The Rich Roll Podcast - White House Presidential Innovation Fellow on Leveraging Technology to Disrupt Healthcare

Episode Date: October 7, 2013

Now for something a little different. Meet Adam Dole- a White House Presidential Innovation Fellow currently studying the various ways technology can improve our healthcare system. Adam leverages an expertise in human behavior and sociology to help technology improve lives. A rare and specific skill set that landed him a coveted gig at NASA problem solving Mars mission human transport issues and subsequently led to various entrepreneurial stints at Silicon Valley start ups. A developing interest in health and wellness then found Adam spearheading technology innovation for the Mayo Clinic, more specifically a project he conceptualized called Blue Button — a healthcare software application empowering consumer access to healthcare and medical record information. The White House took notice. And before he knew it, Adam found himself in Washington as part of the prestigious Presidential Innovation Fellow program. Under the direction of White House CTO Todd Park, Adam spends his days (at least before the government shutdown!) studying the intersection of technology and our health care system with the purpose of identifying opportunities for cooperative collaboration between healthcare executives, government bureaucrats and technology entrepreneurs to identify and execute systemic, functional healthcare improvements for the benefit of the consumer. Adam is an energetic and fun guy. His enthusiasm and passion for his work is infectious. Work that is and will improve lives – no question. Adam gives me hope and optimism that we can conquer the challenges faced by healthcare. I truly enjoyed our conversation and think you will too. For a really nice feel for where Adam is coming from, check out this piece he co-authored for Fast Company Magazine: “Empathize Like A Doctor, Design Like An Entrepreneur” Now, put your earbuds in and enjoy the episode! Rich

Welcome to episode 55 of the Rich Roll Podcast with White House fellow Adam Dole. The Rich Roll Podcast. Empathize like a doctor, design like an entrepreneur. That's the theme of today's show. What show is this? It's the Rich Roll podcast. I'm Rich Roll. Yes, the theme of today's show.

Also, the title of an article written by today's guest, an article that is up on Fast Company Magazine, who is today's guest. Well, his name is Adam Dole. He's a guy I did not know anything about before he was introduced to me on Twitter. And I'm glad that I took the opportunity to go and meet this guy and sit down with him because he has a powerful message and he's a very interesting guy. Currently, he is in residence at the White House as part of the Presidential Innovation Fellowship Program. And that's a very prestigious program in which the White House recruits

the best and the brightest minds in the private sector, entrepreneurship, academia, and nonprofit, and pairs them with top innovators in government. And they collaborate over, essentially, in Adam's case, a 12-month period, this like tour of duty experience where they develop solutions to save lives, fuel job creation, and save taxpayer money.

And Adam is sort of there with the purpose of taking a look at healthcare, what's broken about it, why is it broken, what can we do to solve these problems and improve the consumer experience, where the consumer can have greater control over not just their medical records, but the trajectory of their treatment and how they manage and exercise domain and personal responsibility over their own healthcare, their health, their fitness, their diet, and all these things. So it was really interesting. Adam's a guy who kind of cut his teeth at NASA. He came out of college with a communications degree and sort of a bent and an interest in sociology and human behavior and how you can sort of take a look

at those things from a scientific point of view and come up with solutions to historical problems. And we talk about NASA, we talk about space travel, we talk about Mars. And we talk about NASA. We talk about space travel. We talk about Mars travel. We talk about all kinds of cool science stuff and then lead into kind of the healthcare discussion. What exactly is wrong with our system? What's broken about it? How can we fix it?

And Adam is very frank. He's also very charismatic and dynamic in his responses. And I think that you'll find this interview really, really interesting. Not just the things that he's doing at the White House, what he's done at the Mayo Clinic, what he's done in Silicon Valley as an entrepreneur. So really what he is, is an entrepreneur who, rather than attempting to disrupt government or healthcare from the outside outside recognizes the need and the importance of collaborating in partnership with the industries and the governmental programs that they are trying to improve. So it's cool. I mean, the idea that you could sit down with somebody who's working in the White House on these big problems that affect all of our lives And he's working on the problem from a very high level is a pretty cool treat.

And he's just as excited. He's like a kid in the candy store, the fact that he has this opportunity. And it was really fun to sit down and talk to him. So I'm dispensing with all this introductory stuff. I've been getting some complaints from you guys about being too long-winded and blah, blah, blah. stuff. I've been getting some complaints from you guys about being too long-winded and blah, blah, blah. So if you want to support the show, just check out the Amazon banner ad at richroll.com. You can click that, get whatever you're going to get on Amazon. It doesn't cost you anything extra and helps us out. Other than that, you want to know anything about me, what we're doing here,

go to richroll.com and you can find out more. and you can find out more. We're brought to you today by recovery.com. I've been in recovery for a long time. It's not hyperbolic to say that I owe everything good in my life to sobriety. And it all began with treatment and experience that I had that quite literally saved my life.

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When you or a loved one need help, go to recovery.com and take the first step towards recovery. To find the best treatment option for you or a loved one, again, go to recovery.com. Without further ado, please enjoy my conversation with White House Innovation Fellow, Adam Dole. All right, Adam, thanks for taking the time, man. Oh, it's a pleasure to have you here. Appreciate it. We only talked for a couple minutes beforehand, but I already feel like we covered ground where I was thinking,

I wish I was recording that. It's crazy. Like, this is the beauty of Twitter because I was coming to DC and a Twitter follower of mine just said, oh, you got to meet my buddy, Adam Dole. He's great. He'd make a great guest for the podcast.

And I get tweets like that from time to time. And I just kind of, I have like a folder where I put that stuff for future reference. And sometimes I look into it, sometimes I don't. But I just, in the moment, I just clicked on your thing. And I was like, oh, this guy's got some cool stuff going on. He's a pretty interesting guy. I think I'm going to make some time to go check this guy out. And I've been running around DC the last couple of days. And

usually I'll take the time to prepare a little bit better. But, uh, basically I just looked into you a little bit and now we're sitting here. So is, uh, slightly unprepared. So you're going to have to, I'm going to have to work a little bit harder, but I want to hear your story, man, cause you're doing some amazing things. Oh, well, I love how Twitter connects people like that. It's incredible, man. I've met so many amazing people. I've never had a bad experience. I've just been able to connect with so many amazing people. And then the podcast just gives me an excuse to come over and sit down and talk to people that I would like to meet, but probably otherwise wouldn't have an excuse to, hey, can I come over to your house and sit down with you for two hours and find out what you're

all about? Well, and this is amazing for me because I saw you were coming to DC. I was like, oh, I'll get a chance to go see Rich Talk. Maybe you get a chance to have him sign the book. And now you're sitting here in the living room. Yeah, cool. Here we are, man. We're going to do the podcast. So we're in DC. You're here for a one year. What is it called exactly? Presidential fellowship at the White House. That's right. I'm a presidential innovation fellow. It's a one year program. We are hired in by the White House and then put on different government projects that could use some entrepreneurial horsepower. Right. So basically interjecting a little of that entrepreneurial disruptive spirit into the bureaucracy of the federal government, right? That's right. Two things that you don't usually put in the same sentence. Those worlds don't always, it's going

to be interesting as we get into this because those worlds are distinct in certain respects and kind of need each other though. Absolutely. It's interesting timing coming on the Tuesday decision for a government shutdown. I think those two things haven't necessarily found the way to help each other yet. So we're at the mercy of what happens with Congress. I know, it's gonna be interesting to see. I mean, just being in DC,

that's all anyone's talking about. So are we going to work next week or are we not? And it's really sad because I think one of the highest honors is to be able to serve your country. And, you know, a bunch of us came here, we put other things on hold and, and then we're, you know, faced with the realities of a lot of, a lot of really talented government folks are going to be sitting on the sidelines. Right. Well, I would imagine that if there is a shutdown, it's not going to go for more than a couple days at most. There's no way.

That's my hope. Politically, that it could be sustainable beyond that. But all right, so let's get into how you got to this place and what you're doing here. So you have a really kind of circuitous path that could not have been predicted on paper. I mean, just looking at your various experiences, the idea that it would have led you to working in the White House right now is not something that I would imagine you would have predicted. It was nowhere on my radar. So essentially, I mean, what would you call yourself? An entrepreneur, a designer, a technologist?

I would say a bit of all those things. The one thing that served me well is probably not being an expert in any one area. I have a lot of experience working across a lot of sectors and a lot of different verticals that have served me well. I think being a newbie to healthcare has actually been one of my biggest assets. Because your head isn't full with all these old ideas of what you can't do. That's right. Yeah, I look at a lot of my skillset

as really being able to shine a light on the opportunities that other people have either been afraid to point out or just haven't been able to see because they're too entrenched in existing business models or in existing ways of thinking. Right. And I think I read the one article that I believe you co-wrote for Fast Company because there's this idea like I'm going to be the Elon Musk of healthcare and I'm just going to disrupt it from the outside and do my own thing and I'm going to show them the right way to do it. And there's certainly, you know, something to be said for

that. But you're also dealing with a bureaucracy that is so massive that that's not quite possible unless you are like a Trojan horse going into the system and trying to work with it and maybe disrupt it, but also find enough common ground where you guys can collaborate and work together to create real change as opposed to just your motivation being, I'm going to disrupt this and show them. That's exactly right. And I think my approach coming into the healthcare system was to join one of the most influential healthcare providers in the world, and that was the Mayo Clinic. And my whole goal was to figure out how I could co-create something that would disrupt their existing business model with their support.

