Healthcare at the Speed of Life: How Tech is Changing the Game - Ephraim Makuve

[0:00]  all right everybody welcome back to another episode the heart and hustle podcast I'm incredibly excited to bring my guests to you today because he's overcoming some huge challenges in healthcare when it comes to the patient experience but more importantly how people navigate their Healthcare experience today I've got Ephron the CEO and founder of hutano thank you so much for coming today man I really appreciate it thanks a lot Keenan I really appreciate it so one thing I was looking at was your background so you started as a physical therapist so what was kind of your drive to get into the PT Space in general and then what type of challenges do you think you were overcoming in entering into that space you see any gaps in the marketplace or needing to meet patients with better I would say Physical Therapy what was that like for you yeah so you know if you go back like

[0:48]  maybe 15 years before I became a physical therapist I was actually an I.T okay so Physical Therapy was a um there's a midlife crisis at 33. that's not to say I'm going to live to 66. yeah I'm planning on going further than that but anyways it was um at 33 I just decided I'd had enough of it and I was going to move into something else and medicine was the first uh stop and that just didn't fit my my bill Physical Therapy became the thing that I wanted to do and part of it is just uh the ability to bring Wellness without medicating people and just trying to optimize people's body movements because it turns out at the end of the day what really matters no matter what is can you move and if you can move can you move optimally so that became my that became my my heart and soul at the point yeah yeah and one thing I notice is when

[1:37]  you're dealing with in the PT Space in general you know I had a major knee injury back in 2019 ruptured my patellar tendon and had to go to PT for the first time to actually like recover and that entire experience for me was very scary because it was the first time that my body really let me down and I really leaned on my PT to show me that like it's okay I can rebuild this muscle and actually kind of get my Mobility back as well right was that part of your overall Wellness experience and trying to help people get back to where they were yeah so it's love and hate right I mean your PT you're gonna hate them because they cause pain but at the same time but yeah that's that's exactly you know uh the the drive for most pts and definitely myself as well is um getting people from those kinds of injuries and then getting back to their normal life whatever normal

[2:23]  life looks for you uh being able to restore uh mobility and get a person back to you know I'm sure you're back to fully recovered now uh but definitely that that's that was a big drive at the time I was getting back into sports uh so seeing people recover from an injury back to making money doing sports or otherwise was always a drive for me yeah were you dealing with like professional athletes when you say making money no uh so my uh my initial group of people that I worked with were was Pediatrics so I worked with little people literally from uh birth to to 18 years old um and within that there's a lot of um either diseases that they were born with that they had nothing to do with except for nature and then of course they were very active young people you know from

[3:11]  baseball throwers to you name it so getting them back to help and back to health and then beyond that I went into the opposite side which is geriatrics they're really old people and interestingly enough you know people over 65 uh getting closer to that age so I shouldn't say too much about them people but uh it's they are athletes in certain ways right being able to play another another round of golf is more meaningful for somebody who's 65 than someone who's say 45 uh 45 you can always rebound and come back but at 65 you're going this might be the last one so um that those became my athletes um and then later on in life is because I'm a runner I've spent more time taking care of Runners and optimizing uh their running abilities for as long as they

[4:00]  can but I didn't start off with with athletes yeah so do you have like a an inspiring story where you help somebody kind of overcome some of the challenges that they had and then when they first engage with you but then after they were kind of like in their best self again yeah so I was just sharing this story uh with uh with Tasha just just so this morning and we had a gentleman back in my very early years I think I'd only been practicing for a year we had been told that he could never walk like walking was just out of the question completely and as a young therapist you always think you can change the world and yeah sure enough when I met him he was showing just a little bit of movement this gentleman was about 70 years old long story very short with just sheer determination on his part in my part uh we were able after seven

[4:47]  years of not walking we're able to get him to stand walk eventually drive his own vehicle so it was the it was this the the turning point for me I always knew I was I wanted to be a physical therapist but after that I knew this was my calling it wasn't just a job that I was doing so that changed in somebody who literally had been convinced by everybody in the medical field that they were not going to walk and then all of a sudden their family and you know are seeing them walk and drive their own vehicle was just amazing oh my gosh that must have been such an emotional experience oh it really was it really was I tell that story to my students all the time like you know this this what What patients were told they they hold on to the to their heart so if uh if a physician or a physical therapist tells a patient you will never walk again

[5:34]  people internalize that and they'll take that for a lifetime and sometimes you cause them to be disabled when they don't need to be disabled yeah um and then comes somebody who challenged challenges that thought process and says maybe we missed something the first time maybe we're missing something right now but turning somebody's way of thinking from I couldn't walk I can't walk I will never walk to maybe there's something here I think that's the power of being a physical therapist is that we're we're willing to look at those incremental movements over a very long period of time and then wait for the big win which usually takes a very long time to come so it's it's an amazing profession when it comes to that yeah I mean it's amazing that you help people kind of compound little achievements until you get that breakthrough right you know

[6:20]  what I mean like that's super powerful for me one thing you said there was you know the role of a healthcare professional in general and helping people kind of challenge those World Views so one thing I know as well about you is that you are an adjunct or an Adjunct professor at Toro University that's correct so one thing that I think is amazing about that is you're not only impacting the patient experience and helping them change their world view but you're also molding the future Healthcare professionals that come into the space as well that's correct so what let's talk about that mindset perspective because I know Healthcare in general today has become a real I would say churn business right we get people in we get people out and sometimes the role of a healthcare provider Healthcare professional is to challenge that world view so how are you influencing the mindset of new healthcare professionals that are coming into the space what is the emphasis of recognizing that their

