something which they could like see
a demo. And you know, you can't send them the sandbox.
Speaker 1 (17:17):
And let them log into the you know, what's the
tip of the spear? Then what do you send? What
do you try and demo for them?
Speaker 2 (17:23):
So the areas that we've the first thing you can
do with them is find somebody with a good front
end that needs new brains. Okay, So we had a
lot of success with managed care enablement companies. Hey, I'll
get you to win at the aco game. I'll help
you do the best coding you can do on your
(17:43):
Medicare advantage patients. Those companies have manual coders and are
getting faxes and they if they can tap into the
zoos feed, their product gets a lot better and their
costs go down. So we can start with the enablement.
Now they're they're doing customer success and training nurses at
the doctor's office, and we're not in it. Eventually, you
(18:04):
could imagine maybe we have some front ends that are
that are there for them, for the more self sufficient
types to use themselves. You know, CVS sells advil, but
they also have a CVS brand ibuprofen for those who
don't give a shit, you know. And then the last thing,
which I'm sort of obviously most excited about, is where
no one lives right now. Nobody lives in rising risk.
(18:26):
Nobody knows who is the next most sick person, And.
Speaker 1 (18:31):
How do you figure that out? How do you do it?
Speaker 2 (18:33):
On the back end, we have a lot of records,
and we have a lot of you know, we've been
watching this ticker tape now for some time, so we
you know, we're not that big. But five million records,
you know, statistically significant. And the other thing is when
you find someone there isn't a system that lays over
all the systems. So we are so instrumented it we
(18:57):
know the name of the person and putting the Pepperonis
on our Domino's pizza and how many minutes it's going
to be till it's at our front door. And we
have no idea where our patients are in a critical
referral or whether they actually discharge from the hospital and
if they did, whether they got their meds chracked.
Speaker 1 (19:16):
You know, or even pick them up, whether they picked.
Speaker 2 (19:19):
Them up, or whether they're splitting pills or all kinds
of things that aren't in any one's system but are
in fact a product of knowing all the systems. That's
a space that Zeus loves. Okay, we want to be
the Domino's Pizza tracker of the hell. It's taken for
granted and so much of our lives. It's not existing
yet in the delivery of medical care, and that's where
(19:40):
we'd like to play.
Speaker 1 (19:42):
So maybe taking a step back, So I think I
understand the business model, how do you monetize it? I'm
putting my analyst hat on.
Speaker 2 (19:50):
So if you're just getting up to speed and you
don't intend to follow this patient, we charge a one
time get up to speed.
Speaker 3 (19:56):
Okay, here's the record.
Speaker 2 (19:59):
If you f if you are in a risk contract
or in a relationship with a patient where you're engaged
in continuous care, you subscribe the patient. We call it
the zapp, the Zeus Aggregated profile, and if you turn
on the subscription, the aggregated profile is looking for new
updates all day long, and every time Ze's fine something,
it enriches, it adds it. And then if there's workflows attached,
(20:21):
it does the workflow. Maybe it alerts the patient, maybe
it alerts the doctor, maybe it goes on a risk list,
maybe it turns red, whatever the whatever the job. Yeah.
Speaker 1 (20:30):
Yeah, So then you know, as I think about this,
who are the competitors in this space? Is anybody else
trying to do this? And we've had a few technology
companies on that they are trying to link different.
Speaker 3 (20:40):
Pipes and use data for population.
Speaker 1 (20:43):
Health in some cases, but it doesn't sound like so
much focused on the clinician.
Speaker 2 (20:48):
We overlap with those companies. They're less focused on the clinician.
But there's lots of pipe companies. This when when the
Cures Act went under enforcement, you could actually get data
by asking a lot of companies said shit, let's start uh.
And there's been lots and lots of you know, what
was the Monty Python movie with everybody who was trying
to we didn't know what was going to be the
Ten Commandments, it's fifteen commitments. It's a chicken, it's a
(21:10):
you know, there's lots of companies sort of throwing spaghetti
at the wall trying to figure out how to do interoperability.
And you know, our theory is we should actually be
a record. It should be a rewrite, always on fire,
native record that sits inside of your workfloat and it
isn't a pipe, it isn't a packet that you get.
It's a record that you live on. But there are
(21:32):
other theories that are cheaper, maybe less complete, et cetera.
But it's it's happening. Like I believe one of the
twenty companies that are playing in this space will become
the first platform company in healthcare modern healthcare. I don't
know it'll be Zeus, but I did unretire reason Yeah, no,
(21:56):
I mean it's interesting from your perspective because I you know,
if I think back to the Athena day, I think
maybe that was the the end game, right, that was
the end game, and I blew it, you know, I didn't.
I didn't get there, and I and I and I
leaned so far into the future that, you know, the
financial types. I think I looked like prey because I was.
Speaker 1 (22:15):
Not focused on profit at all.
Speaker 2 (22:16):
And you know, I was really trying to get this
this national backbone concept to live. But I was working
with peerl code that we started writing in nineteen ninety
seven in a world that was one hundred percent fee
for service and there was no there was no financial
benefit to having a complete record the way there is today.
Speaker 1 (22:34):
Maybe something you mentioned there just reminded me in doing
some prep for this discussion, I've heard you say, you know,
you had one foot in the future and kind of
or maybe two feet in the future, and so maybe
just present maybe contrast that and you know, how you're
managing zeus to how maybe you were focused at at
the oh.
Speaker 2 (22:52):
So many different things. Yeah, I mean, starting a company
in twenty twenty is different than starting a company in
twenty nineteen ninety seven. Many like the Internet is taken
for granted, like it's that it exists in nineteen ninety seven,
Like we had to focus on places where we could
get the Internet.
Speaker 1 (23:09):
I was in college in the nineties. I remember we
had to go to a.
Speaker 2 (23:11):
Special science center to do email. Oh you have the email,
me too, you know. Anyway, the focus on physical plant,
I mean, you know, Mike's built this incredible Bloomberg metaphor,
and he's got similar icons all around the world that
you guys sort of relate to in some cultural way.
Zeus has a master account at we work, you know,
(23:34):
and at a you know, you know, we had same thing,
very specific architectural guidelines for how to create this idea
of super modern information growing out of old, past dead
industrial revolutions. So everything about the company, just when you
fast forward that many years is really different. The idea
(23:56):
that all of the decisions are made, even the deliberation
in writing instead of in a whiteboard room where the
strongest personality may win. And my finger prints are probably
on way too many Athena decisions because I was a
founder and was the CEO, and I get manic and
talk too loud, and you know, don't do enough active listening.
(24:17):
But if it's on Slack, there's an enormous equalization and
democratization of the thinking. And when a new person joins
the product or the company or the project, they have
the history. They can scroll back in five minutes see
the why that.
Speaker 1 (24:34):
Would have been thirteen lunch chifts.
Speaker 2 (24:36):
You know in the Athena is at some beautiful campus
that gave free apples or whatever. So there's a lot
to be said for building and the component architecture, this
services architecture. You can grab unlimited storage and compute from Amazon.
You can grab whole workflows do and write them really
(24:56):
quickly compared to doing it yourself from sc that's the
whole stack. Those are all things that and you can
you don't have to do everything yourself. You can be
a component to someone else. You know Octa, what is
what's the market cap of you know Octa or the
log in company in healthcare. I'm sure you had them
on at one point inter somebody.
Speaker 1 (25:18):
Oh, I know who you're talking about. Now we haven't
had them inste.
Speaker 2 (25:21):
You know, all they do is like the fingerprint in
the car to get into APIC. That's their whole company.
But it's a really big, successful company.
Speaker 1 (25:27):
Yeah.
Speaker 2 (25:27):
So this idea of component such services oriented, modular modular,
not just architecture, but business structure, economy structure, sector structure.
That's really exciting to me because we can do nothing
but be the stem cell. We do these front ends,
you know, the store brand as Advila, as I said, ibuprofen.
(25:51):
But but really all we really need to do is
be the best at finding when care is going to happen,
the best at really analyzing and putting what happened in
that car into one voice that machines and quick busy
people can see and digest equally, and the best at
turning it into components that people can do work with.
(26:12):
We don't have to do anything else. We don't have
to go and install, you don't need to become a
Zeus enterprise customer and have Zeus training classes. I mean,
we can really be very narrow and be very good,
much better at something than a company that had to
cover the entire waterfront like my ball beloved Athena, would
it would ever be.
Speaker 1 (26:31):
That's interesting. So maybe this is rudimentary, but when you
think about the data, I mean, are you using some
of these tools to structure that unstructured data? That is yeah, yeah,
you're just taking that off the shelf from somewhere or
which we're training.
Speaker 2 (26:43):
We grab AI you know, large language models and then
narrow and.
Speaker 3 (26:47):
Train them on a your data set.