And I think that that idea, to be able to co-create with the existing structure that is in place, was something that a lot of entrepreneurs in Silicon Valley weren't necessarily doing. They were trying to go around the system because there's less regulation and less barriers. And I saw the big opportunity to really partner with, with healthcare to be able to make the biggest change and disrupt it from the inside out. Right. All right. Well, let's, let's backtrack a little bit.

So you're this kid growing up in New Jersey, lacrosse player, Lawrenceville Academy, Syracuse, you play lacrosse at Syracuse. So you're playing lacrosse at Syracuse, so you're playing lacrosse at a very high level. Yeah. Yep. And what was the career plan at the time? Or just like, I'm just being an NCAA champion. Was that, what was the, you know? I hadn't given the career plan a whole lot of thought coming into Syracuse, but playing at that high level and really being tested on all fronts, both athletically and intellectually, just being able to juggle both was a challenge for me. And I think when I finally realized that there was more to life than lacrosse, a big weight was lifted off

of my shoulders because there wasn't really a career path in lacrosse. And I don't think that that would have been something that would have ever fulfilled me. I've always been somebody who needs to make an impact on the world. And I didn't see lacrosse as a vehicle to do that. But surprisingly, I ended up really focusing on what my undergrad major was, which was a science in the way that people communicate with one another and understanding human behavior and what makes people tick. And that's what really got me excited. I really had a big interest from the time I was really young, though, to become an astronaut. And that was something that I think was not unique to me.

Most of my friends growing up probably had the same vision of one day being able to go into space. But I kind of took that one step further and really applied my thinking and school degree to understanding how astronauts could actually communicate under stressful situations and actually perform at their optimal level and ended up getting a job at NASA right out of undergrad to be able to do that. Yeah, that's insane. It's like a little kid in a candy store. What an awesome job. How does that happen? How did you convince NASA to hire you? So there's a good story behind this one.

I walked into the career counselor at Syracuse and told them of my dream of being an astronaut. And I basically got laughed out of the room. They said, you're an athlete. Your GPA isn't anywhere where it needs to be. You're not an engineer. You don't know math. You don't have a chance. I got a call about six months later from the same career advisor at Syracuse telling me that NASA was coming to town and that they were going to be doing some recruiting and that I was more than happy to go to the event, but that there would be no guarantee that they'd even talk to me. Sure enough, I went to the event, and every single one of the recruiters stood up, and they said who their kind of prototype, or who they wanted to recruit, and what their model was for that. And it was everything from a financier, to mathematician,

to an engineer. I couldn't be any further away in terms of the qualitative skills that I was developing in my communications degree. And so I thought to myself, I could walk out of this room right now, probably go have a great time with some friends, or I could walk up to every single one of these recruiters, tell them what my story is, tell them what I'm interested in doing, and maybe they might know somebody. And sure enough, I walked down the line and pretty much was told, we're not here to recruit for that.

We don't even really know anybody. And I was starting to lose some of my momentum. And I finally got to the last person. And it was about after 35, 40 of these conversations that didn't last very long. And the lady's eyes lit up when I told her what I wanted to do. And she's like, you know, it's interesting because I'm here recruiting for a colleague, but my lab at NASA Ames does exactly what you just wanted to do. And she ended up becoming my first boss. That's crazy. I mean, it's funny too, because you think it's very easy to make fun of a communications

degree. It's sort of like, that's the athletes. That's what all the athletes say. He's like, oh, we'll groom you to be a sportscaster or something like that. And it's kind of like, well, that's the easy path, but you actually took it to heart and you were like, oh, I really like, I'm really interested in this, you know, and what I can pursue with this unique little niche. That's right. I think I've always had the ability to get passionate about something and kind of figure out a way to make an opportunity

out of what my passion was. And it just so happened that my passion was in understanding what makes people tick. And it just so happened that NASA had a need for people who could understand that and, uh, and work in a lab to, to better understand the needs of the astronauts. Right. That's so cool. So, so you go off to Moffett field. Is that the NASA, the NASA offices there? Yep. Moved out to the Bay area, started working at Moffett field, um, with full intention of becoming an astronaut. This was like my Trojan horse to eventually. Oh, right. You're going to, okay. Once you're in, then you're yeah. Okay. And again, my, you know, I think being naive to all this was to my benefit because I really thought that this would be a good career path

for me. Very quickly, I realized that it's more glamorous in the movies than in real life. And we got a chance to work with a lot of the astronauts and it's just a tough lifestyle for them. And we did a lot of academic studies in a lab where we brought astronauts in and put them under extreme conditions for a period of time and really understood their team dynamics and developed some technology and some interventions that could help predict and intervene at the right time when communication breakdowns were happening. And this is all in service of the long-duration spaceflight mission to Mars, so that under those conditions, they would have the right tools to not only survive, but to enhance their performance.

Uh-huh. So when you say extreme conditions, what does that mean? Like, what kind of experiments were we talking about beyond the academic ones? So long periods of isolation with oftentimes a lack of ability to communicate face-to-face and trying to solve very complex problems under very time-constrained conditions. And so we had this four-day game, if you will, that they would play,

and we would be measuring a lot of biometrics and understanding and really coding and making correlations between what was happening in the game and what was happening in their body, and then looking at the output of their performance as a team. I see, interesting. I think I read, was it Wired Magazine somewhere? It was a while ago. Maybe I'm getting off track,

but maybe it was, I think it was in reference to planning the Mars mission or it might've been a space station mission, but where they built like a mock model and they were putting astronauts in there for long periods of time to see how they would behave under that kind of isolated experience. Yep. It's very likely that that was part of the lab. Right. And it's very interesting. And so what did you, I mean, what were the conclusions that you were making? I mean, are these people, these astronauts able to withstand

more stress than the average human being or where were the breakdowns occurring? Like, what were you learning? Well, the one big aha for us was that up until that time, a lot of the decisions to decide who was flying with who were really dictated on the wrong things. And we developed some tests that would really understand people's qualitative nature rather than just what their resume showed in terms of who should be flying with who, rather than it being a political decision or based on other metrics.

People's personalities hadn't really been cataloged in the way that they needed to be. So we came up with some interventions, some training modules, and then some bio suit technology that just brought it all together. And are the physical tests anything similar to what you see when you watch The Right Stuff or Apollo 13? You see these crazy G-force tests and what they're doing and they're getting injected with things. I mean, is that accurate?

I mean, you said it's not like the movies. A lot of the training isn't too far from that because they really do have to practice what it's like being under the physical extremes and being in a weightless environment. They can lose a lot of valuable time if their bodies aren't reacting properly once they actually get up there.

So yeah, a lot of that training stuff actually did happen. Interesting. And are these guys like freaks of nature? I mean, they're like geniuses, right? But they're also incredibly physically strong. And I mean, how do they, how do they actually find the guys that they're going to put up? The, uh, the application process is very extensive. Um, these are some of the most talented individuals, um, that I'd ever met. I mean, they command a presence when they walk into a room, some of the, you know, very talented physicians, very talented, uh, scientists, um, some school teachers, uh, these are just leaders upon leaders. And I think the, uh, the skillset to be a leader was definitely high on the criteria. And in reference to, to planning a Mars mission, my understanding is that

they haven't figured out the radiation part of it, right? Like, how are you going to transport a human that far with that kind of exposure for that period of time? I mean, how are they looking into resolving that? That is a great question. I think that there's still a lot of risks that are unknown right now about what happens to the human body. And I think right now there's a couple of private companies out there that are starting to take applications for the first manned mission,

which probably won't be through NASA, the ironic thing about all this. Are you talking about like SpaceX? Yeah, and I think Mars One. And these are one-way trips right now. Right. I mean, it's amazing that somebody would sign up for a one-way trip.

I mean, that's it. You're sign up for a one-way trip. I mean, that's it. You're on Mars. Knock yourself out. Thousands of people have already submitted applications online. I mean, do they have a death way? You're the psychology expert. What is going on with that? That is a great question.

I think there is an aspect of being part of something that's bigger than any one person and obviously bigger than anything on our earth that is a draw to many people. I think the realities will set in if any one of those folks get selected and actually have to go through something. Yeah, the sexiness of saying I signed up versus the reality of doing it. I mean, if you had terminal cancer or something like that, that would be one thing. But if you're in that situation, you're probably not going to be one of the people that's going to get to go anyway, right? And I don't know enough about what they're actually planning

to be able to know whether or not these people would ever have an actual impact on the long-term effect of actually having a colony on Mars. I think if it was pretty clearly defined that you would have a role that would impact, I think it could actually be a really compelling value proposition for a lot of people. But at this point, I think it's a science experiment.

I mean, how many years off do you think that reality is? Oh, that's a great question. You know, I would have said 50 years plus. But now when we have people like Elon Musk and others that are really, I think, taking a new approach to this, I think within 10 you know, within 10 years, we'll have... 10 years, that's soon, wow. Yeah, I mean, this is my own thought and perspective on that. But I think with the rate of exponential technologies and the growth there, just to see where things have gone in the last 10 years, it's not crazy to imagine that in 10 years, we could probably have something on Mars.

Wow. Yeah, I mean, I've been watching Elon's YouTube videos, the videos of the little launches that he's doing. It's just amazing. I mean, it is crazy. It's crazy. You know, when he, what he's doing, it's like Tesla is just his side project, you know, it's all about SpaceX and, and what's the module, what does he call the module that goes up and comes back down? Oh, it's called,'t know what it's called. But you had to watch it sort of blast off and then hover and then land exactly where it took off. And just so beautiful and graceful.