[7:08]  patients are humans and that you have to kind of help them navigate what is like your mindset when it comes to influencing the new generation yeah so I think um Keenan when you're talking about your knee um when you had that injury that was your first time that you had had an injury of that nature and I'm sure a lot of things were going through your mind you know am I ever going to run again walk again am I ever going to do the things that I was able to do again you you were in a state of confusion about what the future looked like as a physical therapist who's been doing what I do for a very long time this is probably if you had come to see me I would probably would have been my 100th time that I've seen something like this so this is where you start when you educate young clinicians is my experience as a clinician having seen

[7:56]  this a million times with the lack of uh better terminology it doesn't should not translate into what the patient is feeling because this is their first time so you have to bring yourself down to being that is their first time that they're going through this how are they feeling right now and how can I get myself to the point where one I can encourage them to to keep on going um have them realize that what they're going through is nothing different or out of the ordinary for people who have gone through an injury like this and then reaffirm them that I'm gonna be here every step of the way when it comes down to it that's I I tell my my students that a simple gesture like putting your hand on your patient for the entire duration of the time that you're treating your patient

[8:44]  reaffirms that I'm here and I'm not going anywhere um if you pick up bad habits like turning away from your patient and writing everything or getting on your computer and typing while your patient is you know doing whatever it is they're doing back there yeah you've disconnected from the patient but looking at them in the eye uh giving them that confidence that you are there and then making sure that they get time to ask questions and you have the answers and if you don't again don't make stuff up just tell them Hey listen that's a good question not the guy but I'm going to find an answer for you so my my role in molding the next group of or the next cohort of therapists specifically is to have them realize that the human being that's in front of you has put all their trust in you but also realize that they've been let down by so

[9:31]  many other people like you they there's there's a physician there's a uh there's somebody who came in fluid and flew out didn't explain a thing but you have an opportunity to make that right and this is your opportunity you do it right not only for yourself and your patient but for everyone else who's coming and not answer the questions and giving the right answers that they needed so that sense of empathy is something that I think is so critical especially as a clinician a healthcare professional in general recognizing that like you said this is the first time that somebody's coming into a new environment it's scary right you need to build that trust is super important I want to use that word of empathy to kind of start pivoting towards your Venture of hutano so empathy in healthcare super important not only from the clinician patient engagement perspective but also the

[10:19]  entire experience right and I realized that in order for us to create the best Healthcare experience we have to have empathy for everybody as they go through the entire process correct so you coming from an I.T background what type of problems did you recognize in the space when it came to the patient experience and just overall patient Journey that made you kind of create hutano in the first place and what type of challenges were you looking to kind of solve with that how much time do we have we got a lot of time I know I it's and that's a very good question uh you know from an I.T standpoint I think what was glaring in my face as soon as I walked into Healthcare was the inefficiency of how the code was written so I give an example of my first electronic medical record system that would not let me write more than 256

[11:07]  characters in a box well for those of us who are computer Engineers we know that that's because you use the wrong input type and this was way back in the day you used an input type that allows you 256 characters you need to find one that gives you unlimited number of characters but this was a problem that um clinicians that just come to live with and say it does it's just the way it is I said well if the story I need to tell about my patient is more than 256 characters what do you want me to do so we We There were so many of these examples of problems that were fixable but the problem was they the the the solution was made by someone who doesn't take care of patients and they don't understand that I do need to tell my

[11:56]  story about what's going on with my patient without any limitations of number of characters right um and the people who approve the software are people who don't know anything about Computer Engineering or software engineering so they look at the solution and they go oh that's the way it is yeah this car has two wheels and that's the way it is we're just gonna drive it like that and you go no you could put four on it and that that'll be much better this is a motorcycle isn't it so anyways that's you know there were many examples of that and that that kind of that's what propelled me to uh let's just do something about it I can't fix the problem but I could create something that makes more sense right and it takes um a real sense of confidence in yourself to challenge the status quo because my experience in healthcare got started back in 2014 and I recognized that the healthcare

[12:44]  Solutions especially from a tech perspective as a documentation tool in EHR has always been created in a vacuum like you said created by somebody who's not in front of the patient and you have a unique background and skill set as a somebody who's in I.T who can actually write code and recognizing there's so much room for improvement here right so what is the mindset was there like a critical moment where you're like enough is enough we can't deal with this anymore walk us through kind of like that aha moment of like I got to do something about this problem yes so um it was really kind of the the time when uh Uber came around and I just said life has changed man you know all of a sudden I'm getting the same treatment that the very wealthy used to get where they could just call on somebody to come pick

[13:30]  him up like I want you here in five minutes yeah and and I'm like gosh I remember the days when you would call the the taxi company uh the day before to come and pick you up at four o'clock in the morning everything was scheduled out right it was scheduled out the guy showed up just about done here killed you on the way to the airport he demanded a tip and the car was not great it was you know there was a barrier between you and the driver and a little tag that said what his name was it was a very uh the experience was just not great right and all of a sudden I have uh this experience where the driver says is the temperature okay yeah okay are you because this is nice and by the way is less

[14:19]  expensive than that taxi ride that almost killed you to the airport um The Experience just changed my way of looking at how we solve problems and was there a problem with the old taxi system no actually it worked fine they picked you up and they dropped you off if you're if your objective was to get to the airport they got you there right but this new experience change not only the convenience of when I could get a taxi but also created a whole new industry for people who had cars that are sitting in the driveway doing absolutely nothing right yeah those people could be put to work um that's when I said Healthcare has got to change something about the customer experience as it is right now where you wait an average of 22 days to see your primary care provider and only to get

