Why Should Physicians Invest in Healthcare Startups?

[00:00:00] Jared: Hello everyone, and welcome back to another enlightening episode of the med+Design podcast, where we illuminate the stories and ideas of healthcare's groundbreaking innovators. Today we're excited to welcome Dr. Daniel Dow, a radiologist turned innovation leader with a remarkable vision for the future of healthcare.

Dr. Dow's many hats. Chief Innovation Officer at Healthcare Shares, director of the Diagnostic Imaging Program and Medical Operations at Health Help and a mentor at Health Wildcatters just name a few. Dr. Dow represents the new breed of healthcare professionals who are seeking to empower their peers through entrepreneurial endeavors.

He's turning the tide in the healthcare industry by promoting increased ownership and participation by physicians in the business aspects of their field. From his early days as a radiologist to his current innovative work, Dr. Dow's journey speaks volumes about his commitment to reimagining healthcare, his belief in merging time honored medical traditions with the latest technological advancements through modern investment vehicles, is set to transform the industry and bring about a new era of patient care.

His expertise in healthcare entrepreneurship and utilization management will provide us with unique insights into the state of the industry and the future of what lies ahead. We'll explore his current projects delve into his passion for healthcare innovation, and uncover his strategies for navigating this complex industry.

So buckle up as we embark on this fascinating conversation, Dr. Daniel Dow. Let's dive in.

[00:01:22] Daniel: Welcome. Thank you, Jared. I appreciate the very kind and generous profile. Introduction. You're very

[00:01:31] Jared: welcome. We're happy to have you here. So, I think, you know, we'll just get started off talking about Healthcare shares.

If you could just tell us a little bit about it, how it got started, you know, when is it going live, and also just how do you get involved as well. Yes, thank you. So Healthcare Shares is a digital marketing and advertising company with the objective to help healthcare entrepreneurs obtain funding for their companies through angel investors primarily physicians.

[00:02:05] Daniel: And so the strategy is to directly market through LinkedIn advertising. Physicians who have expressed an interest in becoming an angel investor and investing in healthcare startups, as well as other non clinical healthcare angel investors. The founder Laurence Girard, this is his second company to found his first company he founded in 2014 when he was still in college.

And the company is Fruit Street Health. It's a pre-diabetic telehealth company. And he raised all of the funding, which was to date, 35 million from 500 individual investors, mostly physicians, about 400 physicians. And then the other a hundred to 150 investors are healthcare angel investors.

And he directly marketed to them through LinkedIn during the past nine years. Many healthcare entrepreneurs that he interacted with at events expressed an interest in helping them to raise funds for their healthcare startups directly from physicians and healthcare angel investors.

And there's a lot of advantages to this style of marketing and fundraising in that the physicians they can act as both investors and advisors and mentors and even future clients and customers. The way that I became involved with the company is mm-hmm.

Actually he reached out to me about investing in Fruit Street Health which I ended up investing a little bit. He reached out to me the beginning of 2021. But when he told me about his idea for healthcare shares, I was much more interested in investing in and being a part of Healthcare Shares.

Okay. That's wonderful. And so essentially Fruit Street was the inspiration behind Healthcare Shares. Was that how he sort of found a need in the market for a healthcare specific crowdfunding platform?

Yes, it was basically the other healthcare entrepreneurs, as I mentioned, that he interacted with, their expression of interest in him helping them basically led to that idea so for sure.

[00:04:24] Jared: That's a cool, unique insight. And then, I guess with the crowdfunding apparatus you know, the opposite of that would be, getting money from VCs and VCs are sort of a easy target for criticism in a lot of ways. But you know, for all the flack they get, they take on a lot of risk.

When you're working in the startup industry it's all about risk. There's no guarantee that anything that you invest in is actually gonna go to market. And so, you know, they're notorious for kind of the spray and pray method to some degree. And also at the same time, they're known for those really I guess poor terms for a lot of their founders and whatnot.

In your eyes, where does, raising capital from a VC go wrong? For startups and founders? And then I guess, what's the brighter side of that for crowdfunding, via something like Healthcare Shares?

[00:05:15] Daniel: Yes. And you bring up great points and, you know, I'm a strong believer in investing in general, and I've participated myself in venture capital and private equity investing.