And it's quite extraordinary that he's doing that essentially on his own. That's right. And he doesn't have a lot of support. I think a lot of people see what he's doing as crazy. And he's finally, I think for the first time, demonstrating that his ideas actually have a place in the world that impact real world outcomes and quality of life, whether it's through Tesla or solar companies, that sort of thing.

I think we need more big thinkers like that. We really do. I mean, he's, for lack of a better comparison, he's really the new Steve Jobs, in my opinion. I mean, he, he, what he's doing right now is so remarkable. He's a rock star. I've, have you driven a Tesla yet? I have not. I have not sat in one. I, uh, I drove, a friend of mine got one recently and he, he came over so I could test drive it. And I'm not like a huge car guy. I drive a crappy car. You know, I'm not like,

I mean, I appreciate a nice car, but I'm not like, you know, the guy who's, you know, foaming at the mouth over fancy cars all the time. Right. And he's like, trust me, just drive this car. And I've never had a better driving experience in my life. I was amazed by this car.

Well, and just with the recent safety stuff that came out, I think it's the safest car. Safest car ever made. It has like more storage space than an SUV because there's, you know, you have a trunk in the front and the back. Super safe. And just the technology of it. I mean, when you, it's quiet, obviously, for people who've never, who don't know what we're talking about. Elon Musk has a company called Tesla Motors, and he's disrupting the auto industry. And he has this fully 100% electric car that's essentially like one of the fastest cars on the road and less expensive than those fancy sports cars, perfectly engineered. It's essentially five stars in every category.

That's right. It's like a perfect car and you drive it and you accelerate and it just goes faster and faster and faster. And you're like, oh yeah, it doesn't have to shift gears. There's no motor. There's no, there's no piston engine here. There's no transmission, you know? And, and, uh, and the whole console is just one giant flat screen. And they can push software updates to it. So the car just continues to get better as they figure things out.

Like my friend was telling me, there's all these forums. And one of the things that was kind of coming up with people is they want to plug it in in the middle of the night because the electricity is cheaper than when you charge it during the day. But people were waking up in the middle of the night or waiting until right before they go to bed to plug it in. And couldn't there be a better way? So they created a software update with a little timer on it that you plug it in when you get home, but it doesn't actually start to charge until a preset time that you can designate so that you're not spending too much on your electricity. Like a simple thing like that. And they just push it to the car and it automatically is there. So your car just gets better. I love that.

Isn't that amazing? The range is 300 miles. I know. Most people don't drive 300 miles ever in one time. I know. It's crazy awesome. So I can't wait to... Oh, and the other thing was my friend, when he went to go pick his car up Elon Musk was there so he had him sign it so it's like his sign he signed the car like on the

on the um visor you know he has his car autographed by the maker which is I mean how many people would be interested in something like that I mean the cult around that guy is remarkable he's really putting his money where his mouth is and And with the Hyperloop idea coming out, you know, San Francisco to LA in 30 some minutes. I know, it's insane. If it was anyone else, you'd just say crackpot. But with him, you're like, well, all right, you know, maybe we could talk about that.

I mean, what it would entail to actually do that is something else. But if, you know, I mean, there's nobody thinking bigger than that guy right now and executing at the same time. Yeah, he's, I think, scaring a lot of the airline industry right now with some of those ideas. Yeah. Well, good. Yeah. You know what I mean? So, all right. So back to Moffett Field astronauts. So I have to ask you this one question. So for people that don't know, Moffett Field is a base that's, it's pretty proximate to Stanford where I went to

college and they have a gigantic blimp hanger on the premises that's enormous. You can see it from the highway when you're driving by. And the sort of urban myth, urban legend when I was in school was that it's so tall, that hanger, that it actually precipitates in there. It gets like cloud formations and starts raining. Is that true? Does that happen? I wish I knew the answer to that. Unfortunately, it got taken down. You're the one guy who I could ask this question to. Oh, it's taken down now? It's not there? I guess it was asbestos filled after a number of years. And so just recently, I think in the last couple of years, they had to dismantle it. And right now it's either completely flat or all the panels are taken off of it. So if you drove by, you wouldn't see it.

Oh, that's a shame. It's like a historic landmark. I know, exactly. So, all right. So how long were you at NASA? About three years. And very quickly realized that I was no longer interested in becoming an astronaut. So, all right. Yeah. So this, the Trojan horse experiment is failing. It was, it was failing. I think I started seeing the realities of what life as an astronaut would have been like. And I started seeing a lot of the value in the work that we were doing, not necessarily in the technology that we were building, but in the process that we were going through to identify people's unmet needs. And we were a team of multidisciplinary specialists. We had physicians on the team. We had engineers.

We had psychologists. I was a lab rat. We all worked together and came to the problems with our own different perspectives and lens. I really enjoyed that process. I call that process the need-finding process, working with a target market, understanding what the unmet needs are, which are oftentimes latent or unstated. You could ask somebody what they need or what they want, and they could tell you what they think they want, but they don't necessarily understand what the right solution is. And so the process that we were going through, while they didn't really call it

need-finding, I was really excited by the process of working with a cross-disciplinary team, discovering what people's unmet needs are, and then developing solutions to fit those needs. And I quickly realized that we should be using this process to disrupt industries or to impact industries, I should say, that have a larger target market than just, say, 50 or 75 astronauts. Right, right, right. than just say 50 or 75 astronauts. Right, right, right. So you could, instead of saying, I know, let's find, we need to find out what happens when we starve and dehydrate these guys

and put them at 5Gs. That's right. There's only a couple of people that will have to experience that and need a solution to that problem. That's right. And, you know, from a basic research or applied research perspective,

those insights and learnings are hugely valuable and NASA is doing incredible work. And I have a lot of respect for the teams there and to that continue to work on a lot of these issues. But I really wanted to be able to see the output in the world and have consumers and people touch the products and services and have their lives be impacted by them. And that wasn't something that I would have been able to do at NASA. Right. So when you're starting to look around then, what's next? I came upon, so I started talking with a lot of people, product design companies, service design companies,

companies that were helping large organizations think differently about their problems. This was in 2005, about 2007, I would say. And this is before a lot of the healthcare crisis became top of mind. And so I looked at a lot of the issues that were going on, and there weren't necessarily any one that spoke to me. But I ended up discovering this one company in San Mateo, just up the road from where you went to school. And it was called Jump Associates. And Jump did exactly that. They worked with usually large Fortune 500 companies to really uncover opportunities for growth. And this could have been in the automobile industry. This could have been in the financial sector.

It could be anywhere. And we would apply this human-centered design approach to understanding what people need and what the unmet needs were, and then really designing a strategy and prototypes to fulfill that. And it was an amazing experience. So I started working there, and we literally would just go and hang out with our target market. We were working with a big car company, and they wanted to understand what was beyond the SUV. They were selling a lot of SUVs today, but as the new generation started coming up through college, they thought that that could be a trend that was going to be declining. So I got a chance to spend a week or two out in the field with some of the people in my own generation,

chance to spend a week or two out in the field, you know, with some of the people in my own generation, um, trying to take it a really objective, uh, view and what their unmet needs were around really the third place. And that's what we, we called the, uh, the opportunity space. They had home, they had school, and they really needed this third place to conduct their activities. And, um, that's just one example of one of the projects. So what did that translate to? It ended up translating to a series, a roadmap that transferred kind of the existing SUV into something much more economical, much more streamlined, something that could be more affordable and a little bit more adaptable.

And that was kind of our big thing was, how do we actually make a car that could transform itself? So we came up with a bunch of concepts around that. And I think, you know, given the auto industry's tough time over the last couple of years, we didn't necessarily see that car in the market. But every once in a while, we would see a new car come out from that company

and it would have one of the features in it. A little dusting of Adam Dole sprinkled on it. But one of the projects that really changed the trajectory for me was a project that we did for a big consumer package company that was distributing milk. And when I got put on this project, I couldn't imagine a more boring project. I was like, oh, my God, I've got to spend another four months working on how to make milk cool. But what I wasn't thinking of at the time was the insight that we came up with, which was really around how do you actually empower families to take care of themselves and to live sustainable lives? And milk traditionally has played a very central part in that part of the family conversation from kind of the old, very tried and true ways of.

The milkman dropping it off and he's your friend and all that. That's right. And really in giving, you know, at the time, like the role that mothers played in their family had, you know, kind of this large story around milk. And so what ended up being a milk project turned out to be a health and wellness project for us. And that's really what got my mind turning, that we should really be using this process of human-centered design to fix our healthcare crisis.

You know, given that 75% of our costs right now in our healthcare industry could be prevented. And heart disease and obesity are things that are really just driving up the cost and creating a lot of downstream effects on our healthcare system. I looked at this not as a healthcare crisis, but as a design crisis, we hadn't designed the right services to actually engage people in what was going to prevent them from getting sick 20, 30 years later. And so I saw this as, you know, kind of the light bulb went off for me. This is what I want to spend the rest of my life doing and pitched it to the company. Um, they weren't as excited about the opportunity as I was. Um, and so there's also not one industry that would be the client for that, right? Like how do you, it's so huge. Like, is it the government? Is it this particular producer of this unhealthy food? Is it doctors?