[15:07]  5.2 minutes with that doctor when you get into the clinic 5.2 minutes yeah that's a 22 day weight yeah in Boston in 66 days I don't know what's going on East Coast but but it's a long time it's a long time so and in that period of time you've got options right you know if because you as you know you have something happen to you right now you believe you're gonna die yeah so the only option is to go to the most expensive point in the healthcare system which is the emergency department and that's why they're inundated with cases that seemingly to medically trained people are not emerging situations yeah but for me as the patient on this day this tour that I just hurt might fall off right I'm going to go and get assistance like right now so

[15:54]  that's that was really the it's that time period that changed my way of thinking about the patient experience how can we change that but also on the back end the clinician experience wasn't that great we were spending so much time documenting defensively for that matter right um the average now is 16 minutes of documentation versus the 5.2 minutes of seeing the patient so it's three times as much time writing stuff as it is actually seeing the patient so it doesn't make any sense no if we could flip that over that would make sense 16 minutes of talking to a patient for five minutes of documentation would be great but we're we're trying to shoot for something even better than that where patients just get enough time to uh to to have face to face with it with their doctors yeah and build that relationship that trust is so important exactly so here's a question for you so when you

[16:42]  recognize this problem in the patient experience customer experience of Health Care naturally did you go to the place of thinking that you had to build an entire new system of how we interacted with patients instead of going Tech first did you ever have that type of like mindset hmm because often like when I think about change in healthcare naturally it almost feels like we have to move a mountain right to do things differently so changing the way we Access healthcare trusted advisors we access trusted resources right has always been a very human capital intensive like you talked about we only from an education perspective as the patient know that we should in emergency go to the ER right right right and changing that mentality of the patient experience in itself seems like we have to reinvent the Whole Health Care System yeah it's the big challenge so

[17:29]  it's it's a and this is what we were told in the beginning you know you are moving a mountain it's in a everybody who's been in this space has so here's to who's telling you this this is everybody from investors to anybody that you talked about I'm trying to build a health tech company I mean they they look at you and they go you're trying to build the moon on Mars that's what you're trying to do this is this it's difficult it's complicated that companies with Bigger Pockets than you that have tried this and have failed and then you go back and you go huh Airbnb that didn't even exist many years ago yeah and there are many big companies that could have started this company that didn't so why not now right um so what we found that was really interesting was um nobody ever defined what accessing Healthcare actually is like when you

[18:18]  tell me it's difficult tell me what is what what are the steps and what are the difficult parts of each step I never heard that story at all you know everybody would just go straight to insurance company or you know insurance companies I go no well but it's a transaction between a patient who needs a service and a clinician who can provide the service you're telling me that is so complicated that we can't get these two together and and just do what they do I can call my plumber right now and say my sink is clogged he does his thing I have the money he comes in and we do our thing or she whatever but you know that's that's so that's how we looked at it was to go back and say what is it that we're trying to solve and once we defined it yes we had to recreate the whole thing from top to bottom because

[19:06]  of constraints that we shall discuss in a little bit I mean so like my question is is when we're creating a new Venture right there's almost like a peak and a valley that people go through and you're starting a new initiative often it's uninformed optimism because you're like we're going to change the world and then you start getting in front of investors people have been in the space I would like to call these people Legacy mindset holders right who are like you guys need to kind of tone it down because you're trying to build the moon on Mars like you said that creates an informed almost like pessimism of like oh maybe this isn't going to be as easy so how did you kind of fortify your mindset and the team's mindset to be like we're tackling a challenge that's going to be worth it and this is why we're going to be tackling this what was that like for you guys so I spent about 400 hours of listening to podcasts from all kinds of business people from

[19:54]  Bill Gates to um Brian chesky I mean I in some of the stories I can remember like almost word for word because I listened to them at least three or four times and I found out that the people who really changed the world are people who go against the grain So based on that I realize that they are very intelligent people who just don't know what they're talking about and once you get to that realization that there's an investor out there who has you know billions of dollars deep in their pockets but when it comes down to your business and your passion and what drives you to make what you're making the advice as good as it is they just don't know this space as well as they think they do I am a clinician

[20:44]  and I'm an I.T guy that's gotta mean something so the confidence you build in yourself that I think I know this problem better than the guy that's got Deep Pockets but has never treated the patient before and has never written a line of code but has looked at many many businesses in this space and this is the conclusion that they've come to you have to dig in at some point and say this is my vision this is my road and this is where I'm going and along the way you are going to start converting some Skeptics especially in the investor world that go you know what I'm gonna go with this guy I know he's crazy in thinking that this is going to work but you know why not this you know he looks confidently crazy let's do it I think that's um something that is incredibly powerful and two folds there because you have to challenge the world view that people have if you're gonna do things differently right I always love

[21:30]  going back to the quote of like if you do things the same way you're going to get the same results and doing the same thing over and over and expecting a different result is literally Insanity exactly you know defined by Einstein himself so your role as founder CEO right you kind of have to be that evangelist that crazy person who believes enough in your idea to convince others were there ever times in the early days when you kind of came against resistance and had to kind of like have that conversation with yourself of these people don't believe but I'm gonna make this happen anyway what was that like oh my gosh we had so many of those so um I remember a gentleman that I had a meeting with and he was uh affiliated with uh uh az16 that's the he knew the people in that organization that have the big