So I think that many people view crowdfunding as a disruption to venture capital and private equity. However, the way that I perceive it is more as, you know, something like an adjunct that increases the number of physicians that can actually invest. But as far as differentiating the model of Healthcare Shares from like a venture capital group. Typically, and again, you know, venture capital, private equity, crowdfunding, they're all just tools.

And so any tool can be used in a very positive way, or it could be used in a negative way. But having said that you know, venture capitals groups, because of all of the risk that they take on, they have to look at, you know, thousands of companies. And so they may only invest in one out of a thousand companies that they look at.

And what that means for healthcare entrepreneurs is that they end up having to talk about their companies to hundreds, if not even a thousand venture capital groups in order to get funding. In addition, the venture capital groups may want to have an extended relationship before they invest, so they may have to have these discussions for one to two years before they ever get funding.

Another advantage of the crowdfunding model versus venture capital groups is that venture capital groups typically want to have board seats within the company, and they also take significant percentages of the company for the money that they invest. And ultimately what ends up happening after the healthcare company or any kind of startup company goes through multiple rounds of investing, at some point they end up giving up more than 50% of their company and they give up control of that company.

And, many founders have found themselves and their leadership teams basically eliminated from the company or the venture capital group decides that they wish to change the business model, change the strategy in a way that no longer aligns, with the healthcare entrepreneurs social ethical beliefs and intentions for starting the company in the first place.

I was curious. Yeah, I mean like this is something I'm fascinated by and one of the maybe perceptions of crowdfunding, I think maybe generally is that it might make it harder to then, like when you need to raise more capital, that the amount of capital you can raise through crowdfunding might make sense at early stage comparable to angel investing.

[00:07:56] Ty: But then perception when you do need to go talk to the VCs or private equity to get to the bigger valuations and bigger raises, how do you make sure you set yourself up for success at this stage so that you don't close the door prematurely to like VC later on?

[00:08:12] Daniel: That's a great point. As you mentioned, I'm involved in a healthcare startup accelerator, and one of the things that the CEO and founder told me from the very beginning was, well, you know, crowdfunding is the funding of last resort.

And I said, yeah, sure. And I understand that. And you're exactly right. Once the founder takes funds in that manner, it may be more challenging for them to get, funding from a larger venture capital group or private equity groups. But private equity actually used to be the funding of last resort.

If you go back to the eighties and early nineties, when private equity started, It was basically they got the absolute best deals because the banks and other investors were unwilling to invest in them. And so over the past 30 years, private equity has evolved to become, a very acceptable and a very profitable way to fund companies and to make investments.

So I anticipate, crowdfunding over the past 10 years has significantly evolved itself. I think that that perception is decreasing and it'll kind of be at times, dependent on the cycle where in the economic cycle that we're at as far as investing.

And right now is actually probably a really good time to be considering crowdfunding because of, the contraction and liquidity with investing. It has significantly decreased for both, venture capital and private equity.

[00:09:38] Ty: What kind of barriers then would you put in place so that you to talk about like funding level of last resort?

I mean, with crowdfunding you also kind of have that ability to kinda enter into a zombie mode where you like raise just enough money to basically create a whole lot of equity promises, but not enough to actually fund the startup. So it's like that in between zone. So I'm curious how you like set up those barriers to avoid the zombie raise if you will.

[00:10:05] Daniel: So you bring up an excellent point and so the way that me personally, the way that I'm approaching it is that, almost as if we're a venture fund or a venture group.

And so we want to look at, the healthcare companies because we don't want to just find an easier way to bring, companies that should not be funded, funding. Mm-hmm. And so, I mean, I'm more looking at companies that have obtained successful funding through accelerator programs and incubators, things like that, rather than, just true.

I just have an idea. I've not gotten any funding. So, my preference, my involvement is, and I'm working, with the Health Wildcatters group and we're looking at collaborative agreements, with other accelerator programs. But definitely my preference would be to find companies that are already successful.

Personally, I think there is somewhat of an niche between companies that have already raised, but they don't want to bring in another venture capital group and not only dilute their ownership, but also dilute their control over the company. So, mm-hmm. That's an interesting use case for this.