Like who, who are you even addressing? Yeah. And I think, you know, the, the big, uh, big concepts that have had legs are really when they can address all of the different stakeholders in that ecosystem and, and really have them work together in a new way that they hadn't before. And that was, you know, not necessarily in the, in the best interest of the company at the time. Um, I ended up, uh, going to grad school soon after that, um, because I really did want to focus on this. And I didn't want to sit around waiting for any company to necessarily get clients in this area. I thought, I could just start these projects on my own. And ended up doing a project that got a little bit of recognition, won some awards through an open innovation platform called Innocentive. And

Innocentive is a crowdsourcing platform based in Boston that puts challenges out to the world, sponsored by organizations, and sees what comes back and awards the winner based on a set of criteria. And I ended up putting a business plan together that would outline a new way of this ecosystem working. And it actually ended up winning.

And I think more than- And what was it? It was a pretty tight ecosystem that would reward people for healthy behaviors, which I think now in hindsight, looking back, it's probably pretty naive to think that people could be incentivized by external rewards as much as that plan put into place. But it really leveraged a lot of social accountability, putting people on teams with peer and peer coaches, which a lot of businesses of its time, whether it's Weight Watchers or others, have demonstrated to be quite effective,

and really aligning the incentives across the payer community, the provider community, so that doctors and nurses were actually getting paid to keep people out of the hospital and really wrapping that all up into this utopia. And what year was this when you were doing this? This was kind of the end of 2007, 2008. So right on the, I think, the time when a lot of other people started thinking about this problem. Right. I mean, in some respects, it's quite prescient

because you look at the proliferation of all these mobile apps now that are all oriented around tracking your food and your calories and the Fitbit and all these tools, it's become a massive market sector, right? That's right. And I think the big difference,

looking back on it now, is people who are having success are people who are actually building stuff now rather than just creating business plans. And so I looked at that as just more than anything, a bit of confidence that this was an area that I should explore more. And that grad school, a couple of years, getting an MBA from a design school might actually afford me the opportunity to- An MBA from a design school? Yeah.

How does that work? It couldn't have been any more perfect for me. So when you think about- Can you get a design degree from a business school? It's surprising. So there is a new trend right now in business programs to incorporate more of this human-centered design skillset. And really what the skillset is, is an applied application to understanding what people's unmet needs are, and then going through a series of rapid prototyping feedback loops to get to the right answer. And I think there's an assumption in traditional business schools that you can apply

existing models to some of these problems and have different outcomes. And that's just not the case. I think when we talk to a lot of leaders at these companies that are trained in the traditional way of thinking about things, they seem to be asking the wrong questions. And rather than trying to think of what the right answer is, I think the design thinking type of the MBA programs out there really teach you how to design something that will help you learn quicker. And the shorter those cycles are,

the sooner you can actually get to something that is actually providing value for real customers. And that was really the skill set of this MBA program was to design businesses that have sustainable business models that leverage a lot of traditional elements of the MBA program but then layer on this whole other world of what has made designers really successful in creating products and services that people use.

In other words, it's sort of taking a look for, I guess I'm trying to wrap my brain around this, but the idea would be because of technology, we have so many new tools that we're just starting to understand the power of, right? And how they can be applied to traditional business models as opposed to taking traditional tools and applying them to find out solutions to problems they don't even know they have. That's exactly right. And when you look at some of the examples that exist in the world today, there is very, it's very unlikely that Marriott could have ever come up with Airbnb, you know, as one example. And when you look at, you know, how much market share Airbnb has taken away from the Marriott's of the world, a lot of the leadership at some of these traditional companies are probably sitting around scratching their heads being like, how do we get some of these people? We were already in this business.

Why didn't we? Yeah, exactly. Right. Or looking at a company like Kodak with digital photography coming in and how could they have maybe adapted better to that or been more forward thinking so that they were prepared for that seismic shift. That's exactly right. I think Kodak's kind of the poster child for what the new type of MBA programs are trying to arm the future workforce against. And I think that a lot of the traditional MBA programs

are unfortunately hampered by their brand and their alumni. And it's really hard to really re-architect an education from scratch. And so some of these newer programs are actually having quite a lot of success and demonstrating that there's some value out there to be had. Well, the whole notion of business

is changing so rapidly. It's not about getting a job at J.P. Morgan or Morgan Stanley anymore. It's not about feeding into that system. It's about looking at a completely different system and learning what's going on right now and its gestation level and being prepared for that. It's about looking at a completely different system and learning what's going on right now and its gestation level and being prepared for that. That's right. When you look at a lot of MBA students wanting to go work at startups, but there isn't really a whole lot of

need for PowerPoints in startups. You need to be able to build and create value in a very tangible sense. And I think it's pushing some of the MBA programs to really set their student population up to be more builders and doers rather than just theoretical thinkers or creating models that basically, I love the quote, I don't know if it's Mike Tyson, but everyone's got a plan until they get punched in the face. And the same can be said,

as soon as you let your product out in the world, the first user is going to smash every hypothesis that you ever had about what your product would do, how much people will pay for it, how people will interact with it. And it's what you do with that feedback that really sets people apart right now. Right, the ability to adapt and change your business plan

as users start to tell you what it is or what they want it to be or what's not working. That's right. You know, I mean, didn't Twitter go through that? I mean, originally it was intended for kind of a different purpose, right? It was about public transportation becoming more efficient or something like that.

Yeah, absolutely. And being able to listen to the market, whether it's qualitatively or quantitatively, understanding why people are doing what they're doing. I think these are all skill sets that traditionally really hadn't been valued or hadn't been explicitly valued until the democracy of a lot of this technology has really shown its value. So you're doing this program, you're starting to think about healthcare. Yeah, it's a two-year program. I basically convinced every one of my team projects to

focus on another one of the aspects of healthcare that I seemed to think was broken and that we could fix. So out of the two years, I probably did a dozen or maybe even two dozen projects focused on different pieces of the healthcare system, from insurance to primary care. And this is all coming from somebody who's never worked in the healthcare industry. So I was taking this fresh mind approach and coming up with Blue Sky Projects with oftentimes a team of really talented individuals that we worked together on this with and just saw all kinds of opportunity in this space. And it was soon after I graduated from the program

that I got a call from somebody at the Mayo Clinic and asked me if I did any freelance work. And I hadn't, but I did then. And I said, absolutely, let's talk. And what turned out to be a three-month freelance project turned into a tryout for a new ventures team that they were putting together. And it was a really good fit.

They were looking for somebody to be based in Silicon Valley, which was perfect because there's no way my wife and I were going to be moving to Rochester, Minnesota, which is, if you know the area, which I know you're from, the Minnesota area, Minnesota is great. Rochester, Minnesota is not is, if you know the area, which I know you're from the Minnesota area, Minnesota is great. Rochester, Minnesota is not near any one of the lakes or anything like that. So it's, it's tough to convince somebody to move, but they wanted somebody to be based in Silicon Valley. And I was the right person for that. And so the role that I stepped into was a perfect fit

for me. I was responsible for expanding the scope and impact that Mayo could have outside of their traditional business model of tertiary treatment. So traditionally, Mayo Clinic has been the world's leader in the most complex conditions. When no one else can fix you, you fly to the Mayo Clinic. That's where you go. You go there and they fix you and they fly you home. We've all heard of the Mayo Clinic and like we all know it's the best, but I can't say that I know that much about it. Like how many doctors are there?

Like how big is it and how does it work? So Mayo Clinic is a really unique institution. I think there's quite nothing, nothing quite like it in the world, but there's about a 55,000 employee population spread across three sites. Rochester, Minnesota is the home base, and so it's got the largest number of people. I think about 35,000 people work there.

I think in total there's probably about 15,000 or 20,000 doctors. Oh, wow. It's a lot bigger than I thought. In fact, actually, there's probably fewer doctors than that, but supported by an army of really talented nurses and other practitioners and administrators. And they've really developed and branded themselves around a team-based approach to care. And what would typically take weeks, if not months, to accomplish outside Mayo Clinic could be accomplished in a day or two. And what I mean by that is when you come to Mayo Clinic, you are put in the center of the room and all of the specialists that need to collaborate come to you and collaborate. It's like house. That's right. They actually sit around

and have the debate around the table. And very few organizations put the patient in the center of that conversation. Usually those conversations are happening in absence of the patient. And I think that the team-based approach to care is exactly what we need to do more of. And I think Mayo Clinic has really demonstrated that outcomes are better and even more cost-efficient way of doing work. And so you go there. Because of this team approach. That's right. And it's just the efficiencies of being able to do work together collaboratively with the patient being an equal member of that team. Interesting.

And it doesn't hurt that the doctors are probably all geniuses there too, right? It is amazing. with specialty upon subspecialty and domain expertise upon domain expertise from the specialties that we all know about to things like behavior change. They have behavior change experts that are looking at how to actually impact the outcomes from that perspective as well, which is really powerful. So when you're an outsider looking in at the Mayo Clinic, let's say you're a hospital administrator and you're realizing how successful they are with this approach, why aren't you looking at your own hospital and saying, well, we should do that too? Why doesn't that happen?

I think it's starting to. I can't say that it's happening at the rate because change is really hard, and it's hard to really shift the business model from paying for procedure to paying for performance or outcomes. And, you know, Cleveland Clinic has followed in its footsteps. Kaiser has got a really unique model, specifically on the West Coast, being really big. And I think we're seeing more and more ecosystems like that approach. The problem's in the same way now, especially with some of the ACOs, the accountable care organizations, are starting to get modeled after that approach.

