LS 14 - Revolutionizing Health Care with Ari Tulla

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Welcome to the Longevity Show, Informing listeners on the important aspects of health, wealth, and happiness to ensure you live life to its fullest. With fascinating interviews with top authors and gurus in the field, along with the latest news in the science and technology of longevity, we're going to reveal expert advice and amazing secrets of living a longer, happier life. And now, here's your host, Jason Hartman.

It's my pleasure to welcome Ari Tala to the show. He is the co founder and CEO at Better Doctor, which is a very interesting, possibly disruptive model to the healthcare system. And I think you'll get a good perspective on it today and how you can take advantage of it and potentially get better care. Ari, welcome. How are you?

Hey, thank you. Great to be here.

Well, it's good to have you. So you're coming to us today from San Francisco, is that correct?

Yes, yes.

Okay, good. Tell us about Better Doctor and how it came about.

Better Doctor is a simple platform that you can find a doctor. Finding a doctor is. It sounds very easy, but it can be very, very complicated. So I started the company after many years of personal struggles in health in my family and spent months of time trying to find the right doctor. And in the end got so frustrated that I decided to start a personal vendetta and. And try to make a tool that can help people out there. And it has been helping my family. And in the last couple of years, we've been able to help more than 10 million people find a doctor.

And so what's different about it? I mean, there are lots of directories on the web where you can find a doctor. What makes Better Doctor different?

I think that's a really good question. And I think what I was frustrated myself when I was in the Serbs, and I went all these different services and the data was pretty inaccurate. That was one of the key problems I had. And I couldn't really go beyond the simple thing of finding doctors based on speciality and location. You were lacking information about the quality. You were lacking information about what the doctors are really doing, and you also were lacking information about availability and so forth. So really, what we're trying to do is to put all these five different data points together and build something that can actually help you really find the right doctor.

The five different data points. Just review those again.

Yeah. So the key thing, of course, what you need to know is that the doctor you go to is the right Kind of a doctor. If you go to complain about a specific thing, you need to get a doctor who knows about that. That's the number one given thing. The second thing that you must have is the payment. If you have an insurance plan, you of course want to go to a doctor who accepts that plan and you can pay the copay. Otherwise you pay 10 times more and it becomes too expensive. Then thirdly, of course, you want to find somebody nearby. Us Americans, normally, we don't want to have the doctor further than 10 miles away. And that's kind of if it's 25 miles away, you might not go there too often. And then fourthly, you want to find a doctor who is good, somebody who knows what they're doing. And the quality, of course, is a very complicated topic in healthcare. So it could be about consumer feedback, it could be about the background, it could be about many other things. And then finally it's the availability. So you of course want to find a doctor who is going to be available in the next week, not in the next month.

So can you book appointments right online then?

We are now testing the early kind of beta on the online booking and there will be a lot more that we're going to talk about that later.

I mean, I've certainly noticed that doctors offices tend to be incredibly primitive. You know, they don't have email. It's absurd. It's just ridiculous. So I'm sure that's probably an uphill battle getting doctors to adopt an online booking system, that of, you know, for a haircut, a spa treatment, restaurant reservation, all of those, you can do it.

You know, I think you're right. And I think we are 10 years behind in healthcare. And the kind of lucky thing here is that the Affordable Care act, the Obamacare, is actually driving now a lot of these small practices to go online first time. And, you know, prior they really had these monolithic tools that were sitting in the corner of the office, not even connected to the web. And now that is changing pretty fast. So I think we're going to see actually more and more doctors be able to offer online booking. And I mean, think about it for your specific case, I mean, like, how do you want to see a doctor? You don't need to always go doctor, doctor face to face. I think, I believe that, let's say the Skype type of online appointments are going to be more common going forward. Phone calls are going to be more common, I think even text messages. I mean, you might have new parents who don't know about something. They just want to have a validation.

Much, much more efficient. Yeah, right. Yeah. What does Obamacare have to do with it? I mean, do you think really, wouldn't this have naturally evolved this way anyway?