[22:19]  money right I mean you're talking and recent and Horowitz and you know these are you know billion dollar guys um and I had this meeting with him and he says what you really need to go is you need to go to billing that's where the money is and I was trying to be really kind I said last night we don't have any domain expertise in that which is another way of saying I'm not doing that it's not my thing he says but no I I have uh I have names of these people if you are doing billing they would be very interested I said um still we don't have any domain expertise we're not doing it so many I would say Founders and entrepreneurs end up caving to right which is a huge problem yeah somebody with a checkbook says I believe you guys should be moving

[23:06]  in the this direction it kind of takes you out of alignment I call it found a prostitution you know okay you sleep with a guy that has the money under the terms like uh yeah [Laughter] but it's it's uh so in the Continuum of your company from inception to wherever you end up if you keep on prostituting uh the next person that has a big check comes in and gives you a great idea you run with that idea abandoning some of your core beliefs and where this company was supposed to go in the first place you can only do that for so long again like prostitution you will never feel connected to the vision of your company you will always be wavering so I think there comes a time where a

[23:55]  Founder has to say I would rather have failed having run this Vision my way than succeed on somebody else's terms and that's kind of a place I reached a long time ago that's a an incredibly powerful mindset to come to but I know a lot of people don't have the mental fortitude to do those things especially in the world of like trying to raise money right right always trying to convince somebody and I feel like sometimes it's easy to get off of our why right in order to get people to like you said kind of come and lay in bed with us so we don't use their money in their their resources right right exactly exactly and you know we we find all kinds of um reasons why it's okay to do that but in the long run I've never found it to be satisfying having taken somebody's check and and then go man we'll do this thing to satisfy the check they gave me even

[24:45]  though I really hate this thing yeah well there's there's a reason why I'm I'm a founder of my own company and I'm not clocking in and clocking out somewhere else is because I decided to do something I enjoyed doing yeah so to to betray yourself like that is is something that you will regret eventually if not now you will eventually regret it absolutely let's talk about kind of the vision for hutano and how do you get other people behind your vision for impacting health care so what were some of the early conversations that you had with team members early Founders co-founders or whoever's a part of your team what was that kind of like of articulating the vision for a better patient experience and all the things you guys do at hutana yeah so I think the first the first cell we had was um

[25:31]  and everybody can just relate to this how long did it take to see your doctor the last time you went to the doctor and they go they look at you and they go oh my gosh it's almost like picking at a scab that was starting to heal right they just it's just painful um and we I I would walk through solutions that are already in the marketplace everything from Uber to GrubHub to whatever and I say you're telling me that I can get my pizza in a predetermined time but I can't get my health care that is more important than my pizza what is the difference between those two and so breaking it down especially for my co-founder uh Scott I just say come on Scott there's got to be something we can do to get a patient in front of a clinician as quickly as

[26:18]  possible and we found out that most of it was just really a mindset like yeah people just believe this is the way it is you go to the DMV you just expect to sit there for like three days before anybody sees you yeah true that's true and we're saying does it really have to be that way I mean could they just send me a text three days later and have me come right and and wait for five minutes yeah they could do that but you know it they I guess they like building big buildings and having people just sit there and sit around right so we just it's the self from me to my to my initial investors uh was was was clear and palpable to them and especially those who are clinicians they really knew the the pain points of trying to document and trying to get all these things together uh the

[27:05]  team members I didn't have to do much selling at all I mean everybody just was like if we could make this work let's make it work and at that time I had kind of a nice little prototype that kind of showed you click here you do this you do this and everybody was like yeah I think this might work yeah it might work which is a huge nod to you know tackling a problem and being able to present an idea and getting people to buy into it right you know what I mean when you're comp when you're tackling a common Human Experience like I would do the exact same thing what was the last how long did you wait for your doctor last time you went to the office naturally that creates all the emotions and all the feelings of like I had to get a babysitter I had to cancel a meeting I went in there an hour early I waited in the waiting room for 45 minutes and only see my doctor for 5.2 minutes right right right right which is crazy return on investment is pretty poor it's wild

[27:52]  and it's crazy to think that we've been operating in this space of healthcare for so long and there's not Innovation like what you guys are doing to be able to kind of push us forward right and and that's that's when we when we demo this like we just did yesterday to a group a couple of investors it's so simple yet you're asking yourself are you really telling me nobody else has come up with the solution and we go no not really it's just it's just uh something that nobody has really thought of doing or doing it to this extent um it's a world we live in so thanks because that kind of helped us get where we are yeah absolutely so let's talk about kind of how what pieces of Technology you guys have integrated into the platform the I would say normal consumer experiences Uber was a great

[28:41]  example that you gave in the very beginning what type of elements are you trying to bring into the patient experience that makes you guys so different yeah so the first part is using um the um very curated search features because if you think about the friction that we have with getting to a doctor in the first place walking to a new city you don't know anyone you have an established a relationship with anyone not you don't have a plumber a roofer or anything you don't have a doctor right if if we say if if you hurt yourself you're not feeling well in the middle of the night and everybody says go see a doctor how do you find one it is difficult I mean that's that's it's almost an impossible task so people are left with

[29:29]  um you know you go to Google Google shows you the people that paid a lot of money yeah SEO there at the top but they're also 15 miles away from your house uh and they're not taking any patience and you don't know if they take your insurance I mean there's all these barriers so it leads to a bunch of phone calls that lead to nothing so the first thing we we said is that problem needs to be fixed it's already been fixed in other places right so we just took solutions from other Industries and we say okay so I should be able to go in and with my app or the website just going and say I'm looking for a doctor who practices Family Medicine Show me the ones that are within a five mile radius of where I live boom there you are or I don't know what I'm looking for but I'm looking for somebody who works on I don't know skin when you type that it shows you people