[00:11:22] Jared: We actually to touched on a lot of the stuff that I had for this particular topic, but what I am curious of is for the physicians that are interested in becoming investors, like what does that process look like for them to be able to yeah use this apparatus.

[00:11:35] Daniel: So right now we're just working with accredited investors, so physicians, and we have a third party that does all of the accreditation work for Health Help. We also work with a holding company. There's Madison Trust, so if they want to use their IRA funds which a lot of physicians do want to use those funds for this type of investment.

They're able to do that. And it's relatively simple. We send them an email, they log into the system and they go through the questionnaires. The simplest way to do it is in my opinion, is the way that I did it, which is you have an option to have your financial advisor write a letter that you are an accredited investor, and then you have a decision within 24 hours, but it's a relatively simple process.

The other ways are to verify income and, verify assets through this third party. Okay.

[00:12:33] Jared: So it's not as scary of a process as I guess it sounds like.

[00:12:37] Daniel: No the actual just getting started is relatively painless. Mm-hmm.

[00:12:42] Jared: Yeah. I just have to have the paperwork ready to go and be able to prove the assets.

And so I guess, you know, also I did wanna talk about your journey from, you know, going from being a radiologist to an innovator and you have a very interesting family background as well. And so, you're a third generation physician, so how this background of your familial history influence your career trajectory eventually and yeah so what were also like the specialties of the physicians that came before you and your family. That's really fascinating.

[00:13:11] Daniel: Yes, thank you. So my father was primary care physician in emergency medicine and my grandfather was primary care. And they both owned their own clinical practices. They both had autonomy over not only the practice of clinical medicine, but also their own business practices of their clinics. So they could basically, for the most part, make decisions about healthcare, based on, shared decision making with the patient and determining what was best. They were not limited by the influences of the business of healthcare.

Mm-hmm, my father practiced until, the end of 2003. Both my father and grandfather trained and practiced medicine in Canada. That's where I'm originally from. They both trained at Queens University. My grandfather practiced his entire career in Canada. My father practiced about half of his career in Canada and half of his career in the United States.

And as a kid, obviously I went to clinic with him and things like that. I actually worked with him as a teenager in early twenties as well in his practice. And so I not only from stories from my grandfather, but also just from my own experiences and what I witnessed with my father's practice, I truly witnessed a transformation, a transition.

Predominantly in the, business of healthcare. Obviously there was great technological advances that occurred, in the eighties and nineties and two thousands going on, even in the present obviously. But I did not see the changes in the business of healthcare as positive.

One of the single most negative things that I saw was in the eighties, the insurance companies no longer protected the patient from keeping their own primary care physician in network. So prior, and I think it was maybe around 85, 86, something like that, that the insurance legislation was passed where the insurance companies no longer had to move a

patient's primary care provider in network. They could just determine whether physicians were in network or out of network based on their employer or based on who signed up for the different programs. And so that, to me, that was kind of the beginning of deterioration of the long-term patient physician relationship.

And to me, that's one of the most important fundamental aspects of medicine is that long-term relationship built on trust and shared decision making where the primary care physician, he knows you, he knows your family, your parents. He knows your siblings, your children.

He knows what you look like when you're healthy, and he knows what you look like when you're ill. He knows what type of patient you are, whether you're one that doesn't go to the doctor until you're basically on death's doorstep, or if you're the kind of patient that even with a minor pain that you're gonna present for treatment.

And I think that has contributed to a significant increase or in the utilization and over utilization of the healthcare system in general.

[00:16:38] Ty: As you're describing that, I mean there's a book called the Good Life, which describes basically it's a Harvard study that's been conducted since, I think like the 1930s.

And it's a longitudinal study that looks at happiness and wellbeing over lots of people over a long period of time. And they've had like an 80% continuation with the study rate. And one of their key findings was that the number one source of health and longevity is the quality of your relationships.

Yeah. And you just spoke to that of like the deterioration of the physician, primary care physician relationship with their patients is detrimental to the health of the patient population, but also to the physician as well.

[00:17:22] Daniel: 100% agree. And you know, you're seeing year over year increases in physician, clinician and healthcare worker burnout.

