Startup Machine

Elliott and Sarah are joined by the World Famous Dr. John Noseworthy and John Beadle of Aegis Ventures for some brain-busting banter on how their virtual Startup Machine unites health systems and health tech developers to identify shared problems and co-create digital solutions that not only address core biz challenges, but also help hospitals achieve financial sustainability through revenue model diversification. Wow! That sounds like an online dating profile that would mos def garner a double-click from the ghost of Steve Jobs and Adam Smith.

The Hard Thing About Hard Things: Building a Business When There Are No Easy Answers: Horowitz, Ben: 9780062273208: Amazon.com: Books

Original music by: Evan O’Donovan

Episode Transcript

(00:00):
Welcome to Tech It to the Limit, the humorous and surprisingly informative podcast that

(00:22):
makes digital innovation and healthcare as entertaining as it is relevant.
I'm Sarah Harper.
And I'm Elliot Wilson.
And we're here to pull back the curtain on the world of digital transformation in healthcare.
Don't worry, you don't need a medical degree to join in on the fun.
Just a sense of humor and a penchant for all things health tech.
So buckle up, folks.
It's time to Tech It to the Limit.

(00:53):
What's up, Elliot?
What's up, Sarah?
Welcome everyone to episode eight of Tech It to the Limit.
I think it might be episode seven, but who gives a crap?
Why can I never get this right?
I never know.
Because you can't count.
I can't.
But you can count on us to bring you amazing content every single month here at Tech It

(01:14):
to the Limit.
We're so grateful to have you.
How you been, Sarah?
You all set for spooky season?
I am so set.
I have been planning my costume for months, acquiring small bits here and there.
I am pumped.
So this year I'm going as an AI bot that's going to replace all doctors.
No, just kidding.
Just kidding.

(01:35):
That is terrifying, right?
So fun fact, my son came up with this costume.
He's super into superheroes.
He's super into superheroes.
That's fun to say.
I was born on 4th of July and we had some black cats and he didn't know that they were
called black cats.
On the driveway he's like, mommy, mommy, I want to do Boom Kitty.
Boom Kitty.
That was what he called the firework or something.

(01:58):
That is an amazing superhero name.
And he's like, you should be Boom Kitty for Halloween.
I was like, heck yeah.
So acquiring little elements of Boom Kitty's costume.
She's basically like a tall cat woman with a pink mohawk who is not having a midlife
crisis.
She has really cool hair and is very into method acting.

(02:20):
So really interesting.
Yeah.
She's going to have some bubbles and some confetti cannons and it's just going to be
amazeballs.
That's incredible.
That's incredible.
I have to see some pictures of Boom Kitty.
Does Boom Kitty have any superpowers or is she more of a Batman-esque crime fighter?

(02:41):
She fights on kindness, right?
She sends lateral kindness wherever she goes.
Free hugs, bubbles, confetti, candy, all the nice things, right?
Yes, absolutely.
That's amazing.
I look forward to this time of year too because it's fun watching kids dress up in Halloween
costumes.

(03:02):
My youngest is going as Carmen Sandiego for Halloween, which just be still my millennial
heart.
Where is Carmen Sandiego?
I love Rockapella.
Can't get enough of them.
But anyway.
What about you, Elliot?
What are you going to do this year?
We don't care about your kids.
So last year, I ironically went as a tired, almost 40-year-old.

(03:24):
Anyway, this year, I thought I'd put a new spin on the costume and do it unironically.
Please tell me you're going to wear the same pathetic flannel and not sleep the night before.
You mean the one that I'm wearing right now?
Yes, yes.
That's the intention.
No, that sounded so mean.
I love flannel and it looks great on you.

(03:47):
Why, thank you.
Thank you.
Well, let's not scare the listeners anymore.
Why don't we bring them some good news?
Who do we have on the show today, Sarah?
Oh my gosh.
Total fangirl moment of a lifetime.
We are welcoming two folks named John, Dr. John Nosworthy, former CEO of Mayo Clinic.

(04:09):
I used to attend his leadership lectures in a packed Geffen auditorium when my hair was
brown, not pink, and it didn't make any boomers squirm in their pews.
And now, viewing him on our podcast with you, it's such an honor and a great full circle
moment.
So, I hope to have Dr. John Nosworthy on the podcast.

(04:34):
And why are we having him exactly?
That's his area of expertise now that he's no longer at Mayo Clinic.
What's he doing these days?
Well he is leading as chairman the Aegis Digital Consortium of hospital systems working directly
with Aegis Ventures on finding innovation from the inside out.

(04:56):
But what's really cool about this episode is that we did it with two guests, which is
the first time we brought two guests out.
I should say what's interesting other than the guests themselves.
Also with us today is the co-founder of Aegis Ventures, John Beadle.
Now John, unlike John Nosworthy, is new to us, so we asked ChatTPT to tell us a little

(05:19):
bit about him.
And so what we found, he's not a widely recognized name in pop culture or history, but there
is a historical figure named John Beadle.
He was a 17th century English clergyman and author, and he's known for religious writings
during the Puritan era, particularly his work, The Journal or Diary of a Thankful Christian,

(05:43):
which reflects Puritan spiritual practices and beliefs.
And while John Beadle, our John Beadle, may not be famous in the modern sense, he holds
some historical significance within the context of English religious history.
I have to say that the Puritan era was the best era, especially for women.

(06:04):
Oh yeah, the clothes alone, the fashion.
So we can't just ask ChatTPT one question, right?
Because it's a chat, right?
We have to have a conversation with it.
So as a follow-up to Who the Heck is this John Beadle guy, right?
We asked ChatTPT to help come up with some health tech inventions that might solve for

(06:29):
some of the problems that the 17th century clergyman John Beadle may have faced with
his parishioners.
So I'll share one of them, and then Elliot, you can tell our listeners about the other.
These are pretty hilarious.
So the Piety Pulse prayer beads.
I'll say prayer beads with embedded sensors that monitor your pulse and ensure you're

(06:49):
praying with the right intensity.
If your heart rate drops below a certain level, indicating you're dozing off or not concentrating,
the beads might give you a not-so-gentle shock to refocus your attention on your devotions.
I mean, that feels very of the time, right?
Yes, very on brand for the Puritan.