[30:17]  that do Dermatology and other Specialties that work on that part of the body or maybe you just you know the name of the doctor somebody told me was a Dr mccube somewhere type in makuve and boom there he is so that's the and that technology has been around since oh my gosh since the 2000s right and then from there on well I found them now what I need to book the appointment but I also need to find out can do they take my insurance if I don't have insurance or I have the high deductible um how much is it for me to pay cash all the cash prices I I displayed including the insurance wow I get to make the decision on whether I'm going to pull the trigger on this or not again I'm saving the clinician a bunch of money in employing people to pick up the phone and answers

[31:05]  stupid questions questions that really can be answered by uh by a platform right and isn't that what we expect as modern day consumers to be able to go out gather information and make knowledgeable decisions rather than having to play phone tag and call around and check for insurance and is this okay and blah blah you know what I mean and not and even further than that the the overhead that's involved in answering phones and um just all this stuff that goes on in the back that we call back office and Clinics is so expensive but at the expense of the patient because there's only one person who does the pain in health care it's the patient nobody else so if they have a team of 50 people in the back verifying insurance and and answering calls and all that all that cost you bundle it all together it's going to be

[31:53]  put on the patients yes so that's the you know trying to illuminate that to to Physicians and clinicians who typically don't get their degrees in tandem with the MBA it's usually go out there and figure out how it works and the only way it works or the only way to mitigate for any expenses is to just hire more people and see more patients um so back to um our problem of now that we've gotten the patient we figured out what insurance is the doctor takes how much it costs I'm okay with this doctor I've reviewed all the user reviews from other people who've you know they have Raven reviews of this guy he's just two miles away from my house now the next the next problem is can I book an appointment

[32:39]  well you can see the schedule and it's right in front of you they're available tomorrow at three o'clock if that works with me I'm gonna book that time but the biggest problem that we find is paperwork I booked the appointment I come to the doctor's office now I'm going to sit for 45 minutes watching HGTV yeah and just filling out stuff right so what we do next is just have them fill out that paperwork on the platform it's just interactive like you know what hurts left right whatever you go through the whole process by the time you're done you literally have everything and more information than you would have normally had when you went to the doctor for the first time we are asking you questions as if the doctor was asking the question um and the doctor is having a heads up

[33:28]  on what's going on before you even walk in you have to review what's going on here you get to know what you're up against before your patient even walks in again adding an element of efficiency that doesn't exist in this industry at this point so that's kind of how we went through the process of figuring out what needs to be solved where and then how do we prioritize that and the only way that it's been done up to this point is find one problem fix that problem and then hope that somebody else is going to fix the next problem down the road and that you can interact with that software in some ways and and that's where I lost a lot of uh big money investors who I'm sure they will come in when we have an IPO but with a smile on your face because they kept on saying ah you're doing too much

[34:16]  this is way too much yeah but but the fact of the matter is you cannot build a healthcare platform without solving all the problems in whatever space you're solving we're solving for outpatient care if you're going to go into the hospital system you cannot solve it by just solving for one problem because who's going to solve the other problems and what if the company that's solving the problem too down from where you are goes out of business in five years time then what I mean this is the exact problem that we see in healthcare in general right these Solutions are problem oriented they solve it in a vacuum they roll it out to a Health Care system or a provider themselves and they say good luck with the next problem so I love how you guys are tactically kind of tackling all the challenges that a patient could face as they're coming into the office which creates a better Continuum of experience long term which is incredible because how many times and

[35:04]  I just want to go back to it have I shown up at a doctor's office and unfortunately they don't have the paperwork that I filled out previously and now I have to sit there for 35 minutes and I'm past my appointment time then I get into the doctor it's just like a compounding effect of inefficiency right and I really see you guys tackling all those challenges yeah and I think my um when you look at it more globally and this is where I think public officials need to look at the problem holistically and see how it's impacting this country I mean you go back to the DMV problem right when you have 1200 people sitting in the DMV for an average of six hours the multiply all that out and those are people that could be making tacos and filling out potholes they could be doing things that really have an impact in the

[35:53]  world but here they are sitting literally looking at something that says G22 at window number three why why are we doing this for this long so same thing with Healthcare you know um you and I are fairly young that we can navigate the system and be boisterous enough to stand for our rights but we have senior citizens who are in the 80s and 90s we have way more problems than we have and we are demanding that those same P those people at their ages should get in a vehicle drive to a doctor's office do all these things that we find very difficult and do it three or four times every single month

[36:40]  and we wonder why they end up in the hospital so many times it's because they just say you know screw it I'm just gonna stay at home if it gets really bad I'll call 9-1-1 the firefighters are good looking they'll come pick me up off the floor one of my patients used to say that a firefighters are very good looking they'll come pick me up so it's um it's a self-perpetuating problem that really has an impact that's far reaching into the economy of this country because there's a lot of unproductive hours that are spent with people sitting doing absolutely nothing when they could be doing something else yeah and one of the things that you know I think about in general when it comes to the adoption of technology is often there's a perspective that especially in healthcare because it's been the way it's always been we have to continue to

[37:27]  do the same things that we've always been doing right it's going to give us the same results right and when you hear about Uber or we hear about these other Technologies these are not things that have just like popped up all the sudden but now we have a demographic base of people who understand how to use these Technologies but we've also experienced the efficiencies that they create in our lives right so why should we not integrate those experiences into the healthcare platforms that we go to engage with our trusted Healthcare Providers right right and I think that's only like the next step and I think we do people a disservice by expecting them to do things the old way when the world presents it in a more efficient manner right right right no very very true and um and there are sectors of Health Care that have done a good job uh you know if you look at cosmetic surgeries for

