Facing Healthcare Realities: A Call to Action (ft. Pranam Ben)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation challenges and opportunities across healthcare and life sciences. And now, your host, Ed Marx.

Hey everyone, welcome to another edition of Digital Voices. Thank you so much for being with us. Thank you for making us number 5 as of yesterday And it's because great guests like Pranam Ben. Pranam, welcome to Digital Voices.

Thank you, Ed. Congratulations on being number 5 and belated birthday wishes to you.

Oh, thank you so much. Yeah, it's really a joy that so many people have found it interesting. I think one of the reasons, first of all, is great guests like yourself with great stories and great things that you're doing to really transform healthcare. And then we have no commercials, no ads, no sponsors. So, it's just content. So, people love that because I hate that, like when I'm running, And there's a commercial. And even though as much as I might like the podcast or the YouTube video, I fast forward through that, but we don't have to do that today. So we first met really virtually online because I know about The Garage and some of the awards that you all have produced. I think winners were announced today for your annual awards. So I definitely want to get down into that. But the most important question that we have, Pranav, is what songs are on your playlist? What kind of music do you like to listen to?

I'll tell you, the songs I typically listen to are the songs I grew up in South India in the '90s. And so none of them would be recognized. But I do tell you, my teenage daughter has overridden my playlist with her own, which is filled with Tate McRae and Taylor Swift. So I listen to a lot of Taylor Swift and Tate McRae during our car rides.

Yeah. Yeah, that's cool. Yeah. Afterwards, just on email, we'll have to get some of your South Indian favorites because we do have a playlist on Spotify. And we love to mix it up because we have students around the world.

So it's a lot of fun.

What about life message or mantra? Are there sort of words that guide you or words that you live by?

No, one of the things that I said, it's a slogan, is the thing that I live by, which is, this is just the beginning. Regardless of how far we've come, regardless of how much we think we've accomplished, there's always things to learn. There's always things to do, right? So it keeps you humble. It keeps you grounded. And even if you think about the overall, our existence as a timeline of the entire creation of the universe and things like that, we are such a small speck, right? So, just to have that feeling, to have that humble feeling around, this is just the beginning, right? So, that guides me every day. That motivates me. That energizes me to want to go and learn more and do more.

Pranam, you already sort of told us that you're from India. Tell us a little bit about yourself. And like, so, what city were you born and how were you raised? Just tell us all the way to how you got to the United States.

Awesome. I was born and raised in a city in South India called Bangalore. And I was one of 5 in a very lower middle-class family, very humble beginnings there. I mean, we were lucky if we could have 2 meals a day. That's the kind of life we had. My dad was a very hardworking accountant. My mom was a homemaker. We had an amazing life growing up, just Yeah. 5 living in a 1-bedroom house was the reality for us. And then when I grew up, I couldn't care less. I was an avid cricketer, right? So I used to play cricket on the street the entire time. That was my thing. In fact, I remember telling my mom that if I didn't become a cricketer, I'm going to end my life. That was my thing. So, but then as you grow, life happens. And then I went to an engineering school. So I did my engineering in electronics and communication. And then a major life event was the passing of my dad. He succumbed to a cardiac arrest in 1999, and that was an event that changed all our lives. And what it meant to me was a desire and an urge to change my approach and outlook to life, to want to do and achieve some of the things that my dad always wanted. Those were his ambitions. So, I made them my own and started defining and chasing new targets in life. And that's what brought me to the US.

Wow. Well, I'm sure, you know, he'd be very proud of you, right? A CEO now of a company doing great things to transform other people's lives so that they can be well and be healthy longer. I'm sure that's got to be very meaningful. Yeah, it is. Really. Yeah.

I mean, healthcare is important to all of us.

Yeah. Yeah, absolutely. So, that's how you found healthcare. So, you've been in healthcare for a while. So, take us through sort of your career to the point of becoming CEO of The Garage.

Sure. I got into healthcare in 2004. I joined this company, a startup based out of Orlando, Florida, and they were designing the first commercial kiosks for patient check-in in healthcare.

Yeah.