(07:14):
Or maybe instead the modesty mirror health check, right, which is a mirror that doesn't
just reflect your physical appearance but also gives you feedback on your spiritual
health based on your attire and your demeanor.
So if you're dressed too extravagantly, if you're showing too much ankle maybe, the mirror
might suggest that you change into a more modest clothing to prevent any spiritual corruption

(07:40):
that could lead to maybe physical ailments.
Maybe your humors aren't aligned.
Yeah, some bloodletting is in order.
It's Halloween after all.
Get the leeches.
Speaking of Halloween leeches and bloodletting, let's take a quick break and then we'll come
back for our scary stats down.

(08:04):
Oh, is this a new game?
It's a new game.
I can't wait.
Stick around folks.
We'll be right back.
So welcome back listeners.
I'm going to introduce this spooky scary game called Scary Stat Smackdown.

(08:33):
Thanks Elliot for the homegrown sound effects.
Love it.
You got it.
Anytime.
It's CGI when you have Elliot Wilson.
Alright folks, it's time for something truly terrifying.
And no, I'm not talking about your insurance deductible.
Welcome to our special Halloween edition of Scary Stat Smackdown.
In fact, it's the only edition that we've ever had.

(08:54):
Right?
What?
In this game, Elliot and I are going to be throwing out some spine chilling statistics
from the healthcare world.
Don't have to search far for those.
And challenging one another to guess are these real numbers or have we cooked up something
even scarier than the real world?
To keep you up at night, think of it like trick or treating, but instead of getting

(09:17):
candy, you're getting cold hard truth.
And maybe a few frightening future projections too.
So grab your flashlights kids, get under your blankets and let's see if we can tell the
difference between what's real and what's a healthcare horror story in the making.
Oh.
Alright, so this time though, the prize for the winner is...

(09:42):
What do I win?
What do you win?
You haven't won yet.
It's my turn.
Kind of millennial, it's my turn.
Well, the winner gets to wrap their kid up in bubble wrap after Halloween, after eating
all of their candy and ship them off to the loser's house.
What?
For the rest of November.
We're wrapping up our kids in suffocation hazards?

(10:05):
Are you nuts?
Okay, okay.
Prompt clearly says that the winner gets to wrap their kids Halloween sugar haul.
Oh no, I totally read that wrong.
I totally read that.
I thought, I seriously like, alright, no, it's fine.

(10:32):
I'll wrap my kid up in bubble wrap and I'll put her in a crate and send her off.
They've been naughty.
You deal with them after that much candy.
Oh my God, that is actually more of a punishment than sending the candy itself, sending the
hyper kid.
Let's just leave it in.
It's great.
Let's leave this whole thing in.
I think so.
Absolutely.
No more editing.

(10:52):
This is raw, potty mouth humor.
Alright, so how are we doing this, Sarah?
How are we doing this?
So we're five to five, right?
We're doing five rounds?
Yeah, well, we're going to-
Winner takes all?
Yeah, winner takes all the offspring.
Okay.
Yes, I'll start.
I'm going to read you a stat and I'm going to give you the source, okay?

(11:16):
And you're going to tell me, why don't we say you're going to tell me reality or-
Is it real or fake?
Or is it real or a reality or nightmare, right?
Like because this is-
Reality nightmare, ooh, okay.
I like that.
Alright, so here we go.
Here's the first one.
About 90% of Americans age 65 and older rely on Medicare for health coverage.

(11:42):
Source is the Kaiser Family Foundation.
Reality.
Ooh, dee-nee-dee-dee-ing.
That's a horrible sound effect.
Dee-nee-dee-dee-ding.
I can't do it.
Alright, good job, age.
Alright, it's my turn.
Yes, that's awesome.
Okay, according to the Center for Healthcare Quality and Payment Reform, within the next

(12:02):
10 years, 50% of rural hospitals will be at risk of closing.
Oh, I should know this one given the fact that I serve rural patients through my work.
I'm going to say that that's a nightmare because you hesitated and changed the time
period from something to 10.
Oh my gosh.

(12:24):
Alright, well, you're right.
That is true.
So, that is a nightmare.
However, the real stat is 25% of rural hospitals are at risk of closing.
That was before the pandemic.
Yeah.
So, well, that's the kind of ghost town no one wants to end up in.
Johnny does not want to look under his bed tonight.

(12:45):
Alright.
So, that's a one-to-one, Sarah.
Hit me.
Alright, the US healthcare system wastes over $1 trillion annually due to inefficiencies.
One trillion?
Oh, the source, the source is JAMA.
JAMA.
I say that's reality.
You are so close if you round up.

(13:07):
Whoa, it's a horror story.
What is it, like 800 billion?
Yeah, pretty much between 760 and 935 billion.
Yeah.
Wow.
Wow, right?
But the projection is that by 2025, you will be right.
It'll be up to a trillion.
So, fun times, America.
Wow.
What's a couple hundred billion dollars amongst friends, you know?

(13:30):
Okay, according to the Association of American Medical Colleges, by 2034, there will be a
shortage of up to 200,000 physicians.
By 2034?
That's a rando number.
Well, it was a recent article, I assume, and so they were like doing the whole decade-looking
health thing.

(13:51):
Oh, yeah.
Okay, that's reality.
Wrong.
You were such a loser.
I did, I did.
I should have followed my gut.
It's like Night of the Living Physicians out here, The Walking Dead.
But to me, this is even scarier.
I mean, it's not like the real stat is any less scary.
Right.
It's 124,000 physicians by the year 2034.

(14:14):
So it's pretty bad already.
It's pretty bad.
Yeah, yeah.
It's pretty bad already.
It's like-
All right.
So that is-
We're one to one.
One to one still.
Okay.
After two rounds.
Right.
All right.
Here's the stat.
Healthcare workers spend four hours per day on administrative tasks, according to Health

(14:35):
Affairs.
It depends on what you classify as a healthcare worker.
I know.
This is like, are we really going to do that right now?
All right, fine.
I'm going to go with reality.
It's two hours per day.
What is it?
Two and a half?
It's two hours per day, but by 2030, it's projected to be four.
Right?
So awesome.
We are rolling down the tracks like a runaway train on waste wheels.

(14:59):
Yeah.
Let's get some LLMs up in here, yo.
Hey, we each have one point still.
Yes, ma'am.
Yes, ma'am.
Okay.
According to the US Department of Labor, nearly one in five healthcare workers have left the
field since the pandemic started.
Again, it's like, how do you define healthcare worker?