[38:13]  example yep mostly because those are cash-based businesses that don't depend on anything but the capitalistic forces of this country that say uh if you you have higher efficiency you can lower the cost and you can attract more business if you're more efficient and you can provide better service you're more likely to get more business from your existing customers whereas regular Healthcare works like um the IRS um you can always text more yeah okay you don't have to have good service at all it's it's what are your options here right it's the IRS or the IRS and and if you if you don't we put you in jail and in this case what choices do you have with your Healthcare I can't shop around I'm not feeling good uh if the ER is packed and the wait time is is is 14

[39:03]  hours it's 14 hours I can't change that yeah um whereas technology without changing much can change the inefficiencies that already exist in the system and shorten that 14 hours to sometimes 14 minutes you'd be surprised at how much of that 14 hours is really just inefficient there are people who are sitting in this ER that shouldn't have been here in the first place they are sitting in front of people who really need to be here right if technology could shuttle and put people in the right places at the right time the person that has diabetes that's uncontrolled that's now in the ER if that person could have seen their primary care physician say three or four months ago on time and regularly enough they wouldn't be sitting in this emergency department so that's where technology holistically starts changing the narrative on and start moving the needle on on public

[39:52]  health and what we're seeing as a problem in the US right now absolutely one of the things I want to talk about and this is something that caught my attention when we first started speaking together you mentioned a feature inside of the platform of notifying your doctor when you're on the way a simple efficiency but from my perspective as a patient as a healthcare consumer makes so much sense right so why don't you talk about like that feature in general and how it impacts the overall experience of both the healthcare provider the clinician but also the patient as well yeah so uh this this came as a um one of those I I woke up in the morning I said waiting rooms make no sense to me like this is this is if this is real estate that just doesn't need to exist Because by the time somebody comes to your office you should know they come into your office and they shouldn't be there so long that they're drinking cups

[40:43]  of coffee okay this is these are all resources just just get them in get them to do the business they need and walk away so the way it works on our platform is well once a patient sets up an appointment with the provider we send them a series of notifications if it's outside of 24 hours you know within 24 hours hey you got an appointment with Dr mccube are you going to make it to this appointment if not please reschedule the appointment here's a click here's a button for you to click to reschedule so we make it super convenient for them to just do what they want to do and without having to pick up the phone but when it comes to that two-hour window where they're about to go to the office we send them one last notification that says hey it's going to take about 32 minutes for you to get from here to the doctor's office so you guys have a map in your correct as well correct yeah so we're

[41:31]  Geo mapping between the doctor's office and and the patient and so they go okay well I guess and and then we just tell them when you're ready please uh click here to let us know that you're on the way and sure enough the first time it happened with one of my patients I was like this is so cool so then they basically open the app and they click I am I'm driving and as soon as they do that the office gets a notification that says yo patient Keenan is on his way which gives me as a clinician not only a heads up that my patients on their way but get my act together I got 32 minutes for this guy to get here I don't want him to sit in my waiting room doing absolutely nothing right if I'm backed up say 15 minutes or 20 minutes behind I can just text or I can call the patient in the platform and say hey why don't

[42:19]  you hang back about 15 minutes we're not ready for you yet right the main reasons why patients would patients would need to come in early don't even exist anymore in hutano they've already filled out their paperwork they may have even taken their own vitals at home they don't need all this stuff they don't need to come in and just sit down and do nothing uh and then when your patient gets to the clinic they just push a little thing that says I've arrived which is a way for them to check in now what's really cool about this I kid you not I borrowed this from Amazon because when you look at your package right it shows you the thing is the order has been placed yeah and then it shows you it's being processed this is a little line that shows you it's shipped and nowadays they have this thing that says it's on its way and they tell you it's four stops away from your house so I literally I I didn't have to recreate the wheel I was like wouldn't

[43:07]  that be nice if as a clinician I could see where my patient is in their journey to come to see me and then once they see me where they are in the journey to getting their documentation or the next step so that's basically how it works I mean it's uh I have a big belief in modeling right modeling what other successful businesses have done for the overall consumer experience and then integrating those tools into your overall experience you know I mean like success leaves Clues you're right right Amazon is so successful they're obviously leaving clues about their overall experience and why should we not be modeling those things into things like healthcare why reinvent the wheel I mean they did a good job of it I it's a feature that I enjoy and not only that it's a feature that's now become familiar with a lot of people right everybody knows how that works you look at your app and you go oh yeah my

[43:54]  package is four stops away from my house we're good so how about looking at your app and going my patient is is is five minutes from getting to my office I need to get them ready that to me just makes a lot of sense I mean it's just like the common consumer expectation you know what I mean and this is where I think organizations and Innovative platforms like kutano really have an opportunity to make an impact because it's taking the common experience that we have on a daily basis and then putting it into Healthcare right that's something that people have been asking for for so long but that Legacy mindset of this is how things have been done forever is going to give us the same results that we've always done very true what got us here will not get us there yeah so as we kind of start pivoting towards the future so what are some of the challenges that you're facing in healthcare right now I know we have a

[44:41]  lot of elements when I kind of referenced this earlier but Healthcare has become really kind of like a turnover a churn business get people in as quick as possible when they get them out you're helping efficiencies from both sides of the patient experience but also the provider as well which is incredibly powerful but how do you think some of the I would say business forces of the marketplace are fortifying the need for your guys's solution so I kind of say that to say in our earlier conversation we had before recording the podcast you had mentioned that sometimes you have to reframe the business practices of the businesses and organizations that you support as well how are some of the efficiencies of hutano affecting the way people make money from a practice perspective and the efficiencies that come along with that yeah so the the I think uh We've we've discovered this almost immediately

