Grand Rounds | Covid is Reshaping Employee Care: How Great CEOs are Meeting the Moment

Hey everyone. This is Heather Mack with Greylock Partners. You're listening to Grey Matter, where we share stories from company builders and business leaders. Today we're talking with Owen Tripp, the co founder and CEO of HealthTech startup Grand Rounds. While the coronavirus pandemic has caused a significant downturn in business for many companies, Grand Rounds has had the opposite experience. As a provider of software, data, clinical expertise and resources to make navigating and accessing healthcare easier, faster and safer, Grand Rounds has seen an uptick in usage among their 5 million covered lives. Their the company has also taken this moment to expand its product offering. But having the resources and abilities to rise to meet this new demand didn't happen overnight. Grand Rounds has been around for nearly a decade and has been carefully playing the long game that allowed it to adapt to this surge in activity. So now let's hear more from Owen about Grand Rounds strategy.

Hi Heather. It's good to be here. I guess we'll start with what I do, or what I hope to think I do every day, which is I lead the company as its CEO. I also co founded it with Russie hoffman back in 2013. And we're really in the business of raising the standard of healthcare for everyone. Everywhere we talk about how the model we've built in our building allows people to rethink what the American healthcare system could look like and could feel like as we all go through the American healthcare system some part of our lives and are often taking care of others along the way as well. So we service the Fortune 500 primarily, although increasingly we're seeing smaller and smaller companies be interested in what we're doing. But the company is probably best known for its work with the largest, most progressive buyers in the American and healthcare system from the employer perspective. So those are companies like Walmart, Amazon, JP Morgan and others. And the work that we're most focused on is making sure people access higher and higher quality of care. The sort of recipe at Grand Rounds is actually quite simple when you, when you look at it, which is we've figured out that higher quality care leads to two good things. One, a better outcome for the member. Honestly, that would be enough for me and my colleagues to get out of bed and do our work every day. But it's also true that when you get to a higher quality outcome, you save money. You, you save the company's money, you save the members money because you're not wasting it on inappropriate and ineffectual care.

So obviously with the pandemic, personal health and the Healthcare system as it works is top of mind for most people. And the pandemic significantly impacts every aspect of healthcare, which, whether that means forgoing the doctor visits because you can't actually go in there, or putting off procedures, and how employers are thinking about what types of benefits they need to offer their employees, especially when they return to work, and health and safety is the priority. How does Grand Rounds fit into all of that?

So what we know, though, is that we've actually really only been sort of in this unusual moment as a country for about three months, and still we have seen this massive transformation in those three months from kind of where we were to where we are now. So let me walk you through that, because I think it's been interesting. In the very earliest stages, it was about, wow, there is this virus with these special and terrifying characteristics to it. It is ending up around the world at a very fast rate. Grand Rounds was actually seeing cases of COVID 19 far earlier than when we were even naming it. It was actually still guarded as the coronavirus or the novel coronavirus. And we were seeing people with acute respiratory distress syndrome as early as January in some of our patient populations in Seattle. So if you look at that first month and you think about what we were focused on then, it was about getting people access to testing, making sure that they understood the symptomology associated with COVID 19. Now, we could all probably recite those things by heart, but in that first month, it was highly unclear and unfortunately, it looked like a lot of other things that people would be walking around with the cold, the flu, seasonal allergies. So helping on the education and making sure we were delivering ample testing and connectivity to the testing locations. In the second month, we started to look at, well, gosh, you know, some of these cases are going well, some of these cases are not going well. Lots of work sites are shutting down. How do we make sure that as we redistribute, as we work from home, in cases where you can work from home or where we continued in essential workforces, and a lot of our covered lives are in the essential workforce category, we were doing so safely and that those people were coming in and out of the workforce both safely and so that they could be productively. And there's a whole bunch of work that we've been doing there. And then now we're in this next phase, which. Which in some ways is going to be the most economically important, the most clinically important, and yet I think we're only starting to get our hands around it. Which is how do you get people back to healthcare? How do you deal with the fact that lots of folks have been putting off essential care that they need, they have been deferring chronic care management, they haven't been taking their meds, and what does the new delivery system really require of us to make sure that those people are getting great care? So to say we've been busy is probably an understatement.

Now, the ability to help everyone in that way is because you have this whole platform approach, but you weren't always really known for that. People thought of you as. That's where you go to get a second opinion, explain how you've built that platform over this time.