(15:20):
Right.
Fact.
Yeah.
Fact.
Fact.
True.
True fact.
No, it's not that bad.
It's not that bad.
Oh my God.
It's only one in 10 healthcare workers that have left the field since the pandemic.
All right.
I guess I'm a cynic or a pessimist.
One of the two, right?
Right.
Yeah.

(15:40):
Yeah.
This game is bringing my mood down, man.
All right.
But you know what I think?
But if I'm looking at it, I'm thinking looking at this, I'm like, you know, we seem to both
be believing that fake facts are real, which, you know, in the context of AI is a whole
other thing, but we're really cynical about the healthcare industry, you and I.

(16:02):
I know.
Yeah.
We need to get out and get some sunshine and ride on a few rainbows, I think that would
help.
Heck yeah.
Heck yeah.
All right.
All right.
Tiebreaker, right?
No, this is a short time.
No, this is a round five.
Round five.
Yeah, round five.
So, okay, here we go.
About 5% of healthcare spending in the US goes to public health efforts.

(16:24):
5%.
According to the Commonwealth Fund.
I'm going to say nightmare because I don't think it's that high.
It is true fact.
We spend 5% on healthcare spending.
5% of healthcare spending is on public health efforts.
By 2028, the Commonwealth Fund predicts that only 3% of our healthcare spending will go
to public health efforts.

(16:46):
Because clearly ineffective.
All right.
Hit me with my number five, numero cinco.
Fine.
Fine.
Fine.
Fine.
According to John Hopkins Medicine, medical errors are the second leading cause of death
in the US.
False.
It's the third leading cause of death.
Dang it, dang it, dang it.

(17:07):
Still too high.
No, I should be upset about the fact that humans are killing each other, but I'm just
mad that I'm losing in the game.
But like even accidentally.
Yeah, it's not intentional.
I mean to do it.
Okay.
I'll tell you what.
I say we had a full tie, true tie, and we each send each other the candy from the other.

(17:31):
How about we just dump the candy in the trash and move on?
Yes.
Heck yes.
All right.
So side fact, every Halloween or at the beginning of October, my family has this big jar of
candy and every night at dinner, every night at dinner on the weekends, the kids are allowed
to have dessert and they're allowed to pick one or two pieces of candy out of the candy

(17:54):
bowl.
Right?
And so that's how we'd be like, no, you can't eat all your candy tonight.
It goes in the candy bowl.
Right.
And that candy bowl lasts through to Christmas and then it gets filled up with more candy
from Christmas and then Easter comes around, there's more candy in there and Valentine's
Day candy goes in and blah, blah, blah, blah.
And so we never fill up that.
We never have to buy candy for that bowl, but we have to empty it out come October because

(18:21):
there's still like the Tootsie Rolls at the bottom that nobody wanted from the Halloween
the week year before.
You were literally describing my life.
Right?
Like I have to be downstairs in my pantry with the Tootsie Rolls that's like smashed
into the bottom because it was from last year.
Yes.
Yeah.
Yes.
My kids have really, really healthy teeth because I limit the amount of sugar they're
able to consume.

(18:42):
Right?
Yes.
100%.
100%.
But we're long past, we're so long past having any kind of, anything that even resembles
a Reese's Peanut Butter Cup.
Because I ate all those during my meetings.
Yeah.
A long time ago.
I don't know if Fanna took them.
Okay, I love that we're like the same.
Yeah.
Yeah.
All right.

(19:02):
All right.
Peace out.
So there it is.
We tied, we tied for the first time ever.
I'm going to be magnanimous and allow you to be on the same level as me instead of lording
it over you as I normally do.
How magnanimous of me.
Well listeners, thank you so much.
That was so great to have that time with you and joining us for that Scary Stat Smackdown.

(19:27):
Coming up next, we have our two guests, Dr. John Nosworthy and John Beadle from Aegis
Ventures.
Stay tuned.
Stick around.
We'll be right back.
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(19:51):
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(20:16):
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(20:39):
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(21:00):
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(21:24):
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(21:46):
Welcome back listeners.
We are so excited to introduce our two guests to you today, John Beadle and Dr. John Knowsworthy.
So without further ado, here we go.
In a world where innovation is the new religion, John Beadle emerges as a devotee of smart,
thoughtful digital transformation in medicine.

(22:07):
Co-founding Aegis Ventures, John works with health systems to identify and solve their
most troubling problems, including clinician burnout, inequity, and the unholy trinity
of poor experience, high costs, and bad outcomes.
Leading the Aegis Digital Consortium is just another day in this crusader's journey where
he gathers nine health systems in a quest not for salvation, but for scalable solutions.

(22:30):
His covenant with Northwell Health is proof that John's zeal for healthcare innovation
knows no bounds.
John's strategic acumen, forged at Harvard and refined in the crucible of global affairs,
ensures he's not just making statements, he's making a difference.
Dr. John Knowsworthy is no stranger to the world of healthcare.
As the chairman of the Aegis Digital Consortium, Dr. Knowsworthy, not to be confused with New

(22:54):
Orleans blues legend Dr. John, is orchestrating a symphony of innovation across nine health
systems.
He's got a flair for turning the ordinary into the extraordinary.
His legacy as Mayo Clinic CEO is the healthcare equivalent of a Grammy, where he hit all the
right notes to make it the number one ranked hospital in the world.

(23:14):
Now he's guiding digitally enabled strategic plans, ensuring that each system harmonizes
perfectly, while tackling the big issues of quality, cost, experience, and equity.
Dr. Knowsworthy is here to remind us all that in healthcare, as in jazz, it's all about
how you improvise and capitalize in the face of new opportunities.

(23:35):
Welcome Dr. Knowsworthy.
May I call you Dr. John?
Absolutely, Elia.
Thanks so much for having us.
All right.
Well, we like to keep things light and fun on Tech into the Limit.
So we always kick our interviews off with a starter question.
And this one, I anticipate a feeding frenzy.
So whoever wants to take it, what's your favorite dad joke?

(23:57):
Well, Elia and Zara, it's great to be with you.
I am not a dad.
Dr. Knowsworthy is, but I'll still take this question.
And I think I found a medical one that I think would be interesting.
Why did the doctor laugh at the x-ray?
Because it was humorous.
I love it.
It's even funny.
Perfect.

(24:17):
Perfect.
Oh, that's great.
Okay.
A way to take one for the team there, John Beadle.
So first serious question of the interview, this is going to be a question for John Beadle.
AI-powered solutions that claim to solve for workforce shortages and clinician burnout
are pervasive.
For health systems, it can be daunting, discerning between hopeful wonder kids and the real deal.