Yeah, interesting. Well, I mean, it would probably have something to do with the way doctors bill and how they get paid. Like, well, if I'm collaborating, there's five doctors sitting around a table, like who's getting paid and how are we working out the business aspect of it? A lot changes when the incentives change.

And if there is one industry that needs to think long and hard about the incentives, I think it's healthcare. And I think groups like the Mayo Clinic have really demonstrated that there's the right way to do things. The challenge is when you try and scale that to the masses and look at the non-critical care situation. So when you look at chronic conditions and the primary care level, Mayo hasn't played a huge role there. And that was actually part of my responsibility was to start new businesses

that could actually put Mayo Clinic on the map in people's communities, in people's pockets, to be able to ideally prevent people from ever needing to go to Mayo Clinic. Right. So let's take a step back. So the Mayo Clinic reaches out to you, come consult freelance. And what is it that they're looking to do there? So what do you start working on? What are you looking at?

So the guy, Scott Ising is the individual there that reached out to me. And he was part of the business development team. And he had been hearing a lot of trends around mobile and gaming and really didn't understand how they would impact Mayo's business. And rather than putting a lot of resource internally on some of those opportunities, he gave me a list of things that he wanted me to explore. And gaming was one of them. Now, I'm the furthest thing from being a video gamer. But I started seeing a lot of trends in business around gamification. And there's a lot of buzzwords around that. But really understanding how do you actually design for engagement. And games have traditionally done a really good job at that. So I said, let's use that as the way for me to learn about this.

So I basically told him, I was like, look, I'll explore what gaming could mean for Mayo Clinic. And spent three months taking a deep dive into the space of game mechanics, a term called self-efficacy, which are tools that can put the power of success into the user's hands. So your capacity to feel like you could actually impact the outcome. And games do that very effectively. And I was able to basically make some connections to things that I knew Mayo Clinic would want to do and charted out a roadmap and a pathway

for how games could actually become adjuncts of traditional therapies. So that if you're trying to engage somebody in a therapy that required taking your medication, maybe there was some corollary experience that you could have in the game that would actually incentivize you and motivate you to want to do both.

Right, so in other words, I mean, in the most simplistic terms, like you would get points when you take your medication on time or something like that. That's definitely one example. You're creating an emotional investment in this little journey. Exactly. That is one example. And we see now a lot of companies trying to do that. Right. So in other words, the application that you're looking at is the communication and behavior modification of the patients and the interaction

between the patients and the doctors and the staff. That's right. As opposed to communication between the doctors and amongst the staff, because you read about and you see something else I want to talk about in a minute is how much technology, the iPad and all this, everything that's now available

is impacting medical education and the doctor. I mean, it's sort of like the porn industry with video, like the medical industry is just seems like it's has the most to gain with all of this incredible 3d modeling and all the kinds of ways that you can teach a surgeon how to operate without, you know, in new and different ways to help them master their craft. It's huge. And we haven't even scratched the surface. Yeah, I don't think we have either. Yeah, absolutely. So you weren't really looking at that.

You were looking at the patient aspect of it. Oh, but one thing I did want to mention, though, because I'll forget. I did read an article. I can't remember where I read this, but it was about IBM's supercomputer, Watson, and how they're starting to use Watson in the hospitals to help diagnose patients and help doctors

to figure out the appropriate protocol. Because I guess Watson, you can just put so many variables into it from patient records and the history. You can load all the medical journals ever written on a particular condition or whatever, and it has the ability in some kind of rudimentary AI way to evaluate all of this and come up with a treatment protocol that takes in so many more factors than the doctor might be aware of. Because I guess, for example, if you're diagnosed with a

certain kind of cancer, there might be 20 kind of medications that would be appropriate to prescribe. Which ones do you choose to prescribe and which ones don't you and why and what amounts and all those kinds of things. There's a lot of subjective doctor judgment that goes into that. And it's not always based on all the information because nobody can know everything. And it's helping these doctors sort of implement the appropriate protocols. Is that correct? Do you know what I'm talking about? Yeah, you're spot on there, I think. So Watson is currently in medical school right now.

So it's not doing a lot of that quite yet, but it's learning. They're talking, but this is the thing that's going to save IBM, right? It absolutely could be the thing. And I think there is no question that Watson will have an impact on healthcare and the way that medicine is practiced. I think Watson reads something, I don't know, I'm going to get this figure wrong, but 200,000 pages in 30 seconds. So there's no way that a human could ever learn as quickly as Watson could. And so- And with an emphasis on this word learn, like there is something about it where it actually, it's adaptable. It is getting better and better every day that it's

in school and sees more patients and everything around it. But it's not quite there yet where I think it's really having a big impact. I think it's going to there. There's no question. And there's a bit of big controversy right now. A lot of people that are technology driven in healthcare, And there's a bit of big controversy right now. A lot of people that are technology-driven in healthcare, big investors, Vinod Khosla, founder of Sun Microsystems, he's now investing a ton into healthcare. He became really known for a statement that he made at a conference that X percent of doctors are going to be out of a job because of technology. And that really set the industry off, I think. because of technology. And that really set the industry off, I think.

And I think that was taken out of context. And I think it was well-intentioned to say, technology is going to impact the way that doctors practice medicine and the way that the industry works. And I think now when you talk to him about it and when you hear him talk about it, he's really of the mind that technology can really help scale great doctors. And that's really where I think the industry is going, which is how do we actually use this technology

to scale what individuals can't do on their own? But it's never going to replace a human in the operating room. It just might be a little bit more like Star Trek, where Dr. McCoy puts you in the bed and it reads all your... I don't know if it'll be like, did you see Prometheus? I didn't. So they're in this spaceship and was it Prometheus? Which one?

No, it was, what was the one with Matt Damon? Were they, Elysium. Oh, I didn't see it. Where they have these beds in this utopian sort of space station that was orbiting around Earth. You could lay in these beds, and it would diagnose you with whatever was wrong with you and just immediately cure you without any doctor.

So I don't know if we're going that far yet. Well, it's interesting. There is a competition out there for the tricorder, which is- Right, Dr. McCoy's gadget. Yeah, and there's companies out there working the tricorder, which is, uh, right. Dr. McCoy's gadget. Yeah. And there's companies out there working on that right now. Just, I mean, it's, it's really, uh, I think reinventing what the, uh, diagnostic, um, capability could be and putting that in the hands of parents and, and people in their own home so that they're not so reliant, um, much like the ATM machine.

Uh, you know, we don't go into banks. We're not reliant on the bank teller anymore. 20 years ago, we wouldn't have imagined a future where you could walk up to a machine and have all your banking done that way. And I think there's something to be said for technology and healthcare moving more in that direction and putting the power into people's hands. And that's something that's going to be happening. Right. I mean, it's going to be. I mean, back to the tricorder, it's like, well, we already have the communicator. It's actually better than the communicator in Star Trek. So it's all, it's, it's insane. The future is coming quickly. All right. So games in the Mayo Clinic. So you're, you're, you're, you're coming into the Mayo Clinic with this gaming idea. Yep. And so what's, what happens? So I started, I came in

pretty, pretty new. This was the first time that I ever worked inside of the belly of the beast of healthcare and very quickly was confronted with all the reasons why some of these new things that I was trying to come up with wouldn't work. And that's when I realized that my job wasn't necessarily to come up with new ideas. My job was to bring others along with ideas that they could get behind that might not have been too new, but that really started pushing the boundaries of where Mayo Clinic had played before. And whether it was remote technologies and looking at different telemedicine concepts or things at the primary care level that would really,

you know, if they were effective, they would prevent people from ever needing to go to Mayo Clinic. And you could imagine how controversial some of those conversations were. Right. But we need them to come to the Mayo Clinic. We don't want to be too good at this, right? And luckily, Mayo, I think, you know, they really live and breathe by the motto that the needs of the patient come first. And that inspired me to really just try to come up with as many concepts as possible that would impact quality of care, healthcare outcomes, quality of life, and really, I think, not waver too much from my vision of preventing people from

coming to Mayo Clinic. And ended up hitting on one concept that seemed to garner a lot of attention. And that was a concept that was really about putting a lot of the services that we delivered to our executives through an executive health program. So executives from Fortune 500 companies can come into Mayo Clinic and have this really comprehensive experience over two days where all of their health care needs are taken care of. Why couldn't that be delivered to everybody in a, in a scalable way? So technology supported by real people. And we started working on this concept pretty early on. And it took us about a year of working with with Matt Johnson's company,

go-kart labs. And we came up with a really interesting concept that we ended up getting outside investment for spinning it out into its own company and it's now off and running in palo alto and it's called better better right yeah i saw that in uh in the stuff that you sent me and essentially that is a mobile app right and uh it basically gives the consumer greater control over all of your not really your your medicals to medical information, but kind of how you're tracking what you're doing, right? I just did a terrible job of explaining it. You explain

it. So better, the value proposition is really about bringing each individual through a mobile service. And the initial touch point is on the phone. Eventually, it'll be anywhere that a user needs to interact with. So whether it's web, on computers, whether it's on the TV screen, doesn't matter. Bringing a personalized healthcare experience to them at their fingertips. And personalized really means just that. I think the idea that personalized medicine is understanding what people need at the right time, delivered by the right person, hasn't found its way to mass market yet. And a lot of that has to do with understanding an individual's risk profile.