You're seeing a phenomenon of moral distress and moral injury that physicians and healthcare workers are experiencing which is leading to a mental health crisis. Which is leading to an increasing number of physicians and clinicians and healthcare workers that are leading medicine to do something differently because it no longer aligns with their beliefs and their values, and they feel like that they have to practice medicine in a way that violates their beliefs.

And it's kind of left the door open for a newer, I won't call it newer. One of our past guests called it a vintage system, which is direct primary care. Which is something that for me, I wasn't really aware that you could almost pay like a subscription model to kind of like renew that sort of long-term patient relationship.

[00:18:22] Jared: And maybe a model like that is something that sort of takes over in the long term. I think that's yet to be seen. But hopefully there are some more advances towards restoring that type of relationship because I think it's beneficial for all of us. I've never experienced anything like that.

Well, I guess I have, I had a pediatrician for my whole life and that was wonderful. Until I was like 17 or 18 or whatever. She was completely wonderful. And just like how you said she knew so much about me, treating me felt like it was a little bit easier because yeah I'd been there since I was a little kid, you know?

And I guess as an adult, I think having that relationship again with the physician would be really cool. I'm sure extremely beneficial, like how you're saying.

[00:18:59] Daniel: No, I agree with you, 100% and in your example, the pediatrician is a perfect example. So my wife and I use for our three sons who my oldest is 22, my middle is 19, and my youngest is turning 16 soon, and we've used just the same two pediatricians and they do not take insurance. They have a very small office. It's just the two pediatricians. They're typically only one is practicing at the, at the time, and they typically have one nurse and one and one staff worker.

So it's very, very small office. Limited overhead. We pay cash and. Even considering that I pay cash, I know that they've saved me a tremendous amount of money because they're always there. Because they have a low overhead. They have a low patient population that they serve.

They're able to have those very intimate relationships with their patients and the parents. And they're willing to come up and see you at the office and treat you nights and weekends to keep you out of the ER, compare that to my friends will call me not infrequently to say, Hey, look, hey, this is what's going on with you know, my son Adam, he's got these breathing difficulties and I called and I was like, well, so have you called your pediatrician? Well, yeah, I called the pediatrician, but I got this nurse practitioner. I got this PA that I've never seen before, and after a five minute conversation, they said that I need to go to the ER.

And do you think I need to go to the ER and I'm a radiologist I'm not a pediatrician. I'm not even, you know, primary care physician or anything like that. And I'm like, well let me see. And I'll, I have up to date and which is a resource for physicians and I'll kind of look up and, try to ask some questions and help them as much as I can.

But yeah, it is very dysfunctional and you can see how that dysfunction just leads to over utilization and increased costs, so, mm-hmm.

[00:20:54] Ty: Just to build on that, I mean we're talking about kind of like that hands-on aspect of healthcare and almost the public good of healthcare.

Where you're treating the whole person and then you've got the business side of that. And from an investment standpoint, or maybe even from like a physician, a collection of physicians investing where they can be able to keep that in mind. I mean, do you see that as more of almost like activist investing of trying to return healthcare back to how it should have been? Or how do you, how do you wear those two?

[00:21:22] Daniel: Yeah, no, I definitely view it as social impact investing in healthcare which is something I'm very interested in. Part of my transition from a clinical career in radiology to a nonclinical career in something else.

Which at the time that I transitioned, I wasn't sure what I was gonna go into was to spend the time that I have left trying to serve others and to improve the dysfunction of the business of healthcare. I mean, personally, I think there's a lot of efforts and a lot of interest and excitement

about transforming healthcare with new technologies. But I think that the low hanging fruit with the greatest opportunity to do the greatest good is really just reforming the business of healthcare and restoring physician autonomy, restoring the long-term patient physician relationship improving satisfaction of

physicians, clinicians, and healthcare workers and patients. There's a tremendous amount of dissatisfaction in trying to reduce the level of burnout that physicians are experiencing and to create strategies that you in enhance the patient physician relationship and support that and allow physicians to practice in a way that aligns with their ethical beliefs and values.

[00:22:45] Jared: When we talk about burnout, Ty and I just got a really good learning on this recently as well, which is, burnout is more than just people leaving the space. It's people's health at the end of the day, it's people's mental health, it's people's physical health.