(24:43):
What advice would you give to provider organizations that are walking the health tech gauntlet for
the first time?
How do you see initiatives at Aegis Ventures making a real difference where others have
fallen short?
It's a great question, Sarah.
And I know it's something that health system leaders across the country are spending a
lot of time in mental bandwidth thinking about, particularly given just the pace of technological

(25:06):
change and the extent to which solutions have totally transformed what's possible, especially
as it relates to generative AI and recent transformations that we've seen and ways workflows
can be transformed, entire processes that can be automated and solutions which, at least
at the surface, can drive extraordinary impactful change.

(25:28):
However, I think what everyone has been scarred from to some extent is the fact that over
the last decade or so, there's been a lot of solutions in search of a problem that haven't
yielded the right ROI or demonstrated the level of efficacy that was promised upon initially
being sold to the health system.
And so there's definitely a high degree of skepticism whenever you're a digital health

(25:50):
company walking into a room with a set of health system executives.
At the same time, I think there's an extraordinary desire among the health systems that we see
every day to implement these solutions, but they want to do it in a way that's safe, effective,
protects their patients, their clinicians, and all the other key stakeholders across
the system.

(26:11):
And so I think the fact that it's challenging to get some of these solutions in is emblematic
of the fact that health care is incredibly complex and difficult and health system leaders
need to approach these types of things with an extraordinary degree of caution.
At the same time, I think what we're seeing is just an extraordinary proliferation of
solutions that really are driving change.

(26:31):
We're developing a lot of them, and I think we're seeing on the front lines the amount
of impact that they can actually drive when they're thoughtfully implemented and executed.
The biggest advice I would give them is picking solutions and partners that are proven, have
the right ROI, have really seasoned teams with track records at the helm that have done
this before in other contexts.

(26:52):
Hopefully they've worked in health care, just given how different it can be from other industries.
The other element of it is change management is often the most challenging element of actually
rolling out these solutions.
And so ensuring that you have the right resources in place and that it's not only top down,
but bottoms up.
I think something we've found is we're co-developing these solutions with health systems is that

(27:13):
if you don't have the right clinical champions or business unit champions that are willing
to really roll these things out in a robust way and support all the changes that are required
to workflows, to processes, to make sure they're successful, it can be really challenging to
drive enduring change.
And so ensuring that you have both that top down and bottoms up support I think is essential.

(27:36):
And the way we do that, as you noted in my introduction, is we'll partner really shoulder
to shoulder with the health systems in co-developing these solutions and building champions who
have the ability to serve as references for us when we go bring these things to new places.
And that's really essential to our model and it's something that Dr. Nosworthy I know cares
deeply about as well from his time at MEA.

(28:00):
That whole concept of change management being such a critical component is a recurring theme
when we're talking to leaders and healthcare leaders on the podcast.
It's so true and it seems like a lesson we always kind of have to keep learning, doesn't
it?
It really does.
Yeah.
And Dr. Nosworthy has lived this and has some great stories about change management from

(28:24):
MEA.
I'll give this one over to him.
Well change is difficult, we all know that, and health systems are complex, healthcare
is complex.
But the reason, to be honest, a cute little story I guess is what am I doing here and
why did I decide to do this?
Having heard pitches all through my retirement years, no one said what Aegis said.

(28:46):
They said, look, our premise is that innovation is lying dormant within the health systems
and we need to help that emerge and help co-develop and co-create it by bringing our technology
solutions to what the health system needs.
They're the experts, we have to listen to them and it's our job to create solutions
that will be lasting and make a big difference in whatever it is they're trying to change.

(29:08):
And I hadn't heard that from any other company or any other leader in the startup space or
the established business space that are looking to change things.
And yeah, we did that at Mayo Clinic.
We embedded our teams in several hundred clinical practice re-engineering efforts as well as
on the business side.
And there, by having the right people who can listen to what are we doing, what doesn't

(29:30):
work, why doesn't it work, what have we tried, what are the timelines and deliverables and
metrics that we need, what does success look like, describing the problem and understanding
the problem is really half the battle.
So once you've done that, you can say, well, where are we today and where do we want to
be next time?
And that's what he just set up to do.
It was brilliant.
Quite frankly, within 10 minutes talking to the headhunter, I said to my wife, you know,

(29:53):
I may want to do this, having turned down every other thing that had come my way except
for board work and some other consulting.
And it's been a great year.
I'm a senior advisor.
I love the company.
I love the people.
And I think the approach is kind of unique to co-invest and co-develop together.
And hats off to John and his team.
It's amazing.
It's been an amazing team effort.

(30:14):
I mean, I think the combination of Dr. Noseworthy with Dr. Feinberg, who is our executive chairman
at Aegis, has been an extraordinary duo in ensuring that we can represent the health
systems interests as we're building all of these companies.
And it's driven a huge amount of impact as we've been building these things out.
Hats off to you, John Beadle, for snagging the industry's most eligible leadership bachelor.

(30:37):
I mean, it means a lot that Dr. John agreed to come and lead this with you.
So, Dr. John, clearly you were snagged up, as Sarah said, as a bachelor.
And I think that's great that you put a ring on it.
You're now at the helm of Aegis Digital Consortium, bringing together nine health systems to innovate

(30:58):
collectively, nine, as you've called it, dormant innovations, dormant areas of innovation
to kind of pull that out, right?
I imagine that's a lot like being assigned to recess duty on the first day of school.
What's the biggest challenge in getting these huge organizations to collaborate effectively?
Play nice in the sandbox.

(31:20):
Share the toy steamroller.
What strategies have you been finding are the most successful in aligning their goals,
their actions, their projects that they take on?
Well, I spent the first half of my education life majoring in recess.
So I feel as though I understand it.
As I remember, when folks are at recess, they have lots of energy and enthusiasm.

(31:43):
And if you look back and define productivity in a different way,
recess is often very productive.
It is for kids, I think, in a sense, although I haven't thought of this job as being a schoolmaster.
There's an important principle I think I want to just clarify, Elliot.
Every health system is different.
They're incredibly different.
They're large and small.

(32:03):
They're urban.
They're rural.
They're both.
They're academic.
They're community.
They're science-based.
They're business-based or they're practice-based.
They have different payment models.
And we have all of that geographically distributed in different areas.
And we have amazing health system partners, as you know, and as you briefly alluded to.