And so the first thing that Better is going to be doing is getting to know you and understanding what your risk profile is and then start delivering you personalized experiences based off of that. The one use case that I love, because I think food is such an important part of people's ability to take control over their own health, is once Better

is really doing its full job, it should be able to know that it's getting close to lunchtime. It knows that I need to be eating a low-sodium diet. It knows exactly where I am because I have a supercomputer in my pocket at all times now. And it's going to not only recommend me some low-sodium options nearby, but it might even give me a coupon to be able to go fulfill that. And so it's not just giving people an action plan, but it's giving people an action plan that makes those behaviors that are sustainable. Interesting. And I think the important part is going to be how better learns, just like in the same way Watson needs to learn for each individual person and what's working for them, what's not, and how to actually augment the experience based on the feedback loops. Right. Interesting. So, for example, I sign up for Better, I get it on my phone, and then I enter a bunch of data points like my height, my weight, my ethnicity, my age, my whatever. What are all the things that it's evaluating in order to come up with these sort of determinations about what you should do? So some of those things are questions that aren't too creative. There are things on a

general risk profile analysis that, uh, that may have got tried and true. Um, Do you have heart disease in your family? Yeah. That kind of stuff. Exactly. But some of the other things, um, that we're playing around with are really some of the things that are not part of the clinical record today. You know, how are your relationships? How busy are you? What does your schedule look like? The things that we know impact our daily lives more than anything else. And putting that stuff in the context of the health record, the future health record, is I think where we want to go.

of the health record or the future health record is I think where we want to go and really treating some of that data, um, just as important as some of the other stuff, um, really hasn't happened yet. And so those are some of the questions that it'll be asking as well to really try and understand you almost as if you had a, uh, a buddy that was there to basically look after you. Right. I like the, I like the recommendations part. Like if I'm driving around somewhere, it knows where I am. And at lunchtime, it says, here are the three places that you rich, the vegan guy could potentially eat. Especially I've been traveling around a lot

and sometimes I got to plan ahead or I don't know where I'm going. Like to be able to have that would actually be really valuable to me. Absolutely. And this could be used by just about anybody. It could be somebody who's managing a chronic condition, trying to prevent a chronic condition. If you've got an acute issue, Better will actually put you through a series of algorithms to help guide you to the

right care. And I think one thing that Better is going to be doing that the healthcare system needs is breaking down the data silos. The data silos right now in healthcare are killing us. What does that mean? Explain what that means. The idea that every health experience that I have right now is siloed into separate proprietary systems. So when I go to my primary care doctor, that data doesn't find its way into a specialist conversation very easily. When I go to Whole Foods and have a health experience there around food that I'm buying, there is no way that that data would ever find its way into a clinical record.

And the information from claims data and all this stuff exists in their own proprietary systems. And that's one thing that's really hurting our healthcare industry right now is the fact that none of these systems talk to each other. Right. And if Watson knew all that stuff, then Watson would be in a better position to advise. That's right. Absolutely. But then you're getting into tricky waters here. This is getting blasphemous because we have a lot of privacy issues.

And how do you deal with all of that? Like that becomes... Rich, that's pretty much the big, huge question and the elephant in the room for all of these new services that are coming up. How do we actually know enough about you to provide you a meaningful experience without being big brother or creepy? You know, now more than any other time,

I think people are aware of that. I got news for you. Big brother's already here and we're all willingly signing up for it. That's right. Yeah, I agree. Or Orwell would not have predicted just how enthusiastic we would be about having big brother watch everything that we do,

but exactly. We're actually paying for it on purpose and welcoming it into our lives. And it's, it's, I don't know where that's leading, you know, that's another whole podcast discussion, I suppose, but I think so it's, It's going to have to change, though. People's expectations around transparency and value in the healthcare system, I think, has never been part of the conversation. And for the first time, I think if we can establish a sense of transparency, and that goes both ways. That's, you know, transparency about us and also transparency about services so we can match those two things more effectively. us and also transparency about services so that we can match those two things more effectively, that's where we're going to start seeing some of the value that can help drive a new,

more consumer-driven healthcare. I think that's happening. And I think it's sociological and it's generational. As somebody who understands psychology and communications and all of that, I mean, you really see it. I see it with my kids and I see it, the difference between them and for example, my parents. I mean, just using Facebook as an example, you have an older generation, they're not comfortable sharing stuff about their life in a public forum, even if only a couple of people are looking at it. Whereas young people, they are completely uninhibited and they just don't have the same perspective about privacy that people from a different generation do. And how that plays out, you know, across every spectrum of how we live our lives remains to be seen. But it's a reality and it's a truth, you know, like they just don't, they don't think about it in the same way. So in 20 years, when those are the people that are making decisions around this, how is that going to affect, you know, everything from Supreme Court decisions to medical records? That's right. Absolutely. We're sharing more and more, you know, each year there's,

I think, Zuckerberg's law out there. Yeah, I know. Well, and it brings up issues of sort of, you know, privacy by its very nature begs the question of like issues of shame and like, I don't want people to know that about me or I don't feel comfortable with it. It's like issues of identity and all these kinds of things that I think are not constants, you know, and we're seeing different priorities with respect to that with young people. Absolutely. So I see, you know, just the gestalt of technology now. I mean, I don't see any way around it actually happening at some point. Yep. You know, agreed. So it's too pervasive. Marshall forward. Yeah. Well, I don't know, but yeah, I mean, so basically you're talking about some repository of all this information,

all your private medical information, your preferences, what you're eating, what you're buying, where you're going, and all of these things being used as a powerful tool to help improve your health. But it is frightening that somebody could have access to that and find out everything that they need to know about you. But with what's going on with the NSA and psych, it's a different world, man. It is. with what's going on with the NSA and psych, it's a different world, man. It is. It is.

Hopefully with Mayo Clinic behind this one and some really great investors, we're keeping our fingers crossed that this company will become one of the examples that I think changes where things are right now for healthcare. So this is a little startup, but it's being funded by Mayo Clinic and then? Mayo Clinic and the Social Capital Partnership, which is a venture fund in Palo Alto started by Chamath Palapatiya.

And he was the person at Facebook who was responsible for getting Facebook from 1 million users to 750 million. So if there's one person in the world that understands how to scale consumer products, it is Chamath. Wow. How did he do that? He's a very talented, very visionary product guy. I think he started out as an engineer, and he just has a really keen sense for how to build technology that engages people. And we were lucky to have him as chairman of the board of Better and primary investor and great CEO, co-founder, and Jeff Clapp, who's got a long history in health technology, built and sold one of the largest remote patient monitoring companies in the world, which

remotely monitored people in their own home around chronic conditions. And he sees this as then even bigger opportunity to really engage people before they get sick. And it's not out yet, right? I went to the site and entered my email address, but it said, I will alert you as to what's going on. So do you guys have a launch date? So given my new role here at the White House, I've stepped away from a lot of the day-to-day work there. but my latest understanding was sometime this winter. And that could be vague in terms of, I don't know if that's going to be November or January, February. Right. And how is it, I mean, is it similar to WellnessFX where you have your blood values and

all of that in there and you can have those monitored as well? The company isn't quite taking those types of metrics, but I see WellnessFX as a potential great partner to really provide that level of metric. Yeah, they're kind of doing the other side of that coin. Exactly. You have a more behavioral one, and theirs is more sort of clinical.

That's right, yeah. Interesting. Yeah. Cool, man. Well, it'll be exciting to see how that rolls out. I am excited. They're building a great team out there in Palo Alto and, um, yeah, I have high hopes for the future of that company. Right. So, all right. So you develop better at Mayo Clinic and things are chugging along and then what happens? Barack Obama calls

you up? So in a parallel track, uh, the, the person who inspires me the most, my wife, Kyoko, she decided to leave her career at Apple after about eight or nine years of working there. She was a designer? She was a designer and then became a manager of a lot of the dot-com efforts on the marketing side. So Apple.com was her baby for a number of years. on the marketing side. So Apple.com was her baby for a number of years. And over the years that she was there, I think she had a lot of great experiences and came home one day and told me

that she wasn't feeling quite comfortable with the public speaking that she was then having to do as a manager. And to make a long story short, I convinced her to take an improv class. And that has somehow matriculated into a new passion of hers. And one improv class led to a next.

We were talking before the podcast. I was like, oh, you what? She got in the groundlings? It's like a joke in Hollywood. And she, fast forward now a year and change later, she's now full time in acting down in Los Angeles. It's fantastic. We relocated down to the Malibu area in Pacific Palisades

and love it down there. And she's now doing acting film and TV full-time. And I couldn't be any more proud of seeing her really. How long ago did that start? That decision was probably about two and a half years ago. And it was propelled by this need that she had to just become more proficient at leading teams. And I think it unlocked a dormant interest in her and a passion that she never knew she had. She's very creative and passionate about anything that she gets involved with.

And so this really followed suit. And how unfortunate things happen to gray people. Her sister unexpectedly passed away. And I think that really shined a light on some of the opportunities that we had in front of us. And this just being one of the things that we looked at each other and we said, life is too short to go through life complacent. And that was the right time for her to leave Apple and to pursue something that

was never on her radar, but something that she clearly developed a passion and skillset for and had some early success getting into the Screen Actors Guild Union and developing some opportunities down there that she's now thriving full-time. That's crazy. So she's already booking gigs and working? full time taking that's crazy so she's already like booking gigs and working she's working she'd like to be working more i think the the opportunities are uh far few between where they actually get you know translated into reoccurring roles but she's um on the path to hopefully getting some of those recurring roles she's now starting to get some of those bigger auditions that's great and so that happened you you know, about a year ago, we made the transition down to Los Angeles. And right around that time, I was going back and forth between Palo Alto.