I found that idea fascinating, right? So if you could check in using kiosks at the airports, why couldn't you check in using kiosks at your doctor's office? So I was employee number 5 in that startup, and we were a small team, had a lot of fun building the product. At one point, we had 170 hospitals using the product, and that company got acquired. And I had a chance to lead the healthcare division of the company that acquired that business for a couple of years and eventually branched out on my own. And my foray into entrepreneurship in healthcare, Ed, was born out of a personal experience. We've all been victims of the disjointed process in healthcare, right?

Yeah.

There are no exceptions here. I distinctly remember it was a Sunday afternoon. I was in my apartment and I had acute stomach pain, right? So I was like, what's going on? First I thought it was something, gas, something I ate, whatever, but it kept increasing. So I went to the urgent care and within 5 minutes of observation, I was sent to the ER. So, you kind of realize that it was part of the process. So, I was sent to the ER. I spent the entire night in the ER where I was practically a guinea pig for every test that ER could run on me. And, the next morning, the ER physician comes to me and says, you're good to go, son. Nothing's wrong with you. To this day, I don't know what was wrong with me that day.

Right.

So, walking to the parking lot, I started thinking, if this was my experience, Yeah. Imagine the seniors in the country that have to go through this multiple times in a year, right? And that triggered this urge to want to do something about it. And I said, okay, let's use the asset I know best, which is technology. And I've been a software engineer by profession. So let's use technology and data to bring in real change. And that's how I jumped into this, you know, to become an entrepreneur in 2009.

Wow. And so what is that like? So tell us for the audience that might not know. So you have this compelling, these life circumstances that happen first with your father, then it gets you into healthcare, and then this situation gets you sort of into analytics and population health, value-based care. So what happens next? What's the next step that you take?

So the next step is to kind of first create, identify a gap, right? Identify a real gap that is validate it and vindicate it in the real world and come up with a very specific tactical solution that you can operationalize it. The thing in healthcare that I learned very quickly is you cannot boil the ocean. You cannot change the system overnight, right? So, what you need to do, the best approach is to fill gaps and seek incremental progress. That's the only way healthcare has progressed if you really think about it. In fact, value-based care is a testament to that approach too. Right? So I took the same approach in my entrepreneurial journey as well to identify this one gap with my first venture, built a solution around that gap without any frictions in the workflow, right?

Yeah.

And then found a partner/customer that was willing to work with us to pilot the product, install the software, and benefit from it. And we found one in Southlake in Florida. And at one point we had more than 200 physicians using my product. So, the first critical mass of adoption, if you will. And then from there on, we were growing very well and a publicly traded company based out of Atlanta, Georgia heard about my story and they were looking to jump into healthcare. So, they contacted me and for me as a first-time entrepreneur, I'm going to live that American dream, right? So, jumped on that opportunity and eventually— They acquired my business in December of 2010.

Yeah.

So that was my first realization of the dream. And it really was a very, very important event for me to kind of realize that this is my thing. This is my identity. This is what I do best. And around the same time, the early beginnings of value-based care were beginning to form in the country. I was thinking about, okay, what do I want to do next? Right. And I had this feeling that value-based care is going to warrant a major disruption. It'll warrant groundbreaking innovation.

Yes.

Data-first, digital-first approach. And I wanted to form a, create a company that would be the hub for those innovations, right? Which is why I initially called this company The Factory. That was the first name I came up with for the garage. So, we could be a factory for innovation. And as I was thinking through the process, the name The Garage clicked. And if you think about every innovative company at scale that started in a garage, Amazon, Microsoft, you name it. So, we said, let's call ourselves The Garage and pay tribute to innovation at scale in healthcare. Yeah.

I love the name. It's very clever, but also very indicative of what you're doing, and that is creating creating solutions for the marketplace in order for us to be more successful and better stewards with all the dollars. Tell us about the logo. So for those who haven't seen the logo, although we will have a visual, it's a bright sun with sunglasses. So tell us about that. Yes.

That's Blaze. That's our mascot. In fact, Blaze was conceived and designed even before I named the company. I was actually sitting in a coffee shop in India with my creative designer. And I was wearing Oakley sunglasses at the coffee shop. He just saw my face and drew this on napkin in the coffee shop. And then we said, okay, this has to be the mascot. If you look at it, right, it has energy, it has positivity, it has a very, very strong vibe to it. So, we said, this mascot, called him Blaze, and then everything else followed from there. Yeah.