Yeah, you're absolutely right. And I actually think there's perhaps a lesson for entrepreneurs who are trying to think about broad based impact in healthcare and other sectors like healthcare that are so complex. So we absolutely did start with the expert medical opinion. You know, our signature piece of research and development thing we launched our machine learning platform around was this whole idea that you could quantify every doctor's ability and expertise in the country. We will go out for any diagnosis in the world. We will go out and we will assemble a team of experts to collaboratively solve the problems for that member. And in solving the problems for that member, we're looking at diagnosis, we're looking at treatment path, and it is that sort of work that allows people to get back to living the way they did. I have personal story on this, which is, which I will mention briefly, which is I was diagnosed with a rare brain tumor in 2016. It was initially, initially missed by my primary care doctor. It had symptoms that could have been explained by a bunch of other things. And frankly, only through the insight of my team and the experts we worked with was I able to actually not only survive this moment, this very scary moment, but continue to thrive. And without grand rounds, I shudder to think of even where I would be. So you're right. We started in expert medical opinions. This is how we built relevance and speed with the employer market. But if you look at the healthcare market in its entirety, you understand that managing highly complex, scary cases through a process like an expert medical opinion is but one thin slice on what you need to do for people. Unless you're thinking about their financial wellness, unless you're thinking about how they administratively get in a nut of appointments, get access to the things that they need, unless you think about that whole patient approach, it's unlikely that you're going to achieve the business results you want to achieve and you're certainly not going to achieve the clinical outcomes that you want to achieve. And so we move from expert medical opinions to this thing that we call navigation, which the simple way to think about that is how do you answer all the questions, big and small, clinical and administrative, how do you hold that member's hand sort of virtually through the entire process so that you can safely and efficiently get them through the healthcare journey to the best outcome that's possible? And that work has come together in this navigation platform.

What made you decide that you wanted to start a company in that field? It's one of the hardest industries to innovate in just for so many reasons. And I'd love to hear why you went from going from other startups to health tech.

I am super keen on problems that benefit society broadly and especially people who may not have access or ability to stand up for themselves. There's a lot of sort of equity and equality that's baked into the grand round solution. The same was true with reputation.com, sort of protecting the little guy on the Internet from threats related to privacy and sort of destruction by ta. This was very motivating for me and the team there as well. B, I like problems where information can be the sort of accelerant and the sharing of information, the quantification of information. So thinking through, in the case of grand rounds, how do we quantify physician level ability? That's the second thing. I think the third thing that was interesting about healthcare is it was one of the major pieces of the world that was fundamentally untouched by tech. And that, that is like shocking to think about. Heather, because it's 20% or nearly 20% of the overall American economy. We spend more money on health care in this country than the entire gross national product of China. So not the gross domestic product, but the gross national product, the things that they consume inside of China, is less than what we are spending on health care. We're larger in spend than the entire GDP of France. So it's, it's mind boggling to think of the scope of this part of the economy. And yet if, if I sort of forced you to come up with like two or three name brand technology healthcare products, I think you'd really struggle to do it. And if I asked you to come up with five fintech names or five hospitality tech brands or travel, you know, you would have no problem ripping those off you. And I could easily come up with 10 dating names. And yet that is a, that is a mere speck of healthcare dollars at Play. So just the enormity of the problem was really interesting, I guess. I suppose I would finally add that I'm a bit of a contrarian at heart and so I think going where people weren't going was appealing. Now we're recording this podcast in the spring of 2020 and what's interesting now is how hot digital health has become.

So over that time that you've been around. Fundraising for the past 10 years has been going up, up, up and up across for startups, but it hasn't always been like that for health tech companies until very recently. There's a bun reasons that are that's happening. You know, people are understanding the, the value that, that these companies can deliver. Some of the companies actually had some public exits like Livongo and Progeny. It seems like investors are more willing to put more money up front even before a company is fully launched versus for health tech for a long time it was taking forever to prove prove their value. But I'd love to hear your your experience fundraising in that environment over time.