And when physicians or anyone's experiencing burnout, I mean, this is not just like, oh, I need a new career. This is in some cases, this could be a life or death or a chronic illness as the result of this sort of thing. And so for us to be able to support our physicians better and support sort of the entire system just making it more humane, like how you kind of talk about bringing humanity back to healthcare, it's something that I think that a lot of us have a need and a want for.

[00:23:26] Daniel: No, I definitely agree. People worry about the cost of healthcare and so the business executives are looking for ways to be more efficient. And one of those ways in being more efficient is trying to squeeze more productivity out of the physicians, clinicians, and healthcare workers.

And unfortunately that's leading to an increased level of burnout just because of the higher workload. So, yeah, I completely agree that there's opportunities to improve the system by looking for ways to enhance relationships rather than looking for ways to just be more efficient.

[00:24:01] Jared: Absolutely. Something I did wanna touch on also was the moment that sort of catalyzed your transition from being solely a radiologist and then going into the business side of things. Because I think that for a lot of physicians, a lot of them are just kind of scared to make that jump.

You know? It's like you've specialized in something for so long and this is like what you sort of, this is your bread and butter, this is what you know so well, and business at the end of the day, there's a lot of failure. There's a lot of hardship that comes with that.

And people are kind of scared to make that transition sometimes. And so what was that sort of like key moment for you when you decided yes, this is that transition moment for me?

[00:24:37] Daniel: Yeah, it was, it was kind of a journey that occurred over about a five year time interval. It started in 2015.

My oldest son who's just graduated college, but he was a freshman in high school and he attended a high school, Jesuit high school of Dallas, that's it's only for high school students. So he was new to that school and they have a very service oriented you know philosophy that's committed to working for justice.

Loving, open to growth ,and intellectually competent. And just seeing how that impacted him. And kind of changed who he was. I felt like I was kind of evolving and changing along with him. And then when he left to go to college, I realized that my time with my three sons was limited.

So he left in fall of 2019 to go off to university. And I already been feeling like I was wanting to transition into something else, but I didn't really know what it was. I had become increasingly frustrated with the business of healthcare. And so he left.

And then his spring semester of his freshman year covid occurred and so he moved back home and I was fortunate in the sense that the group I worked for was primarily rural outside of Dallas. And so we were less impacted and affected by Covid both physically and then also on a business level.

But we were still impacted. And not all of the physicians felt this way, but I wanted to spend, more time with my son. And so I significantly cut back my work time and then in the summer of 2020 I actually was like well, I started taking more time off and the more time I was off, the more I realized that I wanted to do something different where I had more control over my schedule and also a greater ability to impact and to serve others.

I mean, I think as a radiologist, obviously I was interpreting diagnostic imaging exams and also doing image guided procedures. And so I was serving patients, but I wanted to serve a greater number of people. I had no idea how to do that. And after a couple months at home, my wife told me, she goes, well, if you're not gonna go back to work, you gotta work with a career coach and do something else. So she actually helped me and she found a career coach for me to work with. It was an incredible experience and eyeopening for all of the opportunities that are available for physicians as far as transitioning into a non-clinical career. I wasn't sure if I would ever go back to clinical radiology, but I knew I didn't want to shut the door on that.

And so that meant that I would need to maintain my Texas medical license and my board certification for radiology. Once you make that decision, it limits the number of career choices that are able to do that. And utilization management was one of those. And so that's one of the things that I do.

And then at the same time I've always been invested and involved in investing. And so one of the recommendations that was made to me was to get involved with a healthcare startup accelerator. And so I did that as well and I've been involved with them since the fall of 2020.

And then like we previously discussed, I became involved with Healthcare Shares in 2021.

[00:28:08] Jared: That's wonderful. And I think also maybe if we could delve into your relationship with the Health Wildcatters as well. We're on the friendlies with them. Hubert is a wonderful person. I think he's somebody that really should be at the head of an organization like that.

He's got a really open mind. He's really about helping people at all different size of organizations. And like I said, he's been a wonderful ally of ours. So I guess for everyone else that is listening, what is the Health Wildcatters and what sort of impact do they have on the healthcare innovation space?

[00:28:37] Daniel: Okay, great. Yeah Hubert is, wonderful. You know, he's originally from Austria and he moved here and trained at UT Southwestern, same as myself. And decided he was not going to go into clinical medicine. He was gonna do research. And then that kind of involved into volunteering with an incubator.