Yeah, it's great. So, we talked a lot about just being an entrepreneur and just sort of what drives you. We talked about The Garage, how that was formed and the name and also the logo. So, tell us about some of the things that you're really proud of that The Garage has done in partnering with health systems and payers and such.

Yeah. We've been on this road for 13 years and 7 months now, right? So, that's a lot of— if you really think about it, We've been very committed to our mission, which is healthcare needs to change.

Yeah.

And the only way to change it is one community at a time, one provider at a time, one patient at a time. That's how we've come at it, right? And we've been very honest about the work that we have taken on, the impact that we have had, the partnerships that we have secured, right? And that's one thing that's very important to us that we do right. We've been very honest about our journey and capabilities of the platform and things like that. And along the way, we've been relentless in our commitment to innovate. So, it's been a nonstop, absolutely amazing journey. Every day we learn more as a team. Every day we are fascinated by the opportunities and the challenges we face, right? Both are equally important for us. And we typically work with network providers regardless of size, specialty, or location that are either participating in value-based care or looking to participate in value-based care.

Right.

Either looking to shift existing care models or implement absolutely new care models that are anchored on value. So to enable both, we become the platform. And in that sense, we become the operating system.

Right.

For that provider. So that's basically how we come at this and that's been our book.

Yeah. And so if I'm a health system, sure. Or I could be a large practice. Sure. And I want to get into value-based care, not only do you provide the platform, but if, but if I know that I need to do that for a wide variety of reasons, I can come to you and you can help me.

Absolutely. I think we've built enough experience and domain knowledge in the space that we can go in and say, If you're a health system and you're looking to transform to value-based care for X, Y, and Z reasons, right? Here's a playbook for it. Here's how you come about it based on our collective experience working with providers such as yourself. Here's what to watch out for. Here are your opportunities. Here's where you could have potential leakages. And here's a platform that has baked-in best practices with a data-first approach that allows you to scale And build new care experiences for your patients. Yes, absolutely.

So yes, not only are you helping on a business level, but also on the experience level. Can you share an example? You don't have to give names because I know sometimes confidentiality agreements will keep you from doing that, but how it improves sort of the patient or member experience.

So there's one thing that we all, we are grounded on it, and this is something I tell my team as well. Everything we do impacts the patient. Think about it, right? I mean, if you are building a quality reporting system, just as an example, right? The reporting of the quality and the consequences of that directly impact access and cost of care for that population. There's nothing that we do that is patient irrelevant, right? Everything we do is patient relevant.

Yeah.

The question is, Basically, we look at it and say, there's going to be things that we do that have an indirect impact on the quality of life of patients. And there are things that we are going to do that are going to have direct impact on the quality of life of patients. But patients are central. They are in the driver's seat for everything that happens in the garage. We are absolutely grounded in that. In fact, I tell my team as well that our responsibility is towards those patients. Our customers are a conduit for us to deliver that service, have that impact with the patients that they serve. And those patients, they don't know who you are. They don't know Pranav. They don't know the garage, right? So your responsibility is to build the right solutions in a responsible way that those patients can get the care they deserve at the time that they need.

As an entrepreneur myself, or in my background, I've had an opportunity to help found a company. What's your preferred method of working with your customers? Because I'm sure, you know, I'm sure you accept all of them. Some of them will be very transactional, but what's the ideal customer relationship like for The Garage?

I always look for a strategic long-term fit, long-term alignment, because you're not going to fix health overnight. Our problems may seem short-term, but our solutions need to be long-term. That's something that we are very particular on. So if somebody comes to us saying, hey, can you help me with this 3-month project? It's probably something we'll walk away from. And we have done that in the past. But if somebody comes to me and says, hey, we want to change healthcare for our patients, whatever it takes, however long it takes, you're in. You are my ideal, perfect partner, customer, and we will commit to you. We will commit to your mission. Your experience will be that Me and my team are part of your team. You won't see us as a vendor. You will see us as one of your own. And that has been the experience for all of The Garage's customers to the point that today every customer of ours can have direct access to me. They text me, they call me, they brainstorm with me. That was true on April 1st, 2012 when I started the business. That is true today. That will be true 10 years from now.

That's awesome. I really like that approach. And I think that all stems from the humility that you talked about in the beginning, how you were raised and that's the way you lead. You haven't allowed the CEO title or the size of your company and your success to change who you are fundamentally.