Speaker 2 (26:49):
Our side of the privacy wall data set, and so
the model isn't ours, but the training and the interpretation
and obviously the workflow off the back end of that
is ours that that our AI guys are doing. And boy,
it's you know, as we were saying.
Speaker 1 (27:05):
Earlier, it's a different world. It's yes, like that would.
Speaker 2 (27:08):
Have been you know, six trips to India and team
meetings and renting thousands of you know, tens of thousands
of square feet of space and you know, the price
point even at you know, great margins would be ten
twenty x what this is. It's just a really different game.
Speaker 1 (27:24):
So we've talked maybe about the environment you know, into
in the pandemic from a from a business perspective, maybe
just from an investing perspective, term money was free and
loose around the time that you started, Oh my god.
Speaker 2 (27:37):
You with that leaf blow or just blasting money everywhere?
Speaker 1 (27:41):
Whoa oh you know, how have you seen that kind
of that wave ebb and flow over the last couple
of years. And you know you sit on a bunch
of boards. I know you have a bunch of seed investments. Yes,
you know. I'd love to get your perspective on where
we are in the investment cycle. Yeah, you know, from
a venture perspective, from a public company perspective, wherever.
Speaker 2 (27:58):
I mean it might take you in the in the
crossover to other Bloomberg riticals. I mean that anybody had
any doubt about the inflation that was coming today looking
back at twenty twenty is insane to me. I mean,
the prices we were paying for software engineers, you know,
(28:19):
and yeah that's not bread, but like it works its
way through kids, Like this isn't new, right? Why is
these federal nerve banks looking at fucking bread and not
not like take a little peak to the left. Come on,
they're twelve and then make one hundred and seventy two.
No way, you know, no way. I couldn't believe that
anybody was, you know, and the companies were getting narrower
(28:41):
and narrow and narrow more superfluous and still raising huge,
you know money. When there's that much excess supply, like
it's gotta put it to work. The first where it
was like, how did we not know? I was, you know,
yelling raised It sounds like, well I raised an absurd amount.
I mean I raised. It was my seat round and
we raised thirty nine million. I tried to raise thirty.
(29:05):
People were like, Johnny, please remember we were at the
you know, point lookout retreat. I need to you know.
Speaker 3 (29:11):
And of course then in twenty when I looked at
you at hlt H.
Speaker 2 (29:16):
A drink, you know, and I'm like, it's a terrible deal.
Why do you want in at one hundred and fifty million.
I've got six PowerPoint slides and three friends and you've
got me valued at one hundred and fifty million dollars.
Run run away, And no, no, no, you don't understand.
You know, this is when Levongo traded for eighteen billion
and then said, oh you blew it. It was gonna be.
Speaker 3 (29:37):
Work or you know, well, God's happy, Oh God.
Speaker 2 (29:42):
Bless the man. The greatest salesman I ever lived, at
least in healthcare. I don't know about the other salesmen.
Speaker 1 (29:48):
See we're talking about the easy money, and like where
are we ah?
Speaker 2 (29:50):
And then yeah, twenty two comes along and who boy,
you know, everybody's so puckered up, and I don't know,
you know, I'm spending most of my time walking my
battlefield and shooting my wounded and figuring out whether I
can strip off their you know, gun clips and give
them to other of my of my soldiers. The mania,
(30:12):
you know, was extreme enough to create a healthy and necessary,
similarly severe depression.
Speaker 1 (30:21):
It's like a forest fire, almost it out, get the
green shoots in.
Speaker 2 (30:26):
And then you end up with a very different environment.
You know, there's a bunch of dead stuff. But you
have a smaller number of companies that are now in
a place, either through merger or through absence of competition,
to take this proven model, this idea of digital care
or whatever it may be, and grow, not just grow,
but grow the gross margin, the percentage and the nominal
(30:48):
gross margin dollars. And I think that's where we are
right now, as you're suddenly seeing companies with respectable gross
margins and that that whole pile is growing. They're not
growing maybe as fast, but they're not giving it away.
They're growing.
Speaker 1 (31:03):
It's profitable to profitable, yeah.
Speaker 2 (31:07):
Maybe not net profitable growth. But to me, gross margin,
especially in care delivery, is an important concept because you've
got this. You're going to have a provider involved. You know,
that's very expensive, and as long as you're doing your
accounting right, you keep that over on the on the
cost of good sould side. Then you can really see
(31:27):
if it's not just successful from a total cost of
care or other sort of market value driver, but as
a business isn't successful, doesn't have legs as a business,
And then like figuring out how to cover your CAC
and your marketing and all that, I think.
Speaker 3 (31:42):
Is we don't know yet, but not as it'll probably work.
Speaker 2 (31:45):
Yeah, somebody will take over it.
Speaker 1 (31:47):
So as you stay here today, you know we have
the Hinge Healthcare I PO maybe yeah, probably some other
ones in the wings. I mean, do you think we're
going to see a wave of these companies come public?
Speaker 2 (31:58):
I do.
Speaker 1 (31:59):
I think you're an interesting guy to ask, you know,
should they come up with?
Speaker 2 (32:02):
Yeah, I'll say, on being public and on getting married
and other things from which I've been fired, it's absolutely
worth it. It is worth it. If it ends in total
cancelation and flame out, it's still worth it. You are
creating wealth for millions of regular people in four one case.
(32:25):
It is one of the best pieces of the American dream,
of the American experience is that ability to to read
directly and intimately involved in regular people. So accumulating wealth,
I mean, it's I mean, with all due respect to
the two and twenty crowd down here with their university
(32:45):
endowments or whatever like that, maybe mostly from the federal government.
Like it's fun to make money, and it's fun to
have a business, and it's fun to serve customers, but
that the proceeds also go to the wealth of the
average person is just a phenomenal, phenomenal gift. It's a
(33:07):
phenomenal lift on the tough parts of the day. So
I would do it again. I would recommend it. I
think you need to you know, you need to have
your fundamentals in place, and you need some portfolio effect.
You can't have one product. You gotta have a couple
of products. One product can have a bad quarter, another
product steps into the voids. You have a little bit
of you know, a little bit of opportunity to pad
(33:30):
or or at least a little flux capacitors, as Michael J.
Fox would say in your in your results. But at
that point I would say, yeah, it's just terrific, and
the poor public markets has just been screwed. I mean
the SEC makes risk taking illegal. I mean it's it's
(33:51):
you're going to be loved. I think if you get
in there and be brave and actually grow a business
for regular people to profit from.
Speaker 1 (33:59):
No, Well, I said, I'm a capitalist that can agree.
More so, which area is down?
Speaker 2 (34:05):
Burned down?
Speaker 1 (34:05):
Anyway? Right? So what what areas are you really investing
your money? And I mean you're a seat investor, you
sit on a few boards. What gets you excited? What
when you look at the landscape.
Speaker 2 (34:15):
I mean I only know one thing. I mean, first
of all, when you've been canceled, your your investment thesis
becomes anybody who calls because nobody calls. Uh. And so
I find that our first four guys who showed up
like absolutely, and now I can go back and say, oh,
it's a brilliant you know, we're fully carefully in a
mental health and uh uh and enterprise data integration. So
(34:37):
one of the companies I've really enjoyed been on the
board of is Innovasor, which probably will go public you
know in one of these days that you know, just
constantly refactoring the data of these big hospital systems in
order to do population health tasks and other things. Uh
but I I I really think that managing the cost
(35:03):
of care by grabbing a piece, just a piece, focusing
in on it with a digital first or a digital
rich strategy and crushing it is is any cycle a
reliable winner? And you can you can hinge just one
of those soundermind, I was on the board for years.
Speaker 1 (35:23):
Oh we're actually gonna have Mark on soon.
Speaker 2 (35:25):
Oh yeah, so you know, same thing. And there's others
that compete with Mark that are you know, also great
in that space, that are doing well clinically and financially.
And I think those those you know, this company I
told you about, Imagine Pediatrics, you know, taking these slices
and just dive into that slice and crush it. I
think that's brilliant stuff. Firefly is a huge, probably my
(35:48):
biggest investment ever. My wife's the CEO. What do we
gotta do? But and that's not the reason it is
to me, Firefly is exactly is the cleanest example of
what should win. You know, whether and time and circumstance
and you know, will it win, will it be a double,
would it be you know, I don't know, but it
(36:09):
should win. It is exactly what we need, you know.
It's all the things that health plans need to do
differently primarily be connected to care, and all the things
that providers need to do differently primarily stopped doing feed
for service bloat coding, and so that that's a that's
a model. I look for things that look like that
and I get excited about it.
Speaker 1 (36:30):
I have that value piece to it as well. Yeah,
value piece interesting. So I mean, if you think about
the cycle, you know, which maybe Firefly plays into. I mean,
there was a lot of interest the last couple of
years in primary care, a lot of assets traded hands.