(32:24):
There's no competition here.
There's no ego.
There's no elbowing.
Some of those things that happen at recess.
They all join willingly, voluntarily, enthusiastically because they respect each other.
And they also know that by themselves with what they're doing, they're not where they want to be.
And a few years ago, no one would admit how tough all this is.

(32:45):
You know, we all kept it very closed.
We had our hand closed.
And now we all realize that health care is really tough.
It's tough to be successful, tough to get the quality that you want.
It's tough to be financially successful.
But here's the difference.
Aegis's job, in my opinion, is to create a trusted partnership with a big health system.

(33:09):
And then do it again with the next health system.
And then do it again with the next health system.
And as that evolves, and that's where we are now, Elliot, understanding what their needs are,
what their expectations are, and most importantly, what are their strategic priorities?
What are they having trouble?
What do they want to fix?
And we ask them that.
We listen carefully.
And then we tell them what we think we've heard.

(33:30):
And then we say, here's what we're already doing.
Is there anything here that you think?
We think portfolio company A, B, C, or D might be helpful.
Or do you have a plan to create a new company?
What new company would you like to spin out from our venture studio and so on?
And then you go to a health system two and three and four, five, six, seven, eight, nine.
And you realize, wait a minute, health system four and health system six

(33:52):
are both going to work on the same thing.
And if they're comfortable, we can share best practices and best practices.
We can share learnings.
We can share successes and failures.
Maybe we'll share resources.
Maybe we'll share where do they want to be on the cap table if they're going to make
an investment and so on and so forth.
So we have to start small, think big, and go fast.
That's a phrase you've heard a minute from lots of people.
But I guess what underlies this is if we are successful, and I believe we will be,

(34:18):
we're working hard to do so, if we're successful, if we're a trusted partner
and the best partner they have, and we do that with each or most of these health systems,
then we'll be successful. They'll want to do more with us and others will want to join.
You know how that goes.
But if we get going too fast and try to think like there's a consortium,
we all have to think the same way or do the same thing, that would feel to me at least

(34:42):
like an obligation rather than an opportunity.
And we're trying to stress there's no team uniform.
There's no team meetings.
There's no language or song or handshake.
We're here to help you.
We're also trying to help them.
And them and them and them and them.
And they all know each other.
They respect each other.
And again, I don't know where this is going to go.

(35:04):
But if it is close to being as successful as I think it is,
this will be lasting and it'll be durable and it may be a model.
And it may be something that allows a significant change in the way
health care is experienced and delivered that goes beyond any single health system.
That's our goal.
But again, understand each one of them because they're all different.

(35:27):
You figure out one, you go to the next one.
Their culture is different.
The way they make decisions, decision rights, resource allocation, metrics, culture,
how they change, all that stuff is different across all these health systems.
And that's okay.
We just have to understand it so that we can co-develop the future with them.
And hopefully they'll invest with us in the things that they're most interested in

(35:49):
as well as being partners.
This is music to my ears, Dr. John, because it sounds like collaborative capitalism to me.
That's evidence-based, right?
We're talking about learning from one another and proliferating those lessons across the ecosystem
rather than keeping them behind boardroom doors.

(36:10):
And it reminds me, if you'll indulge me for a moment, a quote that I've heard you share
on previous podcasts and in previous leadership lectures that I attended when you were
CEO of Mayo Clinic, if you want to go fast, go alone.
If you want to go far, go together.
And that's essentially the ethos of this collaborative, innovative model that you've

(36:32):
started here at Aegis.
So my hat's off to you.
This is so cool.
Thank you, Sarah.
That's a Chinese thing.
I didn't, I wish I had developed it, but I use it a lot and I think it helps.
Boy, you could have walked away with that one.
Talk about it.
He's too humble.
A man with integrity here.
And humility.
That's one of our core values.

(36:55):
That's wonderful.
To double-click on one thing that Dr. Noseworthy mentioned that I think is really essential to
the success of what we're doing.
Ultimately, we want the health systems to work together, and they are.
But I think the bedrock of our partnership is the fact that it's a one-to-one relationship
with Aegis at its core, where we can serve all of their needs individually.
And then given the extent to which we've studied and have worked on their individual strategic

(37:19):
plans, what we often discover among the dozen or so health systems we're working with is
these five are really focused on digital front door.
These six are really focused on back office automation.
And then given that we have this bird's-eye view, what we can do is pull them together
in unique arrangements.
And then they can collaborate and amortize costs to develop solutions that benefit all

(37:41):
of them and that have the ability to be competitive with the types of offerings that only the
scaled national players, the large retail players, payers, pharma, all the other folks
that are far better resourced than they are could produce.
And given that we have the ability to turn these into companies that can attract best-in-class
entrepreneurial talent versus initiatives that are bred within a health system and stay

(38:05):
there forever, they can be far more effective and have far more velocity and a higher success
rate.
So that's really the core of what we're trying to do.
Well, there's a visible marketability plan, right?
I mean, when you're able to do that.
So you're saving on the front end by sharing the buckets of water between everybody, right?
And then you're making it, you're increasing the ROI on the back end by making it marketable

(38:31):
outside of those locations, which would have otherwise kept it hidden to themselves, right?
And that's that collaborative capitalism, which by the way, is my new rock band name
that Sarah was alluding to earlier.
Hey, Elliot, I heard a joke recently that for millennials, hey, do you want to start

(38:52):
a podcast is like the new, hey, do you want to start a band?
That's right.
But that's great.
That's great.
So a funny story on that briefly. So the first name of Aegis before we actually named it
was Startup Machine.
So we used to joke that we were going to build a machine that pops up startups.
And so the first registered name of Aegis Ventures was not Aegis Venture Partners,

(39:15):
but Startup Machine LLC.
And then we finally changed it.
But occasionally I get some documents to sign where it says formerly known as Startup
Machine LLC.
And when I did it, I had no idea it would permanently stay on some of these documents.
But I was once told it sounds like a band of Silicon Valley entrepreneurs.
Yeah. Yeah. No, it totally is.
It's a garage band of Silicon Valley.

(39:37):
Oh, that's great.
Well, John B, just to kind of bring us back to the digital part of the conversation here.
AI enabled diagnostics, workflow automation.
You talked about backend automations there.
Emotion analytics, health system boardrooms are rife with people talking about these buzzwords.