[45:29]  that most clinicians are not very good at math okay especially when it comes to their money and how they make money so um a clinician who is using who relies heavily on insurance business to support their business to get business through the door now remember a a clinician practice is no different from a guy selling cookies right the more people come in this in the store and buy cookies the more money you make it's as simple as that the more hours you're open the more money you wake but but also the more overhead you have but in this case insurance companies are a vehicle to get patients in the door and out of the door what has been lost in this equation is I equate it to the Automotive Insurance

[46:18]  business right you buy a vehicle today you insure it and you have a thousand dollar deductible and full coverage on it I'm in a thousand dollars if I have offender Bender right here on Eastern however if my car gets totaled I still pay the thousand dollars right but the rest of it to replace a vehicle is going to be covered by the insurance insurance is important but it's important for the big one not for the small issues so educating consumers that maintenance of your body and making sure that you're in tipped up shape should not be something that's one too expensive for you to uh to to do and secondly it should be within reach and it should be something that you can pay for out of pocket

[47:05]  that's where we start but this conversation can can start in doctors offices as well because every time a patient walks in and presents an insurance card there are there's an army of people that has that have to be involved in making sure that this patient one is eligible for the services that are going to be provided that they have the right benefit so they have met their deductibles say it's all these things that need to be done but like I said in the beginning the only person that pays for all those people is the patient yeah so when the patient wonders why it's so expensive I go back to this thing well you came in for the service that I could have easily charged you 60 bucks for but because you put it through this engine that requires 20 people to touch now it's going to cost you 150 bucks that's like a legacy business

[47:53]  so there's a legacy business that's that's attached but it's a it's so unnecessary in in a number of ways it's the equivalent of the plumber coming over to my house and me going yeah to put a garbage disposal a new one I'm going to run that through my insurance company I mean that'll be just it doesn't make it doesn't make any sense right the guy is going to say it's 75 bucks for my time and 180 dollars for the for the new garbage disposal here you go right and my argument to most clinicians is that you can make the same argument to your patients about the value of what you're doing the important thing about a cash exchange between a patient and a patient a patient and a provider is that I have to provide service equal or above what you just gave me in in monetary value and you'll find that clinicians that now

[48:43]  start to use our model of business which is get as many patients as you can to use a less expensive model of business which is give me cash write a check whatever it is drop some chickens off before you leave are obviously going to get much better service from me because instead of the 5.2 minutes which is obviously ridiculous if you just gave me a hundred bucks out of your pocket I'm gonna give you 15 20 maybe 30 minutes of not only treatment time but education time and it comes down to this because that's you mentioned this before creating a relationship with someone requires time yes without time you cannot have a relationship most patients in this day and age are different from patients 50 or 60 years ago in only one

[49:32]  way they don't have a relationship with their doctor therefore they don't trust what their doctor does that's why when they walk out of the doctor's office they're Googling what the guy just said what does this mean I don't know they're calling somebody else they you say this I don't know what this means it means they don't have they didn't get enough time to understand and they don't have a trust Factor so that's what we are trying to turn around is get clinicians to understand that the more time you give to your patients the better the health the health outcomes are going to be for your patients because now all of a sudden instead of just taking out a prescription pad and giving them another medication or changing the medication they're on you can actually sit down with them and talk to them to them about how they got here how did you get diabetes how does that actually work what what does the pancreas do in your body how how is it how is it that the

[50:21]  food that I eat affects the amount of insulin that goes in and out of my my body and how does it get depleted to a point where now I'm diabetic how can I reverse that process but more importantly how many times do I need to see you and what do I need to do personally to make sure that this doesn't happen again those conversations take time and they they take time over a long period of time patients always want to impress their clinicians yeah most of my patients want to come back and say Doc you don't believe what I'm doing now I'm walking without it without a cane right same with patients that come in with with these chronic diseases they want to come back and say Doc you wouldn't believe I've lost 10 pounds I feel so much better but if you're not having enough time to even have the discussion about how to get there it's just never going to happen they're

[51:07]  not going to they're just not gonna move the needle at all in health it takes me back to the early analogy you gave when you were talking about your PT practice of building on those small incremental wins until you can create a big windfall right and in healthcare today specifically I think about the big windfall as being retention right right because if we have an established relationship with our health care provider then we have a relationship that will last long term and I think that's one of the biggest challenges that Healthcare Systems in general that have a big churn model yes is I'm here to make sure I get my Bilbo moments down with you I'm going to spend my 16 minutes documenting and then I'll catch you next time right right but nobody really wants that experience today from the patient side because like you said we all wish we had that I would say previous Generations Healthcare experience where I could lean into my doctor lean into their expertise they're

[51:53]  a trusted resource of information and I don't leave completely baffled right after I leave that environment and I think that's going to be the long-term success of Healthcare in general especially as we start moving away from like fee for service models and we start getting into value based models right being able to leverage that relationship is going to be the thing that's going to help people win long term oh absolutely I think you know try this is a this is a human contact business right you cannot there's no there's no substitute for it I am fortunate as a physical therapist that I I tend to spend I have to spend a sizable amount of time with my patients training them on you know what to do how to do it correctly uh and then the next session I'm going hey from what we did last time what worked and what didn't work uh there's kind of a as a physical therapist I'm forced to have a