Speaker 2 (36:40):
And there'll be more. You think.
Speaker 1 (36:42):
I was gonna ask you where you think that's headed.
Speaker 2 (36:44):
We have an interesting thing because the first movers in
that sector were pre COVID movers. So the idea of
on premise, you know, corporate clinics, and that's that's more
points of contact than just the doctor's office in the hospital.
So I get it, like we're you know, retail clinics, right,
you know, but but your phone is always in contact
(37:05):
with you. So the idea of trying to like build
buildings to compete with the permanent presence of your phone,
especially when eighty percent of our spend is chronic disease
that you know, you can't there's no like device you
can stick into a person to fix their chronic disease.
It's continuous titration and lifestyle management and coaching. So to me,
(37:26):
there was a little bit of a I don't know
if it's a false starter or just a tectonic plate
shift there that the guys who've got all this physical
plant are going, shit, what am I doing with all this?
Speaker 3 (37:36):
And so we should sell it, I mean.
Speaker 2 (37:41):
So you know, merge it, do something so that the
physical plant isn't such a large albatross on the business model.
Because look, there are these companies with hundreds of millions
of dollars in revenue. Customers love them, they're growing like
they're great. And if you had if you take that
physical plant out of their p and L, they look good,
you know, they look they look like real business, like
(38:04):
like better than average, better than a PPM from the nineties,
you know, like really good economics. So there's there's stuff
there to work with. I think we're gonna have an
interesting kind of pe chapter where a lot of these
venture back companies will get just to break even enough,
but we'll need the technology leverage that's happened since COVID,
(38:25):
and they'll take the two and they'll mash them up. Interesting,
and there's a lot of companies that are really good
at that. A lot of my Athena colleagues have gone
to New Mountain capital companies, and you know, they do
very little debt, as I understand it, but they buy
a super high tech leverage company and they buy a
big fat company, and they like the flog rog goose,
they jam the tech down the throat of the big company,
(38:48):
and all of a sudden you've got a big high
leverage company.
Speaker 1 (38:52):
And yeah, we're gonna have one of New Mountains payment
integrity companies come through here.
Speaker 2 (38:56):
Pretty Sam, Yeah, ask them about what were the two
and what you know.
Speaker 3 (38:59):
I think it's four four.
Speaker 1 (39:01):
They slash four together.
Speaker 2 (39:03):
What's the tech leverage and what's the big thing? In general?
I like that idea. And I think with all these
big accumulations of primary care lives whose whose gross margin
isn't quite there yet, But then there's these companies like
Firefly and others that have built very very high leverage
tech first models, I think there's going to be you know,
there's going to be a pony in.
Speaker 1 (39:24):
There somewhere, somebody's going to be the winner.
Speaker 2 (39:28):
Yeah, we don't need you know, in any sense. Yeah,
I know you're saying we don't need ten thousand bloombergs. Okay, right, yes,
maybe an up start nipping at its.
Speaker 1 (39:38):
So we've only got a couple more minutes. And I'd
be remiss if I didn't ask you what your thoughts
were about the current state of play in Washington. Where
do you think you know, I know the uncertainty here
we're recording at the day the terif announcements are supposed
to come out.
Speaker 2 (39:51):
What is your defeat day in Minnesota or Wisconsin when
the judge was right?
Speaker 1 (39:56):
What is your sense of how the changes may be
at I don't know whether it's you know, HHS or CMS.
How are these gonna Do you see a wholesale change?
Are you worried about that? Does it? Is it going
to impact your business thing?
Speaker 2 (40:08):
Because on the one side, I think all of us
precious key sheoters, you know, who look down our nose
at this ridiculous man. You know, have had a have
had an education. Uh, you know that we have to
be a country of borders and that you know, we
some of our social justice super ego may have gotten
in the way of fairness and been unjust, and you know,
(40:29):
we sort of didn't see it. And how awkward that
this this troll you know, under the bridge comes up
and he's right. So I think we we've got to,
you know, keep our Trump Arrangement syndrome at bay and
and make sure we get the goodness that's available from
his his contribution. And then of course we have to
(40:52):
be aware that the governance is very chaotic and and
we need to make sure that we're ready to or
some chaotic swens, you know, So.
Speaker 1 (41:03):
Wait and see.
Speaker 2 (41:04):
Yeah, well, I think I think what what we don't
have to wait and see for is that the Overton window,
you know, the range of things that you can talk
about and do has profoundly shifted, probably more during this
political era than in any one and do to one
political player than at any other time I can think of.
(41:25):
You know, Abe, Lincoln wasn't really about ending slavery until
he got cornered into it. He didn't move the Overton window.
The Overton window moved around him, and he reacted. This
is a guy who literally moved it himself and nobody
wanted him to, and everybody laughed at him and boom.
You know, so I think that happened. It's already happened.
(41:45):
And I think these universities have you know, a bigger
problem than this mass you know, nicks on campus. Uh.
You know when when when regular people say him in
a billion dollars and seventy nine billion har seventy overhead allocation?
Who gets that deal? You know, there's a lot of
(42:06):
a lot of chaos that comes from any major shift,
and so even if the guy was organized, you know,
we should expect chaos, I think. So. I think everybody's
ready for that. I think everybody's got their big boy
pants on and their belts and their suspenders.
Speaker 1 (42:23):
I'm just ready for chaos.
Speaker 2 (42:24):
And then there'll be some chaos, yeah, but there'll be
some evolution too. I'm a big believer in our country
and I'm a big believer in that the best part
about it is that it can be led. And I'm
not referring in this case to President Trump. I'm more
(42:45):
referring to the people who can't stand up to them
by schmucks, you know, or weak people. And the truth
of the matter, is we are all weak. We may
not be permanently weak, but we all have moments of
profound weakness. And so what a lucky thing that we're
part of a program, an experiment that withstands schmuckiness and
(43:05):
weakness so well. And I and I'm completely convinced that
we will withstand this and grow from it and learn
from it and be better for it.
Speaker 1 (43:14):
Well said one more before we kind of wrap it up.
And I'm just thinking, you know, we talked about today's
tariff Day or liberation liberation Day, but within this building
at Boomberg, we're actually having an AI conference upstairs, and
I want to get your take on, you know, how
transformative you think AI is going to be for the
healthcare system. And I guess if you think about the
coming waves, what are you most excited for all of
(43:36):
these inventions?
Speaker 2 (43:38):
You know, of course get overhyped.
Speaker 3 (43:40):
And yeah right, there's a psycho, there's the bubble.
Speaker 2 (43:42):
It's curing cancer, it's reading us. You know, a cell
a plateletten identifying a cancer that the doctor missed. It'll
be like, okay, great.
Speaker 1 (43:49):
I mean this was the genomics product project promised five
years ago.
Speaker 2 (43:53):
Yeah, right, PowerPoint it's staying in power. But if you
go all the way to the other end of the
spectrum into the most mundane, most sort of just exhausting
bloat of a sector, these machine learning models that then
can be more generalized with large language technology that has
(44:13):
a lot of room to run before it's curing cancer
and to add value. And I think the companies that
find lanes to do lots of find piles piles, giant
piles skriscraper sized piles.
Speaker 3 (44:28):
Of draft work all the back office, back.
Speaker 2 (44:31):
Office or front office or but you know, like I
wasn't interested in AI for zeus until I realized it
could read the attachments and graft them to fire. And
I'm like, that is a very humble time. We weren't
going to even do it. We're just gonna be like,
here's what was found in the structured data. And by
the way, you can click and really conveniently see what's
(44:52):
in the notes. Now we can read the notes for
the guy. Wow, that's and that's endless, like endless. The
facts is that come in millions of them by that hour.
All kinds of opportunity to with a large language with
a model of the English language read the English language
and graphic to meaning that that goes on and on
(45:14):
and on and on and on. And I think every sector,
subsector in healthcare has a back room with a thousand
cubicles doing shit work that everybody hates and sucks at
that can be dramatically transformed in like now now, like
next to.
Speaker 1 (45:30):
The click button.
Speaker 2 (45:33):
What did Bill Gates say? It was like, it's if
you look at your one year planned, you can be
really disappointed, but if you stop looking and look back
five years, will be pleasantly surprised. Yeah, I think I
think that's my That's the story of my R and
D leadership. I can't believe how slow they're going until
I look back five years, and I can't believe you
did that.
Speaker 1 (45:52):
That's amazing, you know. No, Well, put so, the way
I like to wrap these conversations up is to ask
the guest about a life lesson from their personal or
profession in life that really drives them, you know, in
the future. Is there one thing, I mean, you've talked
about a number of the lessons you've learned in your career,
but is there one, maybe outside the Athena Elliott scenario,
that that really informs what you see as your mission
(46:14):
day to day.