(39:59):
But there are also core to the companies that you are building.
So how do you cut through the hype to ensure that the technologies that you're developing
actually deliver on those gargantuan promises?
And especially when those stakes are so high in health care?
It's a terrific question.
And it's something that folks are talking about very actively, as you know, in boardrooms every

(40:21):
day.
I think our model really emanates from the core belief, as Dr. Knowsworthy
has mentioned, that health systems know their problems really well.
And so I think a lot of the most recent generation of health tech has first started with a technology
and not with a problem.
And so you see a lot of situations where you have a really exciting, really interesting

(40:42):
technology, but it's not being applied to a problem that is meaningful or significant.
And so you often get vitamins instead of painkillers.
And I think we're very focused on things that health systems are telling us are heartburn,
significant problems that are keeping them up at night.
And so we typically start with that problem, deeply understand the end user, will work

(41:05):
backwards from that problem, co-develop a solution with them and get their feedback every single
step of the way.
And we'll actually forward deploy engineering teams, product teams, et cetera, to shadow
and really work in the trenches shoulder to shoulder with the teams of end users that
are going to be deploying these things.
And we really treat the first five or so large enterprise reference customers as co-development

(41:29):
partners and call them that, given that most of these solutions, as we all know, require
a really significant degree of user feedback, just given the fact that every health system
is different, as Dr. Knowsworthy notes.
Everyone's using different instances of EHRs and has lots of other technologies and bespoke
solutions they've built.
And so there's always a degree of customization that needs to happen.

(41:51):
And whenever you customize something, there's new and unintended impacts.
And so given that that's the case, the services component of most of what we're doing ends
up being really critical.
And I think a lot of folks who are building pure play technology solutions when they try
to come into healthcare, they often miss the fact that there really is a degree of customization
that's required at the beginning to make sure that whatever you're using is not applied

(42:15):
in a purely cookie cutter way that doesn't work for that particular system.
But you're taking the time and the initiative to ensure that it's being applied in a way
that fits into their workflow, is properly integrated in all their source systems and
all the other major IT investments they've made.
And so for us, that really comes down to viewing ourselves as that core co-development partner.

(42:37):
And once you get to five or six customers, these things can be applied with, I think,
a much higher degree of flexibility because there's certain permutations that I think
are universally used.
And once you have six or so implementations, there's components of what you've learned
that you can reapply.
But it really does take you quite a while to apply it in a killer way for the first
six times or so.

(42:58):
And so given that that's the case, we really try to be very patient and thoughtful in how
we do this.
And so that's how we've applied.
That's how we've approached this problem.
I know I'm going to channel my inner Sarah Harper here for a second.
And I know how excited she is to hear that you are sending a vanguard of developers to
live side by side and shadow users and real people to experience the challenges that they're

(43:25):
experiencing in real life.
My question on that, because I have some experience with that in my professional life as well,
you're coming in as an outside partner.
And there is and this kind of goes back to our change management conversation from earlier,
but you're coming in as this external entity.
And so you're not even coming in with a Northwell badge or or what have you.

(43:47):
Right. So your folks are coming in as Aegis.
How much of a wall do you find users that you are trying to collaborate with at the
front lines?
I know the folks at mid level and up and so on that are working with you from a business
perspective, they get it.
Not to say that frontline foot workers don't, but there's a I imagine there's a level of

(44:10):
trust that has to be built up.
And do you experience that?
And how do you work through that?
The trust is really everything.
I think you hit on a couple of really terrific points, Elliot, that we've experienced over
the last four years or so as we've been doing this.
As you mentioned, that top that top down support is critical.
But I think something we've found that's most essential in driving the successful project

(44:32):
is a team of really willing end users that are desperate for a solution to something
and want to work with us and devote their time to the to the code development process,
which is intensive and pulls them away from their roles.
And so it's something that we look for as a really critical determinant of whether we
even want to do a project.
There's a great story in Ben Horowitz's book, The Hard Thing about doing hard things,

(44:56):
where he talks about the fact that when people, for example, go, you know, say, say you have
a cloud transformation project, you go to the big data center and say, we're going to
be moving this to the cloud.
And it always takes five years because all those people look at it and say, hmm, what
does this mean for my job?
And so a lot of the things that we're doing are things that are automation solutions.

(45:17):
They're very scary to people, as you can imagine, because everyone always thinks about
how is this going to affect me and my career?
And so to give you an example of an automation solution that could have been perceived as
a threat, we viewed it not as one entirely.
And so we went in.
This was for case management automation at one of our health system partners, where we

(45:37):
were automating a process of discharge for LTACH and SNF that was taking two and a half
or three hours for a single nurse case manager to do.
And we co-developed the solution with that team of case managers.
And the way we framed it initially, and this is something that's true and the truth is
strong, ultimately, it's hard to be convincing if you're not saying something you don't
believe.

(45:58):
But what we came in and said was, congratulations, you're all being promoted.
You're now managers of an army of bots that are going to make your life a lot easier.
And given that nurse case managers are among the most scarce resources in the health system,
and that team was having trouble growing and having trouble staying on top of their work,
they welcomed us.
And they've been our greatest champions as we've gone and sold this to other health

(46:21):
systems.
And we'll talk to case managers at Health System 23456.
They always want to know, can we talk to the case managers who you developed this with?
And they're our greatest source of referrals and testimonials because they love the process.
And I think we built an indispensable solution for them that they now couldn't do their job

(46:43):
for that.
That's amazing.
I have to say, it's pretty powerful marketing right there.
But also, it's co-designed at its finest.
And I frequently talk about how my kids go to a Montessori school.
And their philosophy and education is follow the child.
And in a way, you're kind of bringing that ethos to the design room and saying, what are

(47:07):
the problems you're trying to solve?
Let's lead with those.
I'll take your hand and follow you.
And that's what's going to make sure that I not only bring you along, but we get to our
destination and you essentially have fully adopted the tool by the time we're ready to
implement.
I also just want to say, you made a comment earlier, John Beatle, about trust and follow

(47:34):
all up to Elliot's question, excellent question.
I had the same one.
In my experience, trust is positively correlated with the amount of listening you do.
Right?
And coffee and smiles certainly don't hurt.
But the more you talk, the less trust you're going to build with your end users.
So it sounds like you guys are doing an incredible job at that at Aegis.