[52:40]  relationship with my patients and even in our field we're starting to see a creep of less time with the patient and having support stuff spend more time with my patients and that's that's again going back to why I teach is to try and teach the next generation of therapists that that's unacceptable you're the doctor you're the person with a name on the door you spend the time with your patients they need to walk away knowing that the direction of this care was driven by the person that has the name on the door but you're absolutely right I think as we as we figure out how to spend more time with our patients Health outcomes will inevitably get better yep and that's a you know it brings you up I have been recently speaking with my dad who uh back in 2021 December was diagnosed with prostate cancer and he's

[53:28]  gone through the process of targeted radiation treatment everything like that but I will always remember the initial experience he had when he was given his diagnosis he was given that diagnosis by a PA who was not his doctor and so this guy came in who was his PA and just very bluntly was like here's the information and to this day he still continues to talk about how uninterested his primary provider was in giving him that news and he still talks about to this day he went in for a checkup last Monday to ask about like what is his new regimen of exercise can he talk about you know testosterone replacement therapy stuff like that to get back to himself and the first thing he said was if that PA comes in the room and tries to talk to me I'm gonna have to say I need to see my doctor but it's just like the emphasis of the

[54:15]  relationship is so important with your trusted Healthcare professional it just really matters well I'm so sorry to hear that and that's that's um I think that's the reason why we we really need to shift from focusing on money and focusing on people Healthcare has always been about people yeah it's uh how you impact uh the person in front of you you may have seen ten thousand prostate cancer cases but for your dad it was his first time yeah you know you you have to treat it as that you have to treat it as if you were talking to your mom your dad or somebody that matters to you um but um it's it's unacceptable that the physician is doesn't make the time to speak to his patient to say hey um this is the diagnosis we have but um here's the good news this is what we

[55:04]  can help you with here are the outcomes that we possibly could be facing but it just comes down to time and these folks are inundated with paperwork they probably spend more time doing paperwork on that day than they could have spent talking to your dad about something that not only life-changing for him but something to this state he still talks about because it's a mistrust in the Health Care system that he's built and he's told everybody he knows that this is just you know so bad news spreads like wildfire and unfortunately in healthcare we are we are short of good news that everybody has had such a bad experience for something that costs so much yeah it should be better I agree and it's just like people like you who are tackling these challenges with a sense of I would say Keen empathy is something that I

[55:51]  want to congratulate you for and that's why I thought it was so important to get you on the show because you are making the challenges or making the changes that people need to have a more trust-based relationship with the trusted people in our in our communities who can actually give them the information that they need to live their best life and I just want to say thank you for that no no thank you I it's uh we're happy to share the story and and uh it's it's when we have conversations with with folks like you that we not only get the validation that what we're doing matters but also find out other things that we could help the Healthcare System kind of start to realize that technology has always been has always saved Humanity Whenever there has been a challenge and the challenge that we face today is is unique in that people are living much longer

[56:40]  we have a uh an an interesting uh ecosystem where food is sometimes the poison that causes us to repeatedly go in and out of the healthcare system so the we have more people living on the planet and we just don't have the resources to take care of every one of them but technology is is amazing at not only making some things efficient but also disseminating information that could help patients literally across the board as this podcast is going to air people who've never heard my voice or heard your voice will be able to sit in this room with us and and participate in this conversation we could do the same thing for healthcare there are many people out there who have real deep questions that could be answered by

[57:27]  technology that we could answer in that format but there's also people that just need to see someone who is a professional that's been trained in the disease process build a relationship with them and then start a path to Wellness that is curated by somebody who knows what they're doing um these These are coaches that are sitting on the bench that have not yet stood up to coach their team every physician every clinician their job is to make sure that the outcome of this game is the best outcome possible but if we just put them in a corner and say go do paperwork write about the game but don't coach the team or don't coach the players it's a losing game and we shouldn't be surprised when you know every player is going in different directions and there's no real curated way to attack the problem of

[58:15]  childhood obesity because of early onset of diabetes on in kids that we never used to see when in in the day right nine years old they've got diabetes and you go well that's that's odd but here we are no no just give them meds they'll be fine yeah it's that just doesn't work we need to we need to cut that and and change that over but thank you so much for uh you know saying that I think um uh we are just one company amongst many that will come before us and ones that have paved the way for us uh that might make the difference in the future to get this to get this problem curved in a way that makes sense well I think you guys are already making the difference that we need right it's those small incremental wins with organizations like yours technology like yours that compound into the big windfall that we're gonna see I'm sure sometime in the future

[59:03]  um I think you've done an amazing job of really articulating what the overall I would say emphasis of this podcast is talking about the heart of where you believe there was an opportunity to win and then talking about the hustle that it really takes to actually Implement that and really make the difference that people are looking for in today's world world so I want to use the last couple seconds here for you to talk about hutano and where people can find more information if they want to reach out to you where can they contact you at and where does that kind of stuff look like sure sure yeah so um you can go obviously the website is the first place to go www.hotano.com the app is available for IOS and Android and you can just get that on the app store or the Google Play Store otherwise you can find me personally I'm on Facebook so facebook slash watano that's where I am or you can find me on Instagram at

[59:51]  hutanoamerica and you can also find me on LinkedIn I'm usually very active on LinkedIn that's the place where I exist most of the time and that's just um LinkedIn slash in and slash utano so those are the places where you find me the most and there's also a YouTube channel if you want to see some of my videos from before and that's just uh hutano is the channel that's how you find me yeah well thank you so much for coming on the show guys that's another episode the heart and hustle podcast once again Efron thank you so much for coming thank you so much I really appreciate it thank you so much it's been amazing guys that's another one check us in the next one thank you