And then that kind of grew into the desire to start a healthcare startup accelerator, which he did in 2013. And the model of Health Wildcatters from my experience is a little bit unique. They run a small annual fund. It's only a little over a million dollars that is invested by the investor network each year.

And there's an investor and mentor group of about 300 people that are involved in the program and the business is divided. Considering it's an annual fund, it's divided into quarters and the first quarter of the business is devoted to marketing the accelerator program to encourage healthcare entrepreneurs to apply to the program. He attends conferences and innovation summits all across the United States and also globally. Going into the end of the second quarter, he starts to whittle the numbers down. And so, the applicant pool has run probably between 200 to over 400.

I think the 2023 applicant pool was roughly 420, somewhere around that. But once he has that applicant pool, he starts to whittle the numbers down to about 20. And then there's a a pitch event for the investors and mentors, and then the investors and mentors get to weigh in on who they think should be selected.

And what the positives and negatives are for each healthcare entrepreneur in their company. And then he makes a final selection of roughly nine to 12 or so companies. And then they invest a small amount of money and a great amount of time and take a significant percentage of the company. Pre covid, it was a requirement for the healthcare entrepreneurs to come to Dallas for the accelerator program. Obviously, that was not possible during the time of Covid. So they made it where it was remote, and then now it's after things have relaxed and opened up.

It's retained kind of a hybrid approach where the majority of the entrepreneurs come to Dallas for the program. But some do stay remote. Some of them are in India or Germany, other countries. And so they don't really have the financial means to travel, so they may stay remote. But the healthcare entrepreneurs show up beginning of September and then for 80 days they have an intensive program, mentorship program where Hubert helps them, guides them, evaluates them with their business models, their strategies, their pitches, their slide decks. And the mentors also, it's a collective effort.

Hubert likes to refer to the mentor and investor group has a collective brain trust, which I think is great. It's a great opportunity for the healthcare entrepreneurs, to get the benefits of that. And then he brings in guest speakers and people to give lectures and presentations.

He has a representative from Polsinelli, which is a legal group that gives a great presentation. And then there's former entrepreneurs, some that were in the Health Wildcatters program and some that were outside to give, lectures about their experiences and what helped them and different sources of funding.

I mean, it can be from funding to legal work to business strategies. But probably the biggest benefit that the healthcare entrepreneurs get from the program is the network of all of the mentors, cuz each mentor brings his own network. And so having that ability to tap into that network is very helpful to them.

[00:32:58] Jared: Yeah, and you talk about a network effect, 300 mentors, all super experienced and all of their own personal networks involved. Just the reach from that I can imagine is incredible. And so also, tell us a little bit about your role as a mentor wildcatters as well.

What's that been like for you?

[00:33:15] Daniel: Yeah, so it's been great. As I mentioned I try to participate as much as possible with the accelerator program. Last year, I actually tried to attend a lot of the lectures and events that the healthcare entrepreneurs that were going through the program

and they kind of joked and said I was the 12th cohort or something like that. Which it was a great experience and I hope to do that again, but I think the two key ways that I help out with is, I mean, obviously if it's related to radiology or diagnostic imaging or utilization management I can give my own perspective and thoughts and evaluate their business model, their product, their service, whatever it is based on my experiences, if it's outside of my experiences and knowledge, then I try to connect them with people within my network that can help them.

And then obviously the funding part, that's something that is vitally important to all of the healthcare entrepreneurs is obtaining funding. So I tried to help them, and that's partly how obviously Healthcare Shares is a startup in itself. And so just like any startup, we're constantly fine tuning our business model.

And so a lot of the fine tuning came from, my experiences with trying to work with the different healthcare entrepreneurs on funding.

[00:34:43] Jared: And so I guess, is funding probably the most fundamental challenge you've come across for some of the startups that you've been mentoring as well?

[00:34:52] Daniel: I think it's, it's more a universal yeah.

I mean, in order to get the funding they have to get the business model. The business strategy, correct. They have to focus. And so that's something for the healthcare entrepreneurs a lot of them. I mean, I, my youngest son has significant ADHD and I definitely would've been diagnosed when I was young and probably would be diagnosed now.