Speaker 2 (46:16):
Well, I tell you, I do think at midlife I
figured out what I love and I really love it.
It animates me more than protection of safety or life
or anything in my life, and that is I love
setting out on nearly impossible missions that are noble with
(46:38):
people I love. To me, if I'm doing that, nothing
that can happen to me is so bad that I'm
you know, uncertain about it. I think that is that
is a great lens for entrepreneurship. It's a great lefe
(47:00):
it's for community, you know, life, it's a great lens
for family, for marriage. To me, if you're setting out
on something that's good but really hard with people you love,
you're gonna have a great, great day, and that.
Speaker 1 (47:14):
Well set a very noble mission's thanks for sharing.
Speaker 2 (47:17):
I appreciate I appreciate it having me. Well.
Speaker 1 (47:19):
That's Jonathan Bush, co founder and CEO of Zeo's Health.
Thank you so much for joining us on our latest episode,
and please make sure to click the follow button on
your favorite podcast app or site so you never miss
a discussion with the leaders in healthcare innovation. I'm Jonathan Palmer,
and you've been listening to the Vanguards of Healthcare podcast
by Bloomberg Intelligence. Until next time, Take Care, missus uses anases,
Welcome to another episode of Boomberg Intelligence's Vanguards of Healthcare podcast,
where we speak with the leaders at the forefront of
change in the healthcare industry. My name is Jonathan Palmer
and I'm a healthcare analyst at Boomberg Intelligence, the in
house research arm of Boomberg. I'm excited to welcome today's guests,
Jonathan Bush. Many in the healthcare and investor communities know
him from his time as the co founder and CEO
(00:37):
of Athena Health, but today he's joining us to talk
about his latest ventures, Zeus Health, which he co founded
in twenty twenty and serves as the CEO. Welcome to the.
Speaker 2 (00:46):
Podcast, Thanks Jonathan, I'm glad to be here.
Speaker 1 (00:48):
So why don't we dive right in. I've got probably
a million things I could ask you about, But why
don't we start with the mission statement of Zeus and
maybe in a couple sentence, what problem you guys are
trying to solve?
Speaker 2 (00:57):
Yeah, the truth in all the places in one clear voice,
and that's on the idea that our vision is that
healthcare has reached a time where it is ready to
operate at information speed. Okay, where everything is information speed.
In our lives. We watch our groceries move in real
(01:21):
time from you know, whole foods to the house. We
can see everything. Are We wake up and look at
our screen to know what time we were in light
sleep versus deep sleep. We are so plugged in, and
healthcare is still very much an analog. You know, information
must only be exchanged when asses are co located. You know,
(01:46):
it's like it's like the storyteller tradition is still living
very antiquated.
Speaker 1 (01:51):
Yeah, I mean, I think we're moving away from facts machines,
but not entirely of healthcare.
Speaker 2 (01:56):
Clinical transactions today are traveling by facts, and nobody has
a fax machine. I mean the fact servers of the
various EMR systems. You know, when I got fired, uh sorry,
I left Athena for family reasons. After being fired, I was,
you know, complaining to my then girlfriend now wife. You know,
(02:19):
these things they said aren't true. She said, yeah, but
there's a lot of things they didn't say that are
And one of them was two and a half million
factxes moved between Athena customers like one Atha customer to
another every month, so Athena couldn't even talk to itself
clinically financially it was a little better, but so it's
(02:40):
still pretty bad.
Speaker 1 (02:42):
So maybe unpack that. How does zeus solve the problem?
You know, where do you fit into the ecosystem? And
I guess maybe maybe rewind a little bit. So, you know,
you left Athena Health, why did you want to start
another couple?
Speaker 2 (02:57):
Well, I had a wonderful venture capitalist kind of into
my metaphorical you know, drunken bedroom and throw the curtains
open and get out of bed. Shave You're going to work, yes,
And I was like, I like the coach, you know.
So there was that, and I'm very grateful to Julie
you Of and Treason Horowitz for kicking me out of
(03:19):
couch mode. But I think I watched during COVID all
of these digital health companies all shoot out of the gate,
but then kind of plane off due to their inability
to generate gross margins doing something that was clearly clinically superior.
Costs went down during COVID, not up. Health status did
(03:39):
not go down. Well, costs did go down. So I thought, geez,
this may be the signal, the signs of that sign
we're ready, the bat sign that healthcare is ready for
really its first platform company. My fantasy was that it.
Speaker 1 (03:54):
Was going to be the platform company.
Speaker 2 (03:56):
But when we built our medical record, it wasn't federated,
you know. You know, the Jonathan Bush in one practice
was a totally different chart from the Jonathan Bush in
another practice, even though it was the same guy. So
we were still we were doing a cloud based online
version of the same blind men and the elephant problem.
And so I thought, she's all these companies that actually
make money knowing the whole truth about a patient. That
(04:20):
may be the thing that will that will not this
over for the first time. And then of course, you know,
we watched AI come up, which is critical when you're
going through old data to find new insights. The cooking down.
You know, when we were building Athena that was called India.
You know, AI was anonymous Indians, you know, big rooms
(04:43):
of keyboards, you know, doing streamlined work. All of a sudden,
we could have ten thousand you know, offshore worker type
of energy with a tremendous degree of precision going through.
And essentially, when you get medical records out of the
back of an EMR, it's a little bit like taking
out the trash, you know, in those police detective movies
(05:03):
and going through the records. It's really bad stuff in
terms of its format and usability. So the ability to
actually have an AI agent read it all and say, hey,
this is fire. You know, this is medicine, this is
ICD ten. Go look for this in these charts. If
you find it, build a link, add it to our
graph so that a doctor or anyone else could see
(05:26):
the provenance of your decision. Yea, and help us build
a ticker tape like the Facebook wall of just always
on truth. And that just wasn't around before. So you
had a business case, you know, you had a technology
toolkit that wasn't there before, and you had a regulatory
environment where suddenly hospitals were actually we passed the twenty
(05:48):
sixteen Cures Acting in twenty sixteen, but it wasn't under
enforcement until twenty nineteen, twenty twenty, so suddenly you could
get in trouble if you didn't respond to another provider.
And we spiked up in the number of records exchanged.
So yet all these it was just like flight of
the concords. Conditions are perfect.
Speaker 3 (06:08):
So that got me off the couch.
Speaker 2 (06:10):
You know, it was Wednesday, it was time.
Speaker 1 (06:13):
So if I think about that, maybe unpacking that and
not being a technologist myself.
Speaker 2 (06:17):
Yeah, me neither.
Speaker 1 (06:19):
So Zeus is gonna help package the longitude longitudinal journey
from all these Sparre places Zeus. So it's gonna look
at Jonathan Palmer's health record from maybe not nineteen ninety nine.
Speaker 2 (06:30):
But we averaged a half years of his Okay, Yeah,
So Zeus goes through the trash. First of all, here's
my here's my like podcast tagline for like. Zeus is
an always on fire native API first longitudinal record for
every American. That's what it's plugs in to do. In
(06:52):
order to do that, there's three functions. Function one we
call fresh making. Go find Jonathan, where has he been?
Look for breadcrumbs that have Jonathan's signature. Follow the bread crumbs,
get the data. We go through the prescription traffic. Come
here's a prescription that was written for Jonathan last year
by doctor Schwartz. Go to doctor Schwartz's practice. Hit the
(07:14):
database for that date, range get the record that led
to that prescription. Now you've got more data. Go look
in that. Find another clue. Go hit that constantly looking
for evidence, admission discharge transfer pings out of emergency rooms.
Grab that, Go pull the discharge summary, Go pull the
chart other specialists were seen at the hospital, Go to
(07:34):
their record systems. So that's the first piece. The second
thing is in Richmond, read the trash, find the fire
in the trash fhir not burning fire.
Speaker 1 (07:45):
Well, maybe for the way person, can you explain a
little bit about.
Speaker 2 (07:48):
Structured, machine readable consistent medical truth. Everybody formats their data
in a different way. So this is a national shared
format and we graph every to that. Okay, So it
goes from being like text to being more like a
Rosetta stone, like a grappable logical object as opposed to
(08:09):
just a text block. Then the third thing is value making,
Like it doesn't matter if somebody doesn't make some more
money right now this month. You can understand the abstract
value of actually having one version of yourself because you've
been given a clipboard two hundred times in the last
five years asking the same freaking questions. Right, But to
make it be cash, it has to do something. It
has to do your risk adjustment, which is sort of
(08:30):
your actuarial work as a doctor with a risk contract
or check the quality of the patient based on the
ncqa's quality measures, identify patients who are about to become
expensive before they do. There's things you can do that
turn into cash. And that's the third thing Zeus is
doing is constantly adding. Just like when you go into
the wonderful Stripe Developer kit, you know, this week you
(08:53):
can collect a visa card with an Apple. Next week
you can get venmo on a iPad or whatever it is.