A friend of mine who was working at the White House emailed me and said, you know, there's this program you should think about applying for. It's a Presidential Innovation Fellow Program. And I couldn't have even imagined going to work for government at the time. Government was nowhere on my radar. And I looked at the application, and I thought, maybe I'll just keep all my options open. My wife looked at me, and she's like, but what if you get it? I was like, ah, don't worry. I don't think I'll ever have to cross that bridge.

Six, eight months later, I ended up getting a call and the interview process started. And what started out as something that couldn't be any further from my roadmap became something that I saw as one of the biggest opportunities to impact the largest amount of people that I could. And the opportunity to come in and leave what I was doing and serve my country in a way that otherwise I might not ever have the opportunity to. A program that's funded out of the White House. We work out of the Chief Technology Officers Program. And most people don't even know that the United States has a chief technology officer.

But he's Todd Park and somebody that has had a huge impact on bringing entrepreneurial people into government. And he set this program up a couple of years ago. And it's really about bringing entrepreneurs into government to try and do something that otherwise wouldn't happen if we weren't here. And I think that speaks to his vision for a new government that really understands how to think about technology and how to build products and services and facilitate the building of those products and services with the private sector to develop things that government has never really been able to do yet. Interesting. So essentially they're bringing, like for example, you're coming in to look at healthcare, but I would imagine that there's a guy coming in to look at transportation or all these different sectors with all, you know, some kind of background and expertise that allows

them to leverage technology into kind of something that's a very bricks and mortar, bureaucratic, you know, kind of broken governmental engine. That's exactly right. So on one end of the spectrum of the projects, there's a, there's a project that some really talented fellows are working on. And it's really to imagine a new way that small businesses can get government contracts. So today, that process, for those of you who've ever done it, is apparently terrible and takes months of paperwork. And for small businesses, this is a huge investment. It's not very efficient. It's huge government spending on some of these inefficiencies.

And so they're coming in to not only reimagine a new process, but actually build the technology. And that's something that I think could potentially happen inside a government traditionally, but it's going to be accelerated with new horsepower within six months with some of these fellows that are working on it. And another group is working within the smithsonian to digitize the all the smithsonian uh artifacts right well these are bones and and you know dinosaur remnants how do you actually digitize millions of artifacts scalably so they're actually building some crowdsourcing technology to be able to do that oh wow so that the idea with that is it's a new way of digital preservation so that you could use a 3D printer to print out a facsimile of this should it degenerate or something like that? I think—

Like for a dinosaur bone or something like that, that code is on file so you have that form. That's right. And I think so much of the work that needs to get done is tagging structure for each one of these and to think about that being done by hand is probably a task that could never be done so right they're really trying to build i think technology to automate some of that but to use the power of the crowd so that anybody could log in to their computer and actually contribute to uh to this that's amazing it's a very know, web 2.0 approach to a problem that government might not have ever come up with. And that's really the value.

Well, and also, they don't, what is their incentive to get involved with it? They're not going to make money. You know, they're just going to spend money and there's no,

there's no public demand for it. That's right. So it's never going to happen. That's right. And it hasn't happened yet. So hopefully, over the next, you know,

year with some of the fellows working on that project, some of those things will come to bear that otherwise we we never see the light of day. So how many of these fellows are there? There's 43 of us. And some of us are working on six-month projects, and others are working on one-year projects.

Mine happens to be a one-year project. I think people recognize that healthcare is as entrepreneurial as we can be. I think there's just the beast of healthcare. Do they bring you, come in, and they put in a room and they go, listen, this is not, nothing's happening overnight here. That's essentially a week. A year, that's like a day. Yeah. All right, cool.

So, you know, the White House calls, says, come on down. I mean, you're going to say yes to that. You know, of course,, that doesn't happen every day. So it was a hard one to imagine saying no to. I looked at my wife when I got the call. I said, you're not going to believe this, but I got it. And without hesitation, she said, this is something you have to do. And it's really coming on the heels of her getting some momentum down in LA. So it was a really tough decision for me whether it would be, to be bi-coastal for a year. And I think she made it very clear to me, um, and confirmed a feeling that I already had that this was really a once

in a lifetime opportunity. And that with her support and that with the relationship that we have, um, this was not only the right thing to do, but something that I had to do. Right. Cool. And for the first time, I think I'm in a role that doesn't feel like a job at all. It's really a mission. And, you know, the opportunity to have this window of time to focus exclusively on one problem is a unique one. I don't know if I'll ever get that back. And so, you know, I have a lot of pressure that's self-imposed about not letting the team down and not letting our country down around making the best of this 12 months.

Right. And no small feat. I mean, healthcare is a disaster. That's all anyone wants to talk about, Obamacare and all of this. And irrespective of your political proclivities, we can all agree that our healthcare system is in dire need of a reboot,

Web 2.0 style, I suppose. So you show up. You've been here three months. What's the problem? I mean, drill down for me. What's wrong with healthcare? What's broken? And how are we going to get on the path to fixing this?

So part of the big problem in healthcare goes back to those data silos that we were talking about a few minutes ago, that healthcare records from one entity won't ever get merged with another healthcare experience that I have. The amount of proprietary data silos out there is literally handicapping our system to the nth degree. And so the project that we're really focused on is a project called Blue Button. And Blue Button is really about empowering individuals with access to their own healthcare records in a digital format. So the idea that everybody in the country, no matter who you are,

should have access to whatever healthcare records exist about you. And those should be in a format that can allow you to take those records out of whatever system they exist in and move them into whatever system you want as the consumer. And this is a big idea for a couple of reasons. Healthcare traditionally has been very top-down in terms of how patients have interacted with the healthcare system.

And doctors traditionally know best in the way that healthcare has been. And for the first time, empowering people with their own records is basically saying, the doctor might know best about a certain treatment, but they're gonna be asked certain questions now that they've never been asked before

because we're empowering patients with access to their own records in a very transparent way that can enable them to really be an equal part of the healthcare team. And there's a lot of research out there that shows that when you empower individuals with their own health records, they not only take more of an ownership over their outcomes, but their outcomes actually are better and enhanced and improved. How did they figure that out? They have done some really innovative studies

out there have done exactly that. They've opened up these records and shared doctor's notes and things that traditionally have been behind closed walls or just for the health team, not the patient. And they've run controlled studies actually that show when you involve patients at that level and share the data about them with them and actually give them the data as if it was their own because it is, that this happens and they become much more engaged. There's a whole movement right now around the engaged patient. It starts from access to their own healthcare records. Access is not alone. Access alone is not going to change outcomes. Access needs to really be inside of a system that can make those data actionable.

And that's really what we're focused on is working with both public and private institutions, so with CMS and Medicare and outside federal agencies, whether it's payers and providers, to get on board with this philosophy and then use a structured way to format the data so that it can be interoperable across systems. So now I can take my claims information from, say, United,

merge it with my healthcare record from Mayo Clinic, and let developers, let entrepreneurs build services to mash those things up and create a way to actually make that stuff engaging and make it better. Right, right, right. And allow them to communicate between each other better. That's right.

And so the Blue Button project that I'm working on is really about accelerating the adoption of this philosophy and technology blueprint. Well, it seems so elementary to just sort of empower the patient to have access to these records and allow that person to make a choice about who they want to share it with. I mean, is there a resistance to this? I mean, what are you coming up again? Like, what do you, I mean, is there resistance to this? I mean, what are you coming up against? I want to peel back the layers here.

Where is it truly broken? Where are the points where you're coming up against these seemingly impossible obstacles? So a lot of healthcare institutions out there feel that the data about their patients is their intellectual property. And they actually, in a lot of cases, want to protect their patients sometimes from their own data. And I think that's a bit of a— That's very paternalistic and condescending. It is. And when you talk to a lot of patients, that's how the healthcare industry has come across, is very condescending and paternalistic. And so, you know, that rich history, you know, starting from the ivory towers of medical school has filtered their way into these conversations. And a lot of these organizations

have been resistant to changing that. Now, with some of the changes and policy levers that we have on our side, they're changing slowly. But it doesn't mean that they're eager to just open up the data in a secure way to allow the patients to move it within the system. But legally, who does own those records? The patient does. The patient gets to make that call. That's right. Through HIPAA, it empowers people with legal right to their records and in the format that they request. So for the first time coming up this year, some modifications have been made to HIPAA to make this actually real for patients. And they're going to start enforcing it. And I think there's a lot of progressive data holders out there.