Sort of fascinating to think about that passage of time. Things move very slowly in healthcare on a relative basis. And when we joined the digital healthcare landscape it was pretty sparse. Now there are billions and billions of dollars in venture and growth investing that have gone into this space with a lot of good names around us. But at the time it was a pretty empty party. Now every marquee brand on Sandhill Road and beyond has a healthcare strategy, or I would say 90% plus of them do. That was absolutely not the case when we started the company. Going to investors who had a perspective on healthcare. And anything closely related to what we did was excruciating. Even the investors who were investing in healthcare were investing in what we call life sciences. And while you can say that both have to do with the world of medicine, that's about all that's shared between Grand Rounds and a life sciences company. Because what we actually found was there were a small group of investors who were interested in early stage health care investing in software. Our series A was led by Venrock, one of those firms. And in the series B, which Greylock led, we sort of love the fact that Greylock had all of the enterprise software background. That was actually really essential DNA for us because our go to market motion is in selling to large enterprises who are trying to, you know, get a better handle on their health care spending, their health care spending, which by the way, often if not always exceeds their IT spending. And so there's so much we talk about in terms of enterprise software portfolios, but these very same companies are spending more on healthcare benefits than they are on their internal IT portfolio. It's just sort of striking to think about it in those terms, but it's entirely true. It's an underpenetrated part of enterprise selling. But what I can say is if you look at any sort of, you pick your favorite blue chip American company and you're going to find that health care spending usually ranks only behind payroll in their total sort of expense line items as you go through. So one to consider is that in the case of Starbucks, you know, they spend more money on health care than they do on coffee, which is kind of shocking to people when you think about it. But, but actually, and they have this sort of massive supply chain team that's better than anybody else in the world in finding and selecting coffee beans. But they have like a few people, and I literally mean a few people who are thinking about the selection and procurement of healthcare and healthcare benefits. So that that's just sort of the world as we inherited it, you know, and the numbers, you know, become eye popping. Walmart spends, you know, six and a half billion dollars on their health benefits each year. Just to give you a sense and size and scope of, of how these things work. Now back to your question about investors. The thing I wanted to flag is, you know, and my advice to any entrepreneur that's listening to this is you would really be well advised to making sure that any sort of capital partner that you pick has an understanding of the speed of the cycles in selling into these markets because they don't look like other sales cycles. And the last thing you'd want to do is have somebody who is used to a sort of consumer sales cycle or an, or even a traditional enterprise sales cycle who is sitting on your board and doesn't understand that sort of building the momentum and building the influence through all the partners that you need to in order to start to conduct these employer sales is time consuming. Very little happens in this industry overnight.

Now talking about sales cycles and speed of anything that's happening, customer acquisition, how has the pandemic impacted your operations there?

You know, you said, you kind of made this offhanded remark about how sort of capital cycles might be slowing after a ten year bull run. And I would say broadly in tech, I'm sure that's true. I'd say in my little corner of the world that's probably not true. I think you're actually, you're going to see acceleration in digital health because we are at a moment now where one, two or three of the companies that we are seeing emerging in digital health will be the managed care companies of the future. And many of the managed care companies we're familiar with now, like the UnitedHealths, like the Aetna CVSS of the world, are in not just the Fortune 100, they're in the Fortune 20, right? They're some of the largest companies in the world. And so there's this incredible moment right now to sort of get capital behind companies like Grand Rounds that have a blueprint to service massive addressable markets. So I'd say things feel relatively good from where I'm sitting, acknowledging and respecting that. It's probably not feeling as good in other parts of the tech economy in terms of sales cycles. In the moment of COVID 19, there too, there's good news, because while corporate budgets have been frozen on a number of topics, benefits went from being the thing that you kind of needed to do as a company to make sure that people had access to health care, to now the thing you need to figure out, otherwise your company can't run. So consider the case of Tyson Foods, for example. That's a customer of ours, right? They, they are sort of working to keep the food supply chain safe and secure for all of us. We're consuming their products daily. There's no work from home strategy for Tyson Foods. There is no way for them to sort of keep America's grocery stores stocked and sort of take people or a lot of people off the line. And so thinking about the entire strategy for wellness, the entire strategy for how to safely take care of people, how to take care of people when they get sick, you know, protect, prevent people from other people from getting sick. This is the sort of work that Grand Rounds is doing across the country with, with companies like that one. And so the budgets have been pretty liquid to make sure that people can attack that problem with vigor. I think the only challenge is knowing that there hasn't been sort of one authoritative playbook written on this. How do we work with those companies hand in glove to make sure that we're accelerating against their strategy? And I'll just give you sort of one other example. I mentioned a food manufacturing company, but we're also working with, you know, the two largest telecommunications companies in the country. And in that case, you know, they, they also happen to be in media and entertainment. And so they have studios that are making movies, they have line workers that are going in and out of homes to fix cable problems. And, you know, the sort of workplace health requirements for those employees are very, very different. While I don't want to discount the sort of challenges of a greylock or a grand rounds and thinking about work from home, it is massively more complex when you have a business that is going in and out of people's homes that you know, has to be in proximity for the business to run in the first place. So we've seen a lot of acceleration around that moment.