Well, I think, you know, government is, of course, interesting. It can impact things many different ways. But I think this is what they now have done. They give subsidies for a small practice to become online enabled, so to speak. And that's of course, something that if you can get $50,000 of free credits, if you become, you implement EMR, for example, that includes maybe the online booking capabilities. I mean, that's great. I mean, it's free and you get money. So of course, people are now kind of driving and adopting more of these things. And of course there's the stick and the carrot. So the stick is that next year or year after next, you get a penalty if you haven't done that as a practice. So that's why it's finally happening. And it's more like it has to be mandated otherwise it won't happen.

Right. Well, it seems like that's a pretty big bill for the taxpayers to have to Pay, I mean, $50,000 to a bunch of doctor's offices for them to get their own technology set up. I mean, no one gives me $50,000 to increase the technology in my business.

Yeah, I think you make a good point there. And I'm not arguing about the political view on that. But the good thing from our perspective, and I think from the consumer perspective, in the end, is that more and more doctors will have. And I mean, it is not only about, of course, you know, simple way to make appointments. It's also about getting your medical records in order. I mean, I don't know if you have done it, but I think many of the listeners have needed to get the medical record from one place to another. And that's kind of a manila folder of paper and that's like so antiquated that if we could get that online, that would be already interesting.

Yeah, very interesting. Okay. Okay, so let's drill down on these five data points. I mean, we already can now book a doctor based on specialty. Availability is a little tricky because you don't have the online appointment system yet. At least, you know, maybe it's only for a small number of doctors. So the availability thing isn't really something that quite works yet. I love your vision for it, but it sounds like it's not quite there yet, right?

Yeah, I mean, I think we are. That's maybe a year away until we're Going to see really a great penetration happening in the market in that direction.

Okay, so we've got three data points left. So one of them is knowing about, I think you said how much that doctor is referred by other doctors, right? Is that one of them?

Yeah, that's part of the quality. And I think that's a very valuable element because.

I agree. But how do you know it? How do you get that data?

Yeah, that's kind of the gold mine that has come available from, from the Medicare and Medicaid. So what is the data about? It looks at the Medicare referrals in and outbound and then tells us the whole landscape from year and a half. And it basically means about 160 million referrals. So most doctors are involved in this. And you can think it as not a complete view of the market, but you can think about 40% of the market. Like if you do your poll, you poll people and you don't ask thousand people, but you will ask 40% of the people, what do they care about? So it's a very, very robust data set.

So you would go to other doctors and ask them if they've referred, say you go to Dr. A and say, how many times have you referred your patients to Dr. B for a different treatment?

Oh, sorry. I mean, it is data that came available after a FOIA request. So the couple of data hackers and media people and so on, they were asking from the government that, hey, Open Data act, we need to get this data. And after a lot of back and forth, it was released about eight, nine months ago. Medicare released the data.

Okay, so in other words, Medicare referring doctors to other specialties. Give us an example of that, how it works. I'm kind of lost on that one. You go to a primary doctor and then the primary doctor says, okay, you need physical therapy. Go to this physical therapist. Is that.

Yeah. And that data is then captured into the process because, you know, Medicare is like one big system where all this data is collected. And that's one reason why, you know, there are so many issues with the Medicare overall, because it's a huge system where you are storing all this data. So where was this patient coming from? Who did it go to? So that is stored in the system and that is now being released publicly.

It's only for Medicare, though, so it doesn't work for the broader market. But Medicare is a huge part of the market, obviously. So it works on the Medicare side, is that what you're saying?

Exactly. And basically it means that it's like a 40% sample of the whole market. And I mean, I think the only challenge with the data is that you don't have so much activity, let's say, for pediatricians or dentists. But for most of the medicine, it's a very, very good data.

Okay, okay, that's good. So I think we've got two more data points left that I didn't ask you about. One is malpractice. You know, doctors being sued. We talked a little bit about that off the air. Tell us what better doctor can do for people there so that they know what kind of doctor they're getting.

Absolutely. So the data around malpractice and the claims, it really is data that is done on a state by state level. So what we have done is we've been collecting that data from states and then put it in a form that we can understand it. It's maybe not a perfect data set because a lot of the claims and malpractice are settled, so they never come public information. But the ones that are in the court and those are public. So what we do, we collect all of them and we look at it and say that if somebody, let's say one doctor, for example, has four recent malpractice cases and they are not settled, so there must be something wrong with this person. So it's kind of giving indication that, you know, this doctor is somebody you might need to be wary about.