We add new little jobs to do with this record
so that it's useful to people.
Speaker 1 (09:06):
So it would have been sort of the key milestones
in that journey, because it sounds like you maybe started
with the connectivity and then now you've been ext It's
almost like I hate to use the land and expand strategy,
but it sounds a little bit like that.
Speaker 2 (09:18):
It's it is. Although I would say Zeus compared to Athena,
Zeus was really a cold start. There was nobody, there
was nothing. There was not one line of code, and
there was not one dollar of revenue, whereas Athena. We
actually took over a women's health clinic and ran it
on its old systems, and then little by little by little,
took off pieces and put on pieces, and after a
couple of years it looks like athena thing, but we
(09:41):
had something to work with this time. It's just cold.
So the bickering because nobody knows there's no data to study,
so it's everybody's it's going to be a build a
bear studio where you can build your own EMR front end.
We had all of these arguments, all of them relatively
data life intuition driven, let's just say, okay, from some
pretty intuitive people. So it was a good argument. But
(10:03):
it wasn't until so's that was years, like not many years,
but two years of really swirling pointlessly.
Speaker 1 (10:11):
And you're doing this all during the pandemic.
Speaker 2 (10:13):
During the pandemic, so you can't go sit over someone's shoulder,
you know, can we zoom surf while you work? Just
sit here and be on zoom with you while you work,
but not talk to you, like it's a weird ask.
And so it wasn't until we got a few customers
to stick with and generate results, and then we could
sort of say, oh, let's iterate, well, that's.
Speaker 1 (10:34):
A good question. There's what was the proof of concept
with some of those first customers.
Speaker 2 (10:40):
Interestingly, one of the first proof of concept sort of
money makers for customers was who do I focus on,
which patient should I call today? And how many times
should I call them before I move on to the
next one. Right, So, in traditional medicine, it doesn't matter
they come to you. In fact, they're supposed to say, oh,
(11:03):
thanks for fitting me in, you know. But in these country,
companies with risk contracts. So there was this incredible company,
Imagine Pediatrics. They take care of the very sickest Medicaid
children in Texas and Florida. I mean these cases are
just rip your heart out cases. And the kids have
nine doctors and parents with literacy or language or financial currency.
Speaker 1 (11:26):
And huge, huge everything.
Speaker 2 (11:30):
Yeah, and they got feeding tubes and wheelchairs and I
mean it's really hard cases. Which ones will move the needle?
What do we do? You could spend forty hours with
every single one of them. Which ones are going to
move the needle today? And what is the best way
to reach whoever is the most influential with that child.
So that was an early job to do, and we
(11:51):
found other companies. Firsthand takes care of acute mental illness patients.
How do we find them? How do we prioritize who
do we need to do our magic with? There's Mike
Bloomberg celebrity sighting. I mean, I guess when you're at Bloomberg's.
Speaker 1 (12:06):
We are in the building. Yeah, and he does in
the company.
Speaker 2 (12:09):
Yes, there's reasons, but yet still and to think I
almost crashed that coffee stand with the anyway. Sorry, we'll
cut back to the anyway. So these companies, their first
problem was who do we focus on and how do
we reach them. One of the things that was interesting
that the data that the state medicaid plan gave you
on how to reach somebody wasn't very good. But the specialists,
(12:31):
you know, had gotten a cell phone number. And when
we get the specialist record and we get the cell
phone number, so there's all kinds of improvements in where
to focus and how to improve your efficiency of focus.
That were the first thing. The next thing was just
get up to speed. Who is this person? I've got
the patient? What are we dealing with here? What has
gone on so far? So guts was our first.
Speaker 1 (12:53):
Real that look back finding all the information about that
patient and all these disparate systems.
Speaker 2 (12:59):
Take every that's happened and cook it down into one
kind of Matrushka doll, all one stack that I can
look at once, and then I can double click and
double click and double click and get all the way
down to Leonid Brezhnev or whatever. But how do I
quickly summarize everything that's going on so I know what
I'm dealing with? And that used to just be a
(13:20):
game with Marco Polo with a stressed out parent or child.
This allowed the caregivers to see the docs, and the
navigators and social worst to see the whole story really concisely,
really quick. These are the care teams, These are the
problem lists, These are the drugs they've been on, These
are the devices they're on. These are the procedures they've had,
(13:41):
you know, like a Facebook wall glance. So those are
the early jobs to do. And then it's like, what
are you going to do next? Well, we're going to
enroll them. Well what's that? Can we can we do
the new member questionnaire for you? We've got the answers
to probably most of the questions. Maybe we prefill it,
and little by little by little we start doing other
jobs besides just get up to speed.
Speaker 1 (14:01):
Okay, so I think I understand that evolution. So where
where's the evolution going next? So what are you excited about?
I guess if we think about the product roadmap in
the next couple of years.
Speaker 2 (14:09):
Well, our early customers right now you have the mavens,
and then you have the pit of despair, and then
you get into the mainstream connectors. You know. The mavens
are all companies where there's no CIO, there's no CMO,
there's a CPO, a chief product officer, and a CTO
and they actually write their own code as a provider.
So that crowd is a small crowd venture back, mostly
(14:34):
super sophisticated time outside of healthcare and modern tech and
now sort of possessed of an exciting mission inside healthcare,
crossing over their tech expertise. That was our early customers.
Speaker 1 (14:47):
So they're your evangelists.
Speaker 2 (14:49):
There are evangelists, but also they're pretty self sufficient as customers.
They're like, just give me the freaking API, leave me alone,
you know, or I'll take that component, you know, and
they're working with it quickly on their own h self
sufficient text acts. The next step for us is to
get over to more traditional providers who have of which
there are many, many, many many more, and frankly are
(15:10):
much less tuned in on what's missing because they're so
used to you know, their old tech environment. They don't
have software.
Speaker 1 (15:17):
What is that old tech environment? Is it just an
antiquated the HR?
Speaker 2 (15:20):
Yeah, whoever got to kiss them first? During the Obama
kissing contest, you know there was you know, obviously Epic
did incredibly well with people attached to the hospital on
my old my old friends at Athena did well in
the independent practice area, and then Epic next Gen and
all Scripts were able to hold on to some. So
(15:41):
there's there's probably ten mrs that make up ninety five
percent of traditional providers, and there's four or five that
are trying to nip away that have focused on newer,
newer age providers as their anchor, but are trying to
cross over, like we are, into the into that traditional
(16:01):
provider space. But really, you know, in the traditional provider space,
if they're already on a system, if you show them
a system that's thirty percent better, there's no way they're switching.
That's just not enough energy to not enough potential energy
to go through the kinetic chaos.
Speaker 1 (16:21):
Of doing that, we slop out.
Speaker 2 (16:22):
So there has to be either white space where there
is no system. So for example, so.
Speaker 1 (16:26):
Who's the ideal customer? Then well, so the ideal.
Speaker 2 (16:29):
Customer, of which there are very few, are these digital players,
and we love them and they're growing.
Speaker 1 (16:34):
So the companies that have been created in the last
five to ten years, yeah.
Speaker 2 (16:37):
Okay, they're exciting to watch. They grow really fast. So
our customer base grows about twenty five eight quarter just
without any new customers.
Speaker 1 (16:47):
Just because of their underlying growth.
Speaker 2 (16:49):
They're just underlying, they're just water skiing behind them. But
as we cross over to folks that are already in
the world and we're in the world long before COVID
and before soft healthcare companies, that software developers on them
that crowd. You need white space that there is no
piece of software resident and you need kind of a
(17:11):
finished product. You need something which they could like see
a demo. And you know, you can't send them the sandbox.
Speaker 1 (17:17):
And let them log into the you know, what's the
tip of the spear? Then what do you send? What
do you try and demo for them?
Speaker 2 (17:23):
So the areas that we've the first thing you can
do with them is find somebody with a good front
end that needs new brains. Okay, So we had a
lot of success with managed care enablement companies. Hey, I'll
get you to win at the aco game. I'll help
you do the best coding you can do on your
(17:43):
Medicare advantage patients. Those companies have manual coders and are
getting faxes and they if they can tap into the
zoos feed, their product gets a lot better and their
costs go down. So we can start with the enablement.
Now they're they're doing customer success and training nurses at
the doctor's office, and we're not in it. Eventually, you
(18:04):
could imagine maybe we have some front ends that are
that are there for them, for the more self sufficient
types to use themselves. You know, CVS sells advil, but
they also have a CVS brand ibuprofen for those who
don't give a shit, you know. And then the last thing,
which I'm sort of obviously most excited about, is where
no one lives right now. Nobody lives in rising risk.
(18:26):
Nobody knows who is the next most sick person, And.
Speaker 1 (18:31):
How do you figure that out? How do you do it?