But a lot of the healthcare entrepreneurs are the same way. And so, as you know, focus is a challenge. Focus is very important in a startup. Because you want to be focused on one problem with one solution so that you can present that in a way that the investors can understand and have, confidence that you're going to be able to execute on the problem set.

So I think focus is a big issue. Obviously funding and then just having the right network, the right opportunities. So there's one company when I met. Hubert for the first time. It was, I believe October of 2020. And as I mentioned, there's an annual fund that he does, and so I missed the annual fund in 2020.

I was too late, but I decided to invest in one of the companies within the fund which was a company called Iluria and their interestingly enough they're a solution for ADHD. And so it's a wearable technology combined with AI to give an objective evaluation to give objective data concerning ADHD and the efficacy of the medications.

They look at pharmacokinetic curves of the ADHD drug. They compare that to the data that they get from the wearable technology including things like motion and specifically angular motion, heart rate, things like that. But they have a whole host of, of metrics that they look at as far as to determine that efficacy.

But I decided with my own personal experience with a son that has ADHD and I am ultra conservative when it comes to medicine in general. Especially medications, surgical procedures, things like that. I mean, I look at those as last resort. I want to look at any kind of alternative therapy whether it's psychotherapy or there's video games now to help treat ADHD. Wow. But but having said that, I've worked with them since January of 2021 and my mentorship is really just about my own personal experiences with my son. What things are important to me as a parent as far as that relates to the business model and the business strategy. And then connecting them with people within my network to help them.

[00:37:42] Jared: Sounds like it's been a wonderful journey so far. Something else that I think comes to my mind as well is, and I think you alluded to it as well earlier on, which was there has to be some level of synergy between Wildcatters and Healthcare Shares as well.

And so what does that sort of cross-collaboration, if any, look like for you guys?

[00:38:03] Daniel: Yeah, I mean, there is definite collaboration. Healthcare Shares is a global company, just like Health Wildcatters. Laurence actually lives in London. He's from New York, but he lives in London now. Several of the companies that that we have met with are international companies and so there's definite and we're a, a funding solution for the cohorts within Health Wildcatters and we're looking to help them to obtain funding. So yeah, there's definite opportunity for collaboration. And again, we're a relatively new startup and still trying to determine what's the best way for that collaborative partnership to move forward.

Absolutely. Yeah. Well, as you guys progress along, I'm sure some wonderful things will come of that. And we're coming up 10 minutes left. So I still wanted to talk about utilization management and why it's crucial in healthcare today and in the industry. And maybe if you could just delve into that a little bit as well.

Yes, definitely. So, I mean, I think every discussion about healthcare and utilization management should begin with the concept that healthcare is a limited resource. I mean, we have staffing shortages now with physicians and nurse practitioners, PAs, healthcare workers. These staffing shortages are leading to delays in getting appointments. Anybody who's tried to make an appointment with a specialist would definitely agree with that statement. So, considering that, and also considering the increasing cost of healthcare. Utilization management to me, it's one of the most important challenges to address.

It's absolutely necessary in my own personal life. I hate, fraud, waste, and abuse. So it actually was not too big of a leap for me to consider utilization management at least as a part of what I am focused on. And that's the mission of utilization management is to eliminate fraud, waste, and abuse from the healthcare system.

There's different types of problems within utilization management, like I mentioned, there's the issues of fraud, waste, and abuse, but there's also overuse, misuse and underuse. And so people may not be as familiar with those concepts, but an example of underuse would be antibiotics that are needed to treat a specific condition that aren't provided they're medically necessary and appropriate, but they're not provided a surgical procedure.

That could treat a condition like a large fibroid uterus that's not employed, that would be underuse. Overuse is what people are more familiar with and that's unfortunately the current system where the business of healthcare is focused on profits within healthcare and profits are important for a business to succeed.

But it can definitely be taken too far. And so we're now in a situation where different hospitals are competing against each other to be able to provide the most lucrative procedures. And an example would be like spinal surgeries, things like that. You'll see a lot of marketing and advertising.

So anytime you see a significant amount of marketing and advertising for a healthcare service, whether it's surgery or medications, things like that. I mean, I think it's appropriate to be a little bit concerned and definitely scrutinize the need for it.