Okay, all right, good. So we also talked about the problem with that is that these darn doctors put these arbitration clauses in their agreement. And if you go to arbitration, then you're basically. And this is our whole legal system, broadly, it doesn't, you know, it's not just the medical system, but everything is kept out of view of the public. It's like a kangaroo court in a third world country. And so I'm just making a general statement to my listeners, not just about medical, but medical is certainly part of it, that arbitration is really, really a big scam, in my humble opinion. Because, you know, the whole concept of our founding fathers was things should be in the public view. You know, they should not be hidden. You should be able to know. And a lawsuit is public record, but arbitration, you know, it's just a private court. And so you never know. So it's good that there is some data there, though. So if there is a lawsuit and it's settled, you do have a record of that. And so you can see that this doctor has been involved in litigation. But on the same token, I mean, doctors get sued all the time. Lots of professionals get sued all the time. It doesn't mean they're necessarily bad. Right?

No, I think that's a really good point. And often the case is that if you really are progressive doctor who wants to treat the hard cases, then you probably will have more of this case is happening to you than the doctor who takes a safe road.

Well, that's a good point. The person in any form of business doing something that's really simple, they don't get sued too much, but the person that wants to do something hard, there's more odds of failure when you do something hard. Right?

Yeah. And I think one thing that to add here is that, yes, I agree with your point about the system being too closed. But in medicine I lived in Europe in different countries and I've been kind of following up the system elsewhere and I'm puzzled by the fact that in most countries all the medical information is kept very, very private. And I think now together with the Medicare data opening, actually we have more data open in the US today than any other country in Europe, for example. And to me that's kind of promising. But it tells a lot about the kind of the mindset in healthcare where it is really not open to you as a patient or user, but it's really kept private and it's almost like a hidden society in a way.

Yeah, yeah, I know, I know. There's obviously a privacy rights issue here. People want their medical records to be private. So this is certainly part of the reason it evolved that way here. People didn't want to be in one centralized database. They still don't. You know, there's always risk of breaches of that database. There's risk of certainly the. We know the NSA is going to look at everything nowadays, so that's a whole nother problem. But that's another discussion, my friend. Okay, so there's one more data point left, right?

Well, I think one of the most interesting data points that we've been really excited about lately, it came available two months ago, which is the Medicare procedure data. It involves old procedures done by doctors in the last couple of years. It also involves the price of the doctor was asking for Medicare. So this data really is now giving us first time review into what the doctors are doing. So beyond knowing that this doctor is a pediatrician, you will now know what kind of procedures do they treat. And that is really a goldmine in my mind. And it will change completely the way how we're going to find doctors going forward.

Yeah, good stuff. Well, it's nice to see someone really revolutionizing and kind of disrupting this old hat industry, which really it is. I hope that next your plan is to do it to the legal system because that needs major improvement too. So tell us a little bit about the company.

We started the company three years ago and in the beginning it took us almost a year and a half to build the database because we really are data company by heart. And late 2012 we released the first version nationwide and now you can find pretty much every doctor and dentist and practitioner in the whole country based on the location, the specialty insurance plan and so forth. And you can find these data points that we discussed previously on Almost Every Doctor.

Fantastic. So you raised venture capital?

Yeah, I mean as this kind of company is tricky because you need to have the capital in the beginning to build the database and you need to build the system around it. So we have raised a couple rounds of capital, almost 15 million to date.

Well, congratulations on that. And so how do you accumulate and get every doctor in the database? Do you just get the medical license list and download them or upload them? I should say.

Yeah, that's one of the data points. And I think today we have probably collected data from over 10,000 different sources. So the core data comes from the government. Every doctor has to be listed on a certain databases. You have the medical license data, you have board certification data and so forth and so forth, including the insurance data from the insurance companies and payers. But in the end it really is kind of bulldozing and meddling all this data together and building something that makes sense.

Good stuff. Well, the website is betterdoctor.com and Ari Tala, I wish you much success and thank you for joining us today.

Hey, thank you. Thank you so much. It's my pleasure.

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