Speaker 2 (18:33):
On the back end, we have a lot of records,
and we have a lot of you know, we've been
watching this ticker tape now for some time, so we
you know, we're not that big. But five million records,
you know, statistically significant. And the other thing is when
you find someone there isn't a system that lays over
all the systems. So we are so instrumented it we
(18:57):
know the name of the person and putting the Pepperonis
on our Domino's pizza and how many minutes it's going
to be till it's at our front door. And we
have no idea where our patients are in a critical
referral or whether they actually discharge from the hospital and
if they did, whether they got their meds chracked.
Speaker 1 (19:16):
You know, or even pick them up, whether they picked.
Speaker 2 (19:19):
Them up, or whether they're splitting pills or all kinds
of things that aren't in any one's system but are
in fact a product of knowing all the systems. That's
a space that Zeus loves. Okay, we want to be
the Domino's Pizza tracker of the hell. It's taken for
granted and so much of our lives. It's not existing
yet in the delivery of medical care, and that's where
(19:40):
we'd like to play.
Speaker 1 (19:42):
So maybe taking a step back, So I think I
understand the business model, how do you monetize it? I'm
putting my analyst hat on.
Speaker 2 (19:50):
So if you're just getting up to speed and you
don't intend to follow this patient, we charge a one
time get up to speed.
Speaker 3 (19:56):
Okay, here's the record.
Speaker 2 (19:59):
If you f if you are in a risk contract
or in a relationship with a patient where you're engaged
in continuous care, you subscribe the patient. We call it
the zapp, the Zeus Aggregated profile, and if you turn
on the subscription, the aggregated profile is looking for new
updates all day long, and every time Ze's fine something,
it enriches, it adds it. And then if there's workflows attached,
(20:21):
it does the workflow. Maybe it alerts the patient, maybe
it alerts the doctor, maybe it goes on a risk list,
maybe it turns red, whatever the whatever the job. Yeah.
Speaker 1 (20:30):
Yeah, So then you know, as I think about this,
who are the competitors in this space? Is anybody else
trying to do this? And we've had a few technology
companies on that they are trying to link different.
Speaker 3 (20:40):
Pipes and use data for population.
Speaker 1 (20:43):
Health in some cases, but it doesn't sound like so
much focused on the clinician.
Speaker 2 (20:48):
We overlap with those companies. They're less focused on the clinician.
But there's lots of pipe companies. This when when the
Cures Act went under enforcement, you could actually get data
by asking a lot of companies said shit, let's start uh.
And there's been lots and lots of you know, what
was the Monty Python movie with everybody who was trying
to we didn't know what was going to be the
Ten Commandments, it's fifteen commitments. It's a chicken, it's a
(21:10):
you know, there's lots of companies sort of throwing spaghetti
at the wall trying to figure out how to do interoperability.
And you know, our theory is we should actually be
a record. It should be a rewrite, always on fire,
native record that sits inside of your workfloat and it
isn't a pipe, it isn't a packet that you get.
It's a record that you live on. But there are
(21:32):
other theories that are cheaper, maybe less complete, et cetera.
But it's it's happening. Like I believe one of the
twenty companies that are playing in this space will become
the first platform company in healthcare modern healthcare. I don't
know it'll be Zeus, but I did unretire reason Yeah, no,
(21:56):
I mean it's interesting from your perspective because I you know,
if I think back to the Athena day, I think
maybe that was the the end game, right, that was
the end game, and I blew it, you know, I didn't.
I didn't get there, and I and I and I
leaned so far into the future that, you know, the
financial types. I think I looked like prey because I was.
Speaker 1 (22:15):
Not focused on profit at all.
Speaker 2 (22:16):
And you know, I was really trying to get this
this national backbone concept to live. But I was working
with peerl code that we started writing in nineteen ninety
seven in a world that was one hundred percent fee
for service and there was no there was no financial
benefit to having a complete record the way there is today.
Speaker 1 (22:34):
Maybe something you mentioned there just reminded me in doing
some prep for this discussion, I've heard you say, you know,
you had one foot in the future and kind of
or maybe two feet in the future, and so maybe
just present maybe contrast that and you know, how you're
managing zeus to how maybe you were focused at at
the oh.
Speaker 2 (22:52):
So many different things. Yeah, I mean, starting a company
in twenty twenty is different than starting a company in
twenty nineteen ninety seven. Many like the Internet is taken
for granted, like it's that it exists in nineteen ninety seven,
Like we had to focus on places where we could
get the Internet.
Speaker 1 (23:09):
I was in college in the nineties. I remember we
had to go to a.
Speaker 2 (23:11):
Special science center to do email. Oh you have the email,
me too, you know. Anyway, the focus on physical plant,
I mean, you know, Mike's built this incredible Bloomberg metaphor,
and he's got similar icons all around the world that
you guys sort of relate to in some cultural way.
Zeus has a master account at we work, you know,
(23:34):
and at a you know, you know, we had same thing,
very specific architectural guidelines for how to create this idea
of super modern information growing out of old, past dead
industrial revolutions. So everything about the company, just when you
fast forward that many years is really different. The idea
(23:56):
that all of the decisions are made, even the deliberation
in writing instead of in a whiteboard room where the
strongest personality may win. And my finger prints are probably
on way too many Athena decisions because I was a
founder and was the CEO, and I get manic and
talk too loud, and you know, don't do enough active listening.
(24:17):
But if it's on Slack, there's an enormous equalization and
democratization of the thinking. And when a new person joins
the product or the company or the project, they have
the history. They can scroll back in five minutes see
the why that.
Speaker 1 (24:34):
Would have been thirteen lunch chifts.
Speaker 2 (24:36):
You know in the Athena is at some beautiful campus
that gave free apples or whatever. So there's a lot
to be said for building and the component architecture, this
services architecture. You can grab unlimited storage and compute from Amazon.
You can grab whole workflows do and write them really
(24:56):
quickly compared to doing it yourself from sc that's the
whole stack. Those are all things that and you can
you don't have to do everything yourself. You can be
a component to someone else. You know Octa, what is
what's the market cap of you know Octa or the
log in company in healthcare. I'm sure you had them
on at one point inter somebody.
Speaker 1 (25:18):
Oh, I know who you're talking about. Now we haven't
had them inste.
Speaker 2 (25:21):
You know, all they do is like the fingerprint in
the car to get into APIC. That's their whole company.
But it's a really big, successful company.
Speaker 1 (25:27):
Yeah.
Speaker 2 (25:27):
So this idea of component such services oriented, modular modular,
not just architecture, but business structure, economy structure, sector structure.
That's really exciting to me because we can do nothing
but be the stem cell. We do these front ends,
you know, the store brand as Advila, as I said, ibuprofen.
(25:51):
But but really all we really need to do is
be the best at finding when care is going to happen,
the best at really analyzing and putting what happened in
that car into one voice that machines and quick busy
people can see and digest equally, and the best at
turning it into components that people can do work with.
(26:12):
We don't have to do anything else. We don't have
to go and install, you don't need to become a
Zeus enterprise customer and have Zeus training classes. I mean,
we can really be very narrow and be very good,
much better at something than a company that had to
cover the entire waterfront like my ball beloved Athena, would
it would ever be.
Speaker 1 (26:31):
That's interesting. So maybe this is rudimentary, but when you
think about the data, I mean, are you using some
of these tools to structure that unstructured data? That is yeah, yeah,
you're just taking that off the shelf from somewhere or
which we're training.
Speaker 2 (26:43):
We grab AI you know, large language models and then
narrow and.
Speaker 3 (26:47):
Train them on a your data set.
Speaker 2 (26:49):
Our side of the privacy wall data set, and so
the model isn't ours, but the training and the interpretation
and obviously the workflow off the back end of that
is ours that that our AI guys are doing. And boy,
it's you know, as we were saying.
Speaker 1 (27:05):
Earlier, it's a different world. It's yes, like that would.
Speaker 2 (27:08):
Have been you know, six trips to India and team
meetings and renting thousands of you know, tens of thousands
of square feet of space and you know, the price
point even at you know, great margins would be ten
twenty x what this is. It's just a really different game.
Speaker 1 (27:24):
So we've talked maybe about the environment you know, into
in the pandemic from a from a business perspective, maybe
just from an investing perspective, term money was free and
loose around the time that you started, Oh my god.
Speaker 2 (27:37):
You with that leaf blow or just blasting money everywhere?
Speaker 1 (27:41):
Whoa oh you know, how have you seen that kind
of that wave ebb and flow over the last couple
of years. And you know you sit on a bunch
of boards. I know you have a bunch of seed investments. Yes,
you know. I'd love to get your perspective on where
we are in the investment cycle. Yeah, you know, from
a venture perspective, from a public company perspective, wherever.