So yeah, I think there's a lot of opportunities to Improve utilization management. This is one area where technology is extremely important. I think what you're seeing now one example that I could give you with radiology there's a company and it's not a Health Wildcatters company, but there's a company called Covera.

And their business model is to identify centers of excellence. And so they use AI and machine learning tools to evaluate images from studies and compare those to the reports that are generated by the radiologists and to see if they are accurate. So they use the AI and ML to determine accuracy.

And then they, not only are they looking at centers of excellence, but they're also looking at individual radiologists. And then they use that tool to steer Imaging studies to those physicians. Now that's the current model and then hopefully the future, I think there's more opportunity to help the underperforming radiologists than there is for the steering cuz the underperforming radiologists still have to work because we have staffing shortages.

So the tools in the future will be used to enhance the accuracy and reduce the number of diagnostic errors by all radiologists. So I think that's a very exciting area that's occurring that not only affects quality, but also utilization management. And then another one would be everybody's excited about generative AI and Chat GPT.

And there was actually Epic announced, a partnership Epic's a electronic medical record one of the largest. And they announced a partnership with Chat GPT. And so there's opportunity to incorporate utilization management real time. And so right now utilization management is done after the imaging study is requested.

Now there's some component at the time, but it's typically not with physician engagement, cuz typically it's not a physician that's entering the request. It could be a nurse or a referral coordinator. But a future solution would be an integrated system that the physician is engaged with while he is evaluating the patient that's going to help him to make the most appropriate decision based on medical necessity at the time.

Eliminating the need, hopefully for retrospective UM.

[00:44:34] Jared: I love to see that. I love to see AI being utilized in a way where people are always worried like oh, AI is gonna take our jobs and stuff. And I mean, I think it's just gonna be a wonderful tool.

It's gonna make us more efficient. And I think right now we're still at the early stage of implementing AI and really figuring out its implications. And as long as it doesn't turn into Skynet on us, you know, Terminator style, I think we're gonna be better off for it.

[00:44:56] Daniel: I completely agree. I mean, I look at, just like you said, AI is just another tool that can be used in a positive or negative way. And I definitely think that businesses in that concept I don't want to suggest that business. All businesses, all healthcare businesses are negative. In no way do I want to suggest that. But I do believe in the concept that businesses exist to serve people and communities not the other way around. And that businesses should serve all of their stakeholders not just their shareholders and for profits.

So the profits are important, but the profits are there so that the business can serve the people in the communities.

[00:45:47] Jared: Right. And I think that in the current day and age, I think that model is kind of flipped upside down right now. So hopefully we can get back on track in regards to that.

And shoot, we're, we're coming up on time here, so I wish we could have talked about Health Help and maybe we'll have to have you back on, talk a little bit more about that in the future. But something that we always like to ask at the end of our conversation is just what advice would you give to health care professionals and physicians in particular that are interested in entrepreneurship and innovation and they're trying to follow your path.

[00:46:17] Daniel: Yes, thank you. One thing that I would've told myself was to get involved earlier. I really focused on just being a radiologist and I think getting involved early with whether it's utilization management or with a healthcare accelerator or an incubator or an angel investment group that's in interested in healthcare, I would definitely recommend.

All of those things or any other interest that you have within healthcare to get involved early. Don't wait until you retire or think that you're going to retire, to start becoming involved in those things. I think working with a career coach is phenomenal. And I have one career coach that I worked with initially who referred me to a second career coach that focused on the healthcare investment sector.

And then listening to podcasts, I found a third career coach that I now work with. And I highly encourage listening to, to podcasts, going to healthcare innovation summits, conferences, just getting involved as much as possible and networking with others. My everyday goal is to get up bring a positive influence to the people that I work with, to network, to collaborate.

And then hope to repeat the same thing. And then eventually hope to have a positive impact on finding solutions to improve healthcare. So

[00:47:48] Jared: yeah I definitely think you are and so, Dr. Dow, thank you so much for your time today. Thank you for your perspectives.

Sounds like you're at one of the most interesting parts of your life right now. So excited to follow everything that you've got going on. And just thank you for your time today.

[00:48:01] Daniel: All right. Thank you Jared, and thank you, Ty.

[00:48:04] Ty: All right. Thank you, Dr. Dow