So providers could be providing all sorts of services, whether it's traditional healthcare, could be a lab. So like, you know, organizations like Quest or LabCorp, Walgreens, CVS, they're providers of certain services that have health data about them. Some of those more direct to consumer organizations

have been more progressive in their thinking because they see some of the business opportunities behind it. And there's a lot of new developments in that area. So we're working as fast as we can over this year to really put some pilots together to demonstrate to the community that might be more resistant, hey, this is not only the right thing to do, it actually can impact your bottom line. Again, going back to the ATM analogy, if Wells Fargo 15, 20 years ago decided not to get on board with this interoperable

system, you could stick your ATM card into any bank, but Wells Fargo, they'd be left out of the whole loop. And that's a bit where I see things going. So it's going to take a while to get there. Right. I mean, what have you learned about our healthcare system since you've been at the white house that you were surprised to find out, or that somebody who's listening to this might not be aware of them. Maybe they should know, like, you know what I mean? I think a lot of people give the government a hard time for putting certain laws into place. And the one thing now that I've gotten the chance to work side by side with some of the policymakers, truly understanding

that they want the best for the American people and that their intentions are to do the right thing. There's so many stakeholders at the table that sometimes it's hard to please everybody. And I think that the policymakers are doing their best, but with the rate of technology going where it is, it's hard for them to keep up. And so I think that we're going to start seeing more and more efforts outside of the policy that are going to impact healthcare

more than any policy could. And I think that's an interesting thing. I don't think we can rely on policy to make all the changes that we need to happen. And I think that's an interesting thing. I don't think we can rely on policy to make all the changes that we need to happen. And I think it'll be the coming together of those two things that ultimately change the best, whether it's payment reform or other things that can help make some of the things

on the technology side more easily adaptable by these organizations. Right. I mean, it's got to change. And it's got to change. I mean, it's just, from a consumer perspective, just to simply engage the system, it's just, it's overwhelming, you know, it's completely Byzantined and archaic and frustrating beyond all measures and too expensive and, you know, every, you check any box. That's right. And I think for the first

time, possibly in history, we don't have a choice anymore. It's gotten to the point where not only can we not afford to keep going down the path we are, but when you walk down the aisles of the supermarket, you look around both at the people walking next to you and the food on the aisles, and you really fear for the future generations. And unless something starts happening today, it's only going to get worse. And we're seeing higher rates of heart disease and diabetes and obesity in the younger generations now that it's going to take some new thinking

and some new collaborations, I think, across the ecosystem, both traditional healthcare, consumer, brands, and everybody in between to really make this happen. Right. So when you come in, I mean, the problem is so massive. How do you decide what you're going to focus on? I mean, are you trying to just do one thing and execute on that? Or are you looking at all different kinds of things and throwing darts and seeing what sticks? So we spent the first couple of weeks really understanding this landscape and trying to

figure out what levers we could pull that would have the biggest impact. And we identified some very high value use cases that we wanted to be able to demonstrate, even in a very limited way, to be able to say, look, if we can give patients the ability to flag errors in their medical record and actually make those changes happen, that's a bit of a Trojan horse to a whole new level of engagement around getting patient-generated information back into the healthcare record. So this idea that we're generating all kinds of health data about ourselves every day, our phones are probably collecting terabytes of it all the time, that data could be useful in a certain context if it was actually

made available in the right format with the right level of interpretation. But today, no data can go into the healthcare record that's patient-generated. So just by the act of making it possible for patients to amend an error, which exists, we see that as a big Trojan horse to a much larger conversation. So if we can start chipping away at some of those use cases, we see a huge domino effect with where this can go, because we only have a year. And so we don't want to spend a whole lot of our time working on things that won't ever happen. But we think if we can start with some of these really high value use cases in a very

limited way and do them with institutions that are very influential, then we think that that's probably the right approach. Right. It's a great starting point. I mean, just simply, I mean, think about the idea that there's a piece of paper in a filing cabinet in, you know, my allergist's office from 20 years ago. And then there's a different piece of paper in my dentist's office. And there's a different piece of paper in, you know, somebody's oncologist's office, like, and none of those, you know, unless you root them out and find them, those, those things exist in separate worlds and are collecting dust. You know, your medical record should be one fluid dynamic document where all there's one repository for all that information so that any healthcare professional

that is treating you has the ability to look at everything and make a well-reasoned decision. There could have been something that came up in some appointment that you were at 15 years ago that could be determinative and something that you're struggling with now and how there would be no way of knowing that. That's right. Very well said. We could use you on our team right now. I'm ready to use you on our team right now. I'm ready to go to the White House right now. Give me the application. Tell me what it's like to go to the White House every day.

It's pretty sexy. So the project that I'm working on is actually based out of Health and Human Services. And so as one of the largest agencies in the government, the team that I work with on a daily basis is actually not inside the White House. Oh, so you're not going in the White House every day. Not every day.

We find our way there every once in a while, and it's always even a treat for us. We haven't met President Obama yet, although we've been told that we will, barring any disaster that happens on that one day that can't be controlled. Knock on wood that that doesn't happen. We haven't been inside the West Wing yet,

but there's a number of buildings on the White House complex that we go to, usually on a once-a-week basis, that we meet with all the fellows to learn about what we're all working on. We present to each other. Oh, that's cool. It's very cool.

It's humbling, and I pinch myself pretty much on a daily basis that I'm getting a chance to work with such talented individuals that come from pretty much everywhere in the country and are all working on very different things. Name one of the sort of mind-blowing cool things that one of the other fellows is working on.

I think- I put you on the spot. Yeah, no, this is great. So there's a team, Jeff and Sokwu are two fellows that are working on cyber physical systems. And no one, trust me, you don't feel bad about not knowing because none of us knew what it was. And they didn't even really, I think,

know what it was when they came in. It's essentially when you think of the internet of things. So everything now could be a connected experience. Almost anything you touch could have a sensor in it. Everything is wired. But a lot of things aren't necessarily talking to each other. And so their project is really to figure out how and in what way things should talk to each other to maximize the way we live our lives. And that is a mind-blowing project when you think about all the things that you could connect to each other to have some sort of impact on the world. That could be manufacturing so that computers are more optimized.

That could be in healthcare so that medical devices are actually connected to other things that could trigger alerts that otherwise would never happen. alerts that otherwise would never happen. And then what's interesting is when you think about connected devices within these verticals, whether it's healthcare, transportation, manufacturing, what happens when they're all connected? So all those industries can actually talk to one another. Right, it's sort of like looking at our society as a living, breathing organism

and the internet is sort of the circulatory system, but how do you sort of enhance the nervous system? That's right. That's pretty cool. It's mind-blowing. And these are engineers with years of experience working at levels far beyond my comprehension to figure this one out.

And I think that's an example of a project that obviously isn't going to end at the end of their term here. That's not a one-year deal. That's definitely not a one-year deal. And so for them to be able to put a ball in motion that could hopefully jumpstart some momentum that could really, I think, chart a path

for how our world could be connected to really improve our lives is a really powerful project. Cool. Yeah. So where's this all going? Well, I'm trying my best not to think about what next year looks like

because I have too much to focus on to try and impact my project so that at the end of my year, not only do I give something for President Obama to talk about, but that I feel good that I put everything I possibly could in trying to improve patients' lives and our society from a healthcare standpoint and the best of my ability. So I'm basically looking two months out. Every two months, I kind of reset expectations for myself. And I'm leaving all my options open for next year. I haven't determined what next year is going to look like at all. But I know that it's going to involve trying to do things that no one's really ever tried to do before to really enhance people's lives. And I think health wellness from a consumer perspective is something that's dear to my heart and something that I think we haven't even scratched the surface of. So I think I'll be spending a lot of my time next year, hopefully with some new ventures in that

space. Right. Cool. And if you were to look back five years from now on the state of our healthcare system, what do you think we can accomplish and what would you like to see in terms of change? I'd like to see payment reform so that we are paying health systems for outcomes rather than procedures and treating that with a team-based approach that could be modeled after a lot of the work that's being done at Mayo. That's right. And I think that sets the foundation for the incentives to be aligned across the industry where we can now think about interoperable data in a new way and what it means for organizations' business models to share information in a new transparent

way. And I think whether it's through Project Blue Button or other initiatives that are actually making that data interoperability happen, that's a very powerful thing. So I think if I could wish for two things and look back on in five years, I'd love to see both of those things happen and then have the unintended consequence be more transparency in the system that empowers consumers to really take ownership over their own health like they've never had an opportunity in the past to do so. That's pretty good. That would be my wish. I like that. Yeah, we got to figure out a way to get you involved in it too. I'd love to, man. What do you think I'm doing here? Now we're talking. No, cool, man. Well, I think it's a great place to

end it. That's inspiring, man. I appreciate that you're here doing that. We need you. And it's great work, man. Well, thank you, Rich. I really appreciate the opportunity to be on the podcast and to be able to meet you in person finally and to hear your story this week too. The feeling is mutual, man.

I'm fascinated by what you're doing and we need more guys like you, not just in the White House, but in healthcare, in health and wellness. And we need more technology disruptors to come in and figure out how we can reconfigure how we're doing things because the way we're doing them is not sustainable and not heading us in a great direction. So thank you. Well, thank you. All right, man. All good. All good. Yeah. So if people want to check you out and follow your journey and learn a little bit more about what you're doing, you're on Twitter. It's I'm on Twitter at Adam Dole. Yep. All one word, Adam Dole. And, um, yeah, follow me there. I talk

about a lot of these things and, uh, love to engage the community around it. Cool, man. Is there any kind of website for the program that you're doing at the white house or is there any kind of consumer information about that? There is, there's healthit.gov slash blue button is focused on the project that I'm working on. They don't make it. That's the first thing you have to disrupt. Who's going to remember that? I know. Come on. Come up with like. We're pushing for blue button. You need a new URL for that right away. That's one of the projects. Wait, say that again. What was it? HealthIT.gov backslash blue button.

Okay, that's not too bad. Not too bad, but we're working on that. We've got a couple in the works, but we haven't secured the URL quite yet. And then if you want to look up the Presidential Innovation Fellows, it's right on the White House blog. You can check us out there.

And they're actually going to be accepting applications for the third class this winter. Cool. Yeah, we need more disruptors in healthcare. All right. Well, all right, everybody. Get out. You need to start applying.

That's right. Everybody's listening, right? All right, cool. All right, man. Well, thanks for your time. Thanks, Rich. All right. Peace.

Plants. plants.