Speaker 2 (27:58):
I mean it might take you in the in the
crossover to other Bloomberg riticals. I mean that anybody had
any doubt about the inflation that was coming today looking
back at twenty twenty is insane to me. I mean,
the prices we were paying for software engineers, you know,
(28:19):
and yeah that's not bread, but like it works its
way through kids, Like this isn't new, right? Why is
these federal nerve banks looking at fucking bread and not
not like take a little peak to the left. Come on,
they're twelve and then make one hundred and seventy two.
No way, you know, no way. I couldn't believe that
anybody was, you know, and the companies were getting narrower
(28:41):
and narrow and narrow more superfluous and still raising huge,
you know money. When there's that much excess supply, like
it's gotta put it to work. The first where it
was like, how did we not know? I was, you know,
yelling raised It sounds like, well I raised an absurd amount.
I mean I raised. It was my seat round and
we raised thirty nine million. I tried to raise thirty.
(29:05):
People were like, Johnny, please remember we were at the
you know, point lookout retreat. I need to you know.
Speaker 3 (29:11):
And of course then in twenty when I looked at
you at hlt H.
Speaker 2 (29:16):
A drink, you know, and I'm like, it's a terrible deal.
Why do you want in at one hundred and fifty million.
I've got six PowerPoint slides and three friends and you've
got me valued at one hundred and fifty million dollars.
Run run away, And no, no, no, you don't understand.
You know, this is when Levongo traded for eighteen billion
and then said, oh you blew it. It was gonna be.
Speaker 3 (29:37):
Work or you know, well, God's happy, Oh God.
Speaker 2 (29:42):
Bless the man. The greatest salesman I ever lived, at
least in healthcare. I don't know about the other salesmen.
Speaker 1 (29:48):
See we're talking about the easy money, and like where
are we ah?
Speaker 2 (29:50):
And then yeah, twenty two comes along and who boy,
you know, everybody's so puckered up, and I don't know,
you know, I'm spending most of my time walking my
battlefield and shooting my wounded and figuring out whether I
can strip off their you know, gun clips and give
them to other of my of my soldiers. The mania,
(30:12):
you know, was extreme enough to create a healthy and necessary,
similarly severe depression.
Speaker 1 (30:21):
It's like a forest fire, almost it out, get the
green shoots in.
Speaker 2 (30:26):
And then you end up with a very different environment.
You know, there's a bunch of dead stuff. But you
have a smaller number of companies that are now in
a place, either through merger or through absence of competition,
to take this proven model, this idea of digital care
or whatever it may be, and grow, not just grow,
but grow the gross margin, the percentage and the nominal
(30:48):
gross margin dollars. And I think that's where we are
right now, as you're suddenly seeing companies with respectable gross
margins and that that whole pile is growing. They're not
growing maybe as fast, but they're not giving it away.
They're growing.
Speaker 1 (31:03):
It's profitable to profitable, yeah.
Speaker 2 (31:07):
Maybe not net profitable growth. But to me, gross margin,
especially in care delivery, is an important concept because you've
got this. You're going to have a provider involved. You know,
that's very expensive, and as long as you're doing your
accounting right, you keep that over on the on the
cost of good sould side. Then you can really see
(31:27):
if it's not just successful from a total cost of
care or other sort of market value driver, but as
a business isn't successful, doesn't have legs as a business,
And then like figuring out how to cover your CAC
and your marketing and all that, I think.
Speaker 3 (31:42):
Is we don't know yet, but not as it'll probably work.
Speaker 2 (31:45):
Yeah, somebody will take over it.
Speaker 1 (31:47):
So as you stay here today, you know we have
the Hinge Healthcare I PO maybe yeah, probably some other
ones in the wings. I mean, do you think we're
going to see a wave of these companies come public?
Speaker 2 (31:58):
I do.
Speaker 1 (31:59):
I think you're an interesting guy to ask, you know,
should they come up with?
Speaker 2 (32:02):
Yeah, I'll say, on being public and on getting married
and other things from which I've been fired, it's absolutely
worth it. It is worth it. If it ends in total
cancelation and flame out, it's still worth it. You are
creating wealth for millions of regular people in four one case.
(32:25):
It is one of the best pieces of the American dream,
of the American experience is that ability to to read
directly and intimately involved in regular people. So accumulating wealth,
I mean, it's I mean, with all due respect to
the two and twenty crowd down here with their university
(32:45):
endowments or whatever like that, maybe mostly from the federal government.
Like it's fun to make money, and it's fun to
have a business, and it's fun to serve customers, but
that the proceeds also go to the wealth of the
average person is just a phenomenal, phenomenal gift. It's a
(33:07):
phenomenal lift on the tough parts of the day. So
I would do it again. I would recommend it. I
think you need to you know, you need to have
your fundamentals in place, and you need some portfolio effect.
You can't have one product. You gotta have a couple
of products. One product can have a bad quarter, another
product steps into the voids. You have a little bit
of you know, a little bit of opportunity to pad
(33:30):
or or at least a little flux capacitors, as Michael J.
Fox would say in your in your results. But at
that point I would say, yeah, it's just terrific, and
the poor public markets has just been screwed. I mean
the SEC makes risk taking illegal. I mean it's it's
(33:51):
you're going to be loved. I think if you get
in there and be brave and actually grow a business
for regular people to profit from.
Speaker 1 (33:59):
No, Well, I said, I'm a capitalist that can agree.
More so, which area is down?
Speaker 2 (34:05):
Burned down?
Speaker 1 (34:05):
Anyway? Right? So what what areas are you really investing
your money? And I mean you're a seat investor, you
sit on a few boards. What gets you excited? What
when you look at the landscape.
Speaker 2 (34:15):
I mean I only know one thing. I mean, first
of all, when you've been canceled, your your investment thesis
becomes anybody who calls because nobody calls. Uh. And so
I find that our first four guys who showed up
like absolutely, and now I can go back and say, oh,
it's a brilliant you know, we're fully carefully in a
mental health and uh uh and enterprise data integration. So
(34:37):
one of the companies I've really enjoyed been on the
board of is Innovasor, which probably will go public you
know in one of these days that you know, just
constantly refactoring the data of these big hospital systems in
order to do population health tasks and other things. Uh
but I I I really think that managing the cost
(35:03):
of care by grabbing a piece, just a piece, focusing
in on it with a digital first or a digital
rich strategy and crushing it is is any cycle a
reliable winner? And you can you can hinge just one
of those soundermind, I was on the board for years.
Speaker 1 (35:23):
Oh we're actually gonna have Mark on soon.
Speaker 2 (35:25):
Oh yeah, so you know, same thing. And there's others
that compete with Mark that are you know, also great
in that space, that are doing well clinically and financially.
And I think those those you know, this company I
told you about, Imagine Pediatrics, you know, taking these slices
and just dive into that slice and crush it. I
think that's brilliant stuff. Firefly is a huge, probably my
(35:48):
biggest investment ever. My wife's the CEO. What do we
gotta do? But and that's not the reason it is
to me, Firefly is exactly is the cleanest example of
what should win. You know, whether and time and circumstance
and you know, will it win, will it be a double,
would it be you know, I don't know, but it
(36:09):
should win. It is exactly what we need, you know.
It's all the things that health plans need to do
differently primarily be connected to care, and all the things
that providers need to do differently primarily stopped doing feed
for service bloat coding, and so that that's a that's
a model. I look for things that look like that
and I get excited about it.
Speaker 1 (36:30):
I have that value piece to it as well. Yeah,
value piece interesting. So I mean, if you think about
the cycle, you know, which maybe Firefly plays into. I mean,
there was a lot of interest the last couple of
years in primary care, a lot of assets traded hands.
Speaker 2 (36:40):
And there'll be more. You think.
Speaker 1 (36:42):
I was gonna ask you where you think that's headed.
Speaker 2 (36:44):
We have an interesting thing because the first movers in
that sector were pre COVID movers. So the idea of
on premise, you know, corporate clinics, and that's that's more
points of contact than just the doctor's office in the hospital.
So I get it, like we're you know, retail clinics, right,
you know, but but your phone is always in contact
(37:05):
with you. So the idea of trying to like build
buildings to compete with the permanent presence of your phone,
especially when eighty percent of our spend is chronic disease
that you know, you can't there's no like device you
can stick into a person to fix their chronic disease.
It's continuous titration and lifestyle management and coaching. So to me,
(37:26):
there was a little bit of a I don't know
if it's a false starter or just a tectonic plate
shift there that the guys who've got all this physical
plant are going, shit, what am I doing with all this?
Speaker 3 (37:36):
And so we should sell it, I mean.
Speaker 2 (37:41):
So you know, merge it, do something so that the
physical plant isn't such a large albatross on the business model.