And so that's— And a simple thing here, when we started, when we came to these offices that I'm in right now, we said we're going to have an office space that has no walls, no cabinets. So I'm sitting in the pod with the crew, rolling up my sleeves, doing whatever it takes. So everyone can, anybody can talk to me. Anybody can come and ask questions. It's a very, the culture is designed to allow for that level of transparency and commitment to play out as well.

Yeah. I love that approach. I'm always curious, like with, especially at the speed that technology moves, it's always moved so fast and healthcare is moving. What parts of healthcare move fast?

Other parts move slower.

Painfully slow. But how do you and the Garage, how do you keep up with all the technology? So I hate to throw in the word AI, but I might as well. You know, with all the changes with AI, you've got to be thinking about it all the time. So how do you all stay ahead to help your customers?

We are very grounded in the realities of the workflows that we are engaged in. So there's actually the flip side to what you said. We put in more effort to not get carried away by the hype.

Yeah.

Right? We are very, very particular about it. We took 9 months before we even defined our AI strategy. We didn't rush into it. We were not taken away by the hype. There was no ChatGPT that got us to say, hey, this is the direction to go. You're already late. Not going to happen in our world, right? So for me, the A in AI is applied. What is applied is intelligent. So that's one part of the equation. The other part of the equation is we created this initiative within the company to stay on top of all the technology shifts and all the latest and greatest models and AI breakthroughs and whatnot. We call it Mozart. It's kind of like a lab within the garage. And we have a very core group of members in that team. I'm involved in that team. You know what I'm saying? So we meet 3 times a week.

That's great.

That's where we brainstorm. We talk about things that are happening out there. What can we bring into our world while ensuring that it doesn't distract, doesn't defocus, and it doesn't create any friction? So, we have a very grounded, very authentic, real approach to adopting AI. We have 3 agents that we've deployed within our platform today. And because they're ingrained in the realities of the workflows, we are seeing a lot more success where it matters and less hype and more throughput and more outcomes.

Yeah. I love that. Where were you when I was in the C-suite of my health systems? I love where— I prefer the type of partnership that you've been describing as well. And then I always want to make sure that my partner was grounded like you all are, but also thinking forward so that I could spend more time on the things that I needed to do and just know that my partner had some things covered. So interesting. I want to pivot into leadership. What were some things that you think you learned from cricket that helped you today?

That's a great question. You have to truly love the game, man. That's one thing that I've learned. You can't fake it. You can't fake your way as an entrepreneur, right? You have to truly love, you have to truly be passionate about the game. And that was what cricket meant to me. I was never tired of it. I was never bored. I was always energetic and I have played even when I was injured. So that kind of passion is what drives that level of commitment, right? So every day I'm very particular and one is for me to be passionate about what we do at The Garage, right? And then how do we ensure that every moving asset in the company is as passionate or more passionate than I am?

Yeah.

That drives the commitment. That was number one. And number two, which is something that I, you You got to work hard. You got to practice hard. There's no shortcut to it, right? You can't master a craft by just— there's no silver bullet to it. So, sheer hard work and practice and hours and hours of hard work. And I remember Kobe Bryant is someone that I have looked up to as an athlete. And when he received his ESPN award for sportsmanship award or something, and when he was giving a speech, he basically said, We all know I'm here because of 4:00 AM. So 4:00 AM is when he would wake up and go to the gym for his training and workout and things like that, right? So that 4:00 AM is just a metaphor for what that meant, that hard work, that ethic, that commitment. Those two things, those two are the things that come to my mind when I picked up from cricket and applied to the business world here.

You're a super creative person. Everything, you know, we talked about your logo and the name and just the way you think. Where do you go for inspiration for creativity? I mean, do you ever find yourself like in a situation where you might not be creative? So do you do something to sort of stimulate creativity or a place or something you do?

I do things to just have a mental reset. I work out. That's one thing that I'm disciplined about. I'm the crazy softball dad for my daughter. When she's playing, I'm the one that's yelling. So that's me. So I do that, but very rarely do I get creatively drained to the point where I hit dead end. There's something about the creative aspect of what we do that's so fascinating and so beautiful and so arresting that I don't find myself drained per se, but I do look for some resets with the things that I do here.