(47:56):
Bravo.
We get that from Dr. Noswerthy.
That's the first thing he tells everyone when they join is that we need to listen above
everything.
I mean, Dr. Noswerthy, I'm curious if you have any thoughts on that.
I know it's something that you really earnestly believe.
Oh, you both said it really well.
No, I agree completely.
I remember David Feinberg, Dr. Feinberg said, listen respectfully.

(48:21):
They're the experts.
You're lucky to be in the room.
These are health care professionals.
You're here to help them, but you can't help them if you're talking.
David got to the same place very fast.
That's really nice.
I really appreciate the positive response that you've given us to the way we're approaching.

(48:42):
It means a lot.
You've done a lot of this kind of stuff.
It takes time.
It's not easy.
I think, as you said at Montessori, you'll go much faster holding the kid's hand than
if you're pushing him along.
Yeah.
Elliot probably thinks that I hold stock in Montessori, if that were even possible,

(49:06):
because I love to brag about it.
But she talks about it all the time.
I know.
I'm like, hey, have you heard about Montessori method?
Actually, Dr. John is very familiar with it because his grandchildren are a product of
Montessori education as well.
So the apple doesn't fall too far from the tree.
We're going to wrap it up with a question for both of you.
But I'm going to start by asking Dr. John, looking ahead, how do you envision the role

(49:29):
of health systems in driving innovation?
Do you think that we're going to see health systems taking the lead in developing their
own technologies, or are they primarily going to rely on partnerships with external innovators
like Aegis Ventures?
Well, I think they will always remain at the center of innovation.
They have for essentially the last 150 years.

(49:53):
They know the problems, and they're very clever, and they want to fix things, and they can
see what's working and what isn't working.
But whether they build or buy or partner, I think, or a blend of the three, I imagine
that will continue to be a good paradigm going forward.
And sometimes they'll build, and sometimes they'll buy, and sometimes they'll partner.
We want to partner and build together.

(50:19):
I kind of doubt that many health systems will try to build everything.
The margins are narrow.
It's not their core business, really, being a technology company.
So I think there'll be a lot of partnerships, but it'll be a blend.
I think what I'm hoping that will come from this, from John's insight, that partnering

(50:45):
in the right way with companies as a tech company, the right way with health systems,
will help them get there faster.
If we do it right, I think this may become a dominant model.
And everyone says health systems are slow to move and they don't like change.
Well, they've been sold so many false profits in their life, and this is going to improve
your life.

(51:05):
Well, it doesn't.
But if you co-develop it, in my experience, if you co-develop something and it works,
doctors and nurses will change on a dime, literally, and do a product that's better
for them, better for the patients, better for the community.
So I'm very bullish on this.
I would echo everything Dr. Noseworthy mentioned.

(51:26):
I think one of our foundational beliefs has always been that health systems are extraordinary
sources of innovation.
They always have been.
And I think one of the challenges, though, with developing companies within a health
system versus bespoke solutions just for them is that health systems don't naturally have
entrepreneurs and engineers and data scientists and folks who can go out and scale solutions

(51:50):
that can be viable in the market.
And so I think what we've tried to do, and I think you'll see a lot more of this in the
future, and you'll see a lot more of this going forward, is build complementary skill
sets with those that exist within the health system so that we can leverage this model
of outside-in innovation where there's certain parts of the innovation process that make
sense to have within the core confines of the health system.

(52:13):
And there's other elements of it that taking it outside, you can move a lot faster.
And so I think for us, it's really all about how do you create this interesting mosaic
being within the system when it makes sense to do so, and then also being able to leverage
some of the best elements of startups and entrepreneurial skill sets, which wouldn't
necessarily want to go work in a health system but would love to work with health systems

(52:35):
through the ability to work in a startup.
And so and the other nice element of that as well is health systems, as Dr.
Noswerthy mentioned, facing a lot of challenges right now.
There's an extraordinary amount of margin pressure.
The business of health care has never been more challenged.
And I think all health systems realize that they're asset rich.
They have extraordinary assets that can be leveraged and remain untapped and somewhat

(52:58):
cash for.
And one of the ways to solve that is to partner with entrepreneurial groups who can help them
take those assets and turn them into monetizable businesses that can help them reinvest in the
core business of delivering care, of investing in their workforce, of building new facilities,
of investing in cutting-edge treatments, which are the things they're extraordinarily good at.

(53:19):
And so I think as we look at how we can partner with health systems, the way we think of
ourselves is as a wraparound revenue and margin diversification partner where we can partner with
them to ensure that all the extraordinary assets they have are being best utilized in a way that
can drive new sources of revenue and margin to the system.
And at the same time, we can use those solutions to help solve core business challenges.

(53:42):
So that's really how we aspire to be viewed over time.
And as we've discussed earlier, health care really is all about people caring for other people,
and it's built on trust.
And so trust is our number one asset and being able to do that, given that lots of other groups
that have come in and tried to do this in the past have not treated them in a way that puts

(54:03):
their interests first.
So that's really how we've tried to approach all these partnerships.
Wow, I love the concept that you put out there around outside innovation and thinking about the assets
that the health care organizations bring to the table and think about what are they?
They're the health care specific expertise, right?

(54:25):
You are privileged to be in the room to hear them speak, right?
That clinical knowledge, that clinical experience, that's one giant asset.
And then the other giant asset that I see that's supporting this model is the problems that they're
experiencing.
And when they start to view their problems as an asset that they can then go work with an outside
innovation company to solve for, that can change their whole mindset around.

(54:49):
And I just, this whole, again, I wrote it down, this outside innovation, I love it.
I think Elliot and I are going to have a really difficult time competing for nuggets that we
discuss after the interview in our final segment of the show, because this is a goldmine of
insights and wisdom.
So John and John, thank you so much for joining us.

(55:12):
It's truly an honor to host both of you on the show and to feature just Ventures.
Thank you.
It's been a privilege.
Thanks so much, Sarah and Elliot.
Thanks, Sarah.
Thanks, Elliot.
And we're out.
Alrighty.
That was great.
Thank you so much.

(55:36):
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(56:55):
Welcome back listeners to Tech It to the Limit.
I am famished after listening to that amazing interview with Dr. John
Noseworthy and Jon Beetle.
There is nothing I would love more than to snack on something, something tasty, something.
Some wise nugs?

(57:16):
Some wise nugs.
Yes, I would love some.
I don't know about you, Sarah, but that was such a rich conversation
that I certainly walked away with a number of sort of wisdom nuggets
that I liked.
I just want to hit on to really quickly.
Yeah, hit him.
The first one, Dr. John mentioned something about not turning the consortium into an obligation.