Because look, there are these companies with hundreds of millions
of dollars in revenue. Customers love them, they're growing like
they're great. And if you had if you take that
physical plant out of their p and L, they look good,
you know, they look they look like real business, like
(38:04):
like better than average, better than a PPM from the nineties,
you know, like really good economics. So there's there's stuff
there to work with. I think we're gonna have an
interesting kind of pe chapter where a lot of these
venture back companies will get just to break even enough,
but we'll need the technology leverage that's happened since COVID,
(38:25):
and they'll take the two and they'll mash them up. Interesting,
and there's a lot of companies that are really good
at that. A lot of my Athena colleagues have gone
to New Mountain capital companies, and you know, they do
very little debt, as I understand it, but they buy
a super high tech leverage company and they buy a
big fat company, and they like the flog rog goose,
they jam the tech down the throat of the big company,
(38:48):
and all of a sudden you've got a big high
leverage company.
Speaker 1 (38:52):
And yeah, we're gonna have one of New Mountains payment
integrity companies come through here.
Speaker 2 (38:56):
Pretty Sam, Yeah, ask them about what were the two
and what you know.
Speaker 3 (38:59):
I think it's four four.
Speaker 1 (39:01):
They slash four together.
Speaker 2 (39:03):
What's the tech leverage and what's the big thing? In general?
I like that idea. And I think with all these
big accumulations of primary care lives whose whose gross margin
isn't quite there yet, But then there's these companies like
Firefly and others that have built very very high leverage
tech first models, I think there's going to be you know,
there's going to be a pony in.
Speaker 1 (39:24):
There somewhere, somebody's going to be the winner.
Speaker 2 (39:28):
Yeah, we don't need you know, in any sense. Yeah,
I know you're saying we don't need ten thousand bloombergs. Okay, right, yes,
maybe an up start nipping at its.
Speaker 1 (39:38):
So we've only got a couple more minutes. And I'd
be remiss if I didn't ask you what your thoughts
were about the current state of play in Washington. Where
do you think you know, I know the uncertainty here
we're recording at the day the terif announcements are supposed
to come out.
Speaker 2 (39:51):
What is your defeat day in Minnesota or Wisconsin when
the judge was right?
Speaker 1 (39:56):
What is your sense of how the changes may be
at I don't know whether it's you know, HHS or CMS.
How are these gonna Do you see a wholesale change?
Are you worried about that? Does it? Is it going
to impact your business thing?
Speaker 2 (40:08):
Because on the one side, I think all of us
precious key sheoters, you know, who look down our nose
at this ridiculous man. You know, have had a have
had an education. Uh, you know that we have to
be a country of borders and that you know, we
some of our social justice super ego may have gotten
in the way of fairness and been unjust, and you know,
(40:29):
we sort of didn't see it. And how awkward that
this this troll you know, under the bridge comes up
and he's right. So I think we we've got to,
you know, keep our Trump Arrangement syndrome at bay and
and make sure we get the goodness that's available from
his his contribution. And then of course we have to
(40:52):
be aware that the governance is very chaotic and and
we need to make sure that we're ready to or
some chaotic swens, you know, So.
Speaker 1 (41:03):
Wait and see.
Speaker 2 (41:04):
Yeah, well, I think I think what what we don't
have to wait and see for is that the Overton window,
you know, the range of things that you can talk
about and do has profoundly shifted, probably more during this
political era than in any one and do to one
political player than at any other time I can think of.
(41:25):
You know, Abe, Lincoln wasn't really about ending slavery until
he got cornered into it. He didn't move the Overton window.
The Overton window moved around him, and he reacted. This
is a guy who literally moved it himself and nobody
wanted him to, and everybody laughed at him and boom.
You know, so I think that happened. It's already happened.
(41:45):
And I think these universities have you know, a bigger
problem than this mass you know, nicks on campus. Uh.
You know when when when regular people say him in
a billion dollars and seventy nine billion har seventy overhead allocation?
Who gets that deal? You know, there's a lot of
(42:06):
a lot of chaos that comes from any major shift,
and so even if the guy was organized, you know,
we should expect chaos, I think. So. I think everybody's
ready for that. I think everybody's got their big boy
pants on and their belts and their suspenders.
Speaker 1 (42:23):
I'm just ready for chaos.
Speaker 2 (42:24):
And then there'll be some chaos, yeah, but there'll be
some evolution too. I'm a big believer in our country
and I'm a big believer in that the best part
about it is that it can be led. And I'm
not referring in this case to President Trump. I'm more
(42:45):
referring to the people who can't stand up to them
by schmucks, you know, or weak people. And the truth
of the matter, is we are all weak. We may
not be permanently weak, but we all have moments of
profound weakness. And so what a lucky thing that we're
part of a program, an experiment that withstands schmuckiness and
(43:05):
weakness so well. And I and I'm completely convinced that
we will withstand this and grow from it and learn
from it and be better for it.
Speaker 1 (43:14):
Well said one more before we kind of wrap it up.
And I'm just thinking, you know, we talked about today's
tariff Day or liberation liberation Day, but within this building
at Boomberg, we're actually having an AI conference upstairs, and
I want to get your take on, you know, how
transformative you think AI is going to be for the
healthcare system. And I guess if you think about the
coming waves, what are you most excited for all of
(43:36):
these inventions?
Speaker 2 (43:38):
You know, of course get overhyped.
Speaker 3 (43:40):
And yeah right, there's a psycho, there's the bubble.
Speaker 2 (43:42):
It's curing cancer, it's reading us. You know, a cell
a plateletten identifying a cancer that the doctor missed. It'll
be like, okay, great.
Speaker 1 (43:49):
I mean this was the genomics product project promised five
years ago.
Speaker 2 (43:53):
Yeah, right, PowerPoint it's staying in power. But if you
go all the way to the other end of the
spectrum into the most mundane, most sort of just exhausting
bloat of a sector, these machine learning models that then
can be more generalized with large language technology that has
(44:13):
a lot of room to run before it's curing cancer
and to add value. And I think the companies that
find lanes to do lots of find piles piles, giant
piles skriscraper sized piles.
Speaker 3 (44:28):
Of draft work all the back office, back.
Speaker 2 (44:31):
Office or front office or but you know, like I
wasn't interested in AI for zeus until I realized it
could read the attachments and graft them to fire. And
I'm like, that is a very humble time. We weren't
going to even do it. We're just gonna be like,
here's what was found in the structured data. And by
the way, you can click and really conveniently see what's
(44:52):
in the notes. Now we can read the notes for
the guy. Wow, that's and that's endless, like endless. The
facts is that come in millions of them by that hour.
All kinds of opportunity to with a large language with
a model of the English language read the English language
and graphic to meaning that that goes on and on
(45:14):
and on and on and on. And I think every sector,
subsector in healthcare has a back room with a thousand
cubicles doing shit work that everybody hates and sucks at
that can be dramatically transformed in like now now, like
next to.
Speaker 1 (45:30):
The click button.
Speaker 2 (45:33):
What did Bill Gates say? It was like, it's if
you look at your one year planned, you can be
really disappointed, but if you stop looking and look back
five years, will be pleasantly surprised. Yeah, I think I
think that's my That's the story of my R and
D leadership. I can't believe how slow they're going until
I look back five years, and I can't believe you
did that.
Speaker 1 (45:52):
That's amazing, you know. No, Well, put so, the way
I like to wrap these conversations up is to ask
the guest about a life lesson from their personal or
profession in life that really drives them, you know, in
the future. Is there one thing, I mean, you've talked
about a number of the lessons you've learned in your career,
but is there one, maybe outside the Athena Elliott scenario,
that that really informs what you see as your mission
(46:14):
day to day.
Speaker 2 (46:16):
Well, I tell you, I do think at midlife I
figured out what I love and I really love it.
It animates me more than protection of safety or life
or anything in my life, and that is I love
setting out on nearly impossible missions that are noble with
(46:38):
people I love. To me, if I'm doing that, nothing
that can happen to me is so bad that I'm
you know, uncertain about it. I think that is that
is a great lens for entrepreneurship. It's a great lefe
(47:00):
it's for community, you know, life, it's a great lens
for family, for marriage. To me, if you're setting out
on something that's good but really hard with people you love,
you're gonna have a great, great day, and that.
Speaker 1 (47:14):
Well set a very noble mission's thanks for sharing.
Speaker 2 (47:17):
I appreciate I appreciate it having me. Well.
Speaker 1 (47:19):
That's Jonathan Bush, co founder and CEO of Zeo's Health.
Thank you so much for joining us on our latest episode,
and please make sure to click the follow button on
your favorite podcast app or site so you never miss
a discussion with the leaders in healthcare innovation. I'm Jonathan Palmer,
and you've been listening to the Vanguards of Healthcare podcast
by Bloomberg Intelligence. Until next time, Take Care, missus uses anases,
Host
Jonathan Palmer
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