Yeah, that's good. And You know, when I was preparing for our podcast, I spent some time on the web, your website as well. Super creative. I'm sure you have people that help you with that, but super creative people. If nothing else, we'll put it in the show notes. People should go check out the website. I just found it super fascinating because I love creativity myself and I love unique things. I love differentiation and the Garage seems all about that. So.

That's one thing. Like I remember April 1st, 2012. I had no employees. I had no solution, no customers, right? But I was stubborn about the fact that we are going to do something big and we are going to do it different. So that's been a staple from day one that we are going to be distinct in our expression, in our identity, in the way we look at things, in the way we do things.

Yeah. Now I'm definitely— you're based in our— where's your headquarters?

Orlando.

Orlando. Yeah. I was just going to say, next time I'm down in Orlando, I'm definitely looking you up and We'll have some chai or— Absolutely. Absolutely.

Yeah, we'd love to host you.

You know, we talked earlier about your parents. Was there something your parents forced you to do when you were a kid that you maybe kind of like rolled your eyes, not to them, but inside your mind? And, but now you look back and you're like, wow, I'm glad they made me do that. I'm glad they taught me that.

I've seen, there's 2 forms of inspiration. My parents, Growing up, especially teenage years, you tend to be cocky about certain things. You tend to be arrogant about certain things. My parents forced a behavior to be kind to everyone regardless of their social status, regardless of whether they spoke your language or not, regardless of whether they were your same skin color or not, regardless of whether they were your neighbor or not, whether they were at your same academic level or not. That was one protocol we had in the house. be kind to everyone, right?

Yeah.

So I think that helped me in a very big way. It continues to help me even today. That's important, especially in today's world. And 2, I've seen my mother deal with situations with no prior skill or capabilities. So she's an absolute hustler. So she will figure out situations. She will I come up with solutions that are out of the box, creative thinking and how to deal with different kinds of people and things like that. I've seen her do that in all practical situations, right? So that kind of gave me this inner confidence that whatever be the situation, you can figure it out, right?

Yeah.

So you just have to think out of the box, think differently, approach it differently. So those are the two kind of things that were in a way forced on me growing up that helped me in a very big way as I built my career and my journey.

Yeah. And so you mentioned already you have 2 daughters when they—

One, one, one daughter.

One daughter. When she graduates from college, what's the advice that you're going to give her in terms of her career?

I think for her, I, my, my advice would be to never stop believing in yourself. Yeah. And Don't follow the common path. Be a trailblazer. Chart your own path.

Yeah. This has been a fascinating conversation. We talked earlier a little bit about India and some musical influences, and we talked a lot about humility and just, this is just the beginning as a key phrase, which I love in many respects. We talked about cricket. We talked about your parents and how that influenced your career and how you made it to the United States and you've been an entrepreneur at heart. And you've started a couple companies, but The Garage, you've been with The Garage for a long time now doing some great things in the value-based care space. And then we sort of switched to leadership and talked about things that enabled your success. We used cricket as a metaphor, which is great about being passionate about everything that you do, the hard work, the 4:00 AM that it takes, taking practice, being proactive. And then what is success? And Telling your daughter, which I think is a great message, which is why I asked it, to chart your own path. Don't follow the status quo. Be your own person. Live the life that you're meant to have. What did we miss, or is there anything you want to double down on? I'll give you the last word.

I think as a collective, as a community, as a society, I think sometimes we tend to be ignorant to the challenges that healthcare face. Until it happens to us.

Yes.

Yeah. It's not our problem until it's truly our problem, right? So my only message to your audiences is healthcare is important to all. And we are at a point where I think we have to realize a real change in the way healthcare is delivered in this country. And all patients deserve better. So it'll take the collective, it's going to take the entire, it's going to take a village to drive The outcomes that we all seek, that we all deserve. So everyone in their own way can contribute to this movement that has begun with value-based care. I think this is just the tip of what's to come in the next decade or so. I believe there's going to be a lot of different variables that will be at play and a lot of things that we can change. So that's my message is for all of us to put in the effort together to bring a real change in healthcare.

Yeah, Pranam, very well said. Thank you so much for being my guest on Digital Voices.

Thank you so much for having me. Thank you for listening to Digital Voices podcast with Ed Marx. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.