(57:42):
And I thought that was really important to kind of have to keep that perspective.
And he talked about when you've seen one health system, you've seen one health system, right?
Every health system being different, whether your community or academic or your,
you know, maybe the VA or whatever it is, right?
You know, your rural, your urban, et cetera.
And there isn't a way that you can do this successfully where you try to make everybody

(58:06):
do the same thing within this consortium.
Once it becomes this thing that you have to do, this obligation you have to do that everybody's
got to wear the same uniform when they walk into the room to sit around the table and
exact and behave the exact same way, people lose interest in it.
And so my takeaway from that was their ability to have this sort of bird's eye view and personalized

(58:31):
approach to each of these different organizations.
So by being a consortium that is not necessarily competing with each other in any way, but
not all doing the same thing, they have this bird's eye view that can say, okay, this group
over here and this group over here are having the same kind of problem that they want to
focus on, let's bring them together to solve that problem, that issue that they're having.

(58:57):
These two are encountering the same, maybe back office issues, right?
How do we bring those two together?
So the idea being that you focus different groups on the same kinds of problems that
they're trying to solve instead of trying to solve one problem across this broad swath
of different organizations where you'll get nowhere.
So I really like that concept that Dr. John was talking about.

(59:18):
The other one, I think, I can't remember, I honestly can't remember whether Dr. John
said it or John Beadle said it, but it was in reference to working on solutions that
don't really solve the problem that you're trying to solve.
And he described them as vitamins, not painkillers, where these healthcare organizations go and
find a vitamin that they think that's flashy and not FDA approved, and they try and use

(59:46):
it to solve a problem instead of the actual painkiller that's going to at least numb the
pain.
But I wanted to take that a step further and say, you don't really want a painkiller either,
Because that's just solving a symptom, right?
I might solve the pain of something, but I'm not stopping the core reason for that solution.

(01:00:08):
So I just wanted to take that one step further and say, get your damn antibiotic.
Right.
Or your proton beam or some fresh fruits and veggies.
Exactly.
Hey, look, and sometimes it's surgery, right?
And you have to excise the tumor.
Right.
But just taking that one step further, it's not just about vitamins and pain, but I like

(01:00:31):
the way that he referenced that.
Yeah, I know.
You've got to focus on actually solving the problem.
My money is on Beadle.
If my memory is correct, I think our friend, the Puritan minister, stated that, made that
analogy, and yeah, great insights, Elliot.
I love it.
And I think because it's Halloween, we can't say excise the tumor.
We have to say exercise the demon.
But you know.
Exercise the demon.

(01:00:52):
Yes.
Yes.
Especially in light of our clergyman friend from the 16th, 17th century.
All right, my nuggets.
Hit him.
Hit me.
Okay.
Aegis, formerly known as Startup Machine.
Holy amazeballs.
I love their model of collaborative capitalism.
Sort of creating a learning system, a learning partnership between entrepreneurs and healthcare

(01:01:15):
systems that, as Dr. John Nosworthy said, was committed to improving the way healthcare
is delivered that goes beyond any one system.
Boom.
That's their vision, right?
They want to solve these systemic problems that we were talking about earlier, which

(01:01:38):
is the scary fact smackdown together, right?
It's kind of like an apocalyptic moment, almost like a pre-apocalyptic moment, right?
Before the whole system collapses and John and John are like, hey guys, we got to huddle
here, right?
Like we can see the meteors coming and let's fix this together.

(01:01:59):
It's the only way we're going to solve this problem, right?
So I love that.
Another great insight.
I'm sorry.
I have visions of Aerosmith playing while Bruce Willis hits the bomb.
The asteroid blows apart.
This is amazing.
Orange space suits out the nose.
Yes, out the nose worthy.

(01:02:19):
Sorry.
Sorry.
Oh, amazeballs.
Okay.
That's terrible.
I think you would find it funny.
But we keep having this recurring theme in our conversations about
co-development, co-design, change management.
Yeah, blah, blah, blah.
And by change management, I mean change management.

(01:02:40):
But I think an insight that Dr. John added is that when you co-develop something that
works with doctors and nurses, they will change on a dime, right?
So change management becomes easier when you work together on the design and development
because you have that ownership piece, right?
That everyone has skin in the game.

(01:03:01):
And then my last nugget that I wanted to share was John Beadle's insight that healthcare
systems are asset rich and cash poor, right?
We all know that they're cash poor, but they are rich in assets.
And this whole idea that he just wants to partner with them to turn their assets into
revenue and margin diversification strategies.

(01:03:22):
And at the same time, taking the solutions that they're developing to increase their
revenue to solve a core business challenge and reduce costs and cut out waste.
It's that outside innovation that you were talking about.
No, sorry, the inside out innovation that you were talking about earlier.
Fun fact, you said giant asset like three or four times at the end of the interview,

(01:03:45):
and I could not bite my tongue hard enough.
It was so amazing.
So thank you for making that interview memorable for me.
Anytime someone says asset in a meeting going forward, I'm going to think of you.
It's a giant asset.
Yeah, we got some real giant assets out here.
That's great.
Those are fantastic nuggets.

(01:04:07):
I thought the two of them have really hit on something meaningful, right?
The whole bringing in a vanguard on this crusade of resources that healthcare systems
may not have within them to leverage and scale their innovation, right?
Coming in with that expertise and meeting them where they are, just a brilliant way

(01:04:32):
to go about it.
So our hats off to them.
And thank you for joining us.
Well, you have reached the end of our episode, dear listener, and we are so glad that you
once again spent your time with us.
Do us a favor, if you would, please follow us on LinkedIn, leave us a review wherever
you pod.

(01:04:52):
That really helps our algorithms.
And if you liked us, tell a friend.
If you didn't like us, tell an enemy.
But for goodness sake, please tell someone about the podcast.
We'd love to talk there.
You're off too.
Sarah, send us off with a spooky Halloween health tech haiku.
It would be my pleasure.

(01:05:13):
It would be my pleasure.
Ghost in the network.
Data lost in shadows deep.
AI whispers doom.
I've got chills.
All right.
See you all next time.
See you next time.

(01:05:35):
See you next time.
It's like my voice cracked.
Maybe you should go with Bobby Brady for Halloween.

(01:06:09):
Digital transformation in healthcare.
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