And you also have resources for people who are office. Can you explain what, what you've added to your resources and platform to help with people thinking about going back to work?

Yep. So we, we have put together operating guide. So for the operators who are listening to this pod and trying to figure out how they safely get their folks back to work, we have the Blueprint for Healthy Return which is a really comprehensive and terrific document. I'll sort of briefly outline it because it really, whether or not you access our document specifically, these are things that everybody should be thinking about. I think the most important thing for organizations to understand first is what is the forecasting in their specific area with respect to this disease, its implications, hospital capacity and sort of looking zip code by zip code to try to understand and model out that data. So we have specific resources and calculators to do that work that are dynamical models that are updated constantly. The second thing is then figuring out what are your clinical risk factors, who are the people you need to take most care of and pay most attention to and how do you make sure that they can be accommodated and safely work from home, or that you have a, a policy effectively to make sure that they are particularly protected in the workforce as they return. Then there's a whole set of considerations about how we need to redefine our environments. It's really interesting. I think this may spell the end to the open space cubicle layout that all of us in the valley have become so accustomed to over the last frankly two decades. I think you are going to see sort of a return to blocked off workspaces. You're going to see elevator management and big buildings look very, very different. I think you're going to see check in protoc and procedures look very, very different. So there's a whole sort of environmental context to this as well. And then finally, as you think about people, you know, the point of view of our epidemiologists is not so much that we're going to see sort of one big second wave of COVID and then we'll be done with it, but more a Sort of, sort of rolling waves depending on the geography. And there's plenty of evidence that that's actually already happening in the United States. And so because that's true, the forecasting and using data to predict when it's going to happen, that's important. But also understanding, you know, how you're going to take care as they become symptomatic and potentially sick as you readmit them based on sort of what your testing protocols allow. And I should say that's an important additional piece of work we're doing is helping people administer their testing protocols. Thinking through sort of what that flow of people in and out of the office is going to look like is important. The last comment I'd make on this is I think when Grand Rounds sort of invoked our business continuity plan, we moved people out of the office, which was earlier than most. Based on what we were seeing, it went okay. But I would probably, in retrospect, there are things I've now learned about how we would want to do that, that I'd want to be ready for the next time this happens. And so in my mind, it's not a question of if it's going to happen again, but when it's going to happen and what that's going to look like. And how are you going to think about people who have tested positive for the antibodies, what science can tell us about what that means in terms of their relative safety. So these are deeply company by company considerations, honestly. But that blueprint for a healthy return gives people a lot of context and ways to think about it and tackle.

The things are not going to be normal. Ish, who knows. But there are still definite spikes in usage of certain products or demand for certain services. How do you figure out what you should lean into as a company to build out a product or build out a new strategy or position your messaging in such a way when. How do you know that it's something worth, like investing the time and money into if it might have only a temporary necessity.

Yeah. I would say as we confront this moment, how do we make sure we don't build something that is really only purpose built for this moment? And I would agree. So we thought about whether, for example, we wanted to build a sort of robust contact tracing approach. You know, we certainly have the connectivity with these employees. We could sort of do that work. And for. And I'm sort of taking you inside of our war room and leadership team on this. But the debate was, was really around whether that was something that was going to have a lot of Longevity or whether that was a purpose built thing for these next sort of couple of iterations of the virus, not to mention sort of the obvious privacy considerations that, that we would have to consider in building anything like that. So I'm sort of less enthusiastic about things like contact tracing, but I am more enthusiastic in things like virtual primary care and longitudinal ways of connecting and developing a relationship with people so that they can get the majority of their healthcare needs that through sort of the ease, convenience, security and personalization that these new virtual care platforms will allow. This is a big part of our, of our forward strategy virtual care. So the notion that I will connect with my medical team through my camera, through short texts, through a primarily digital environment, that wave is here to stay. This is not sort of a passing moment. We've gone from about 3% telehealth usage in the country to about 40% in less than three months. Just getting from 0 to 3% took us about 10 years, 10 years to go from 0 to 3%, 3% to 40% in three months. And we're not going backwards because even when we start to recover from, you know, sort of the COVID 19 specific implications, you're going to have a whole bunch of people who are high risk medical conditions, who are over a certain age, who are not going to want to go into a traditional doctor's office unless they absolutely have to. So for all of us working in healthcare and healthcare delivery and the digital side of it in particular, that is a massive call to arms and a huge opportunity. We are all going to like the healthcare system. We get on the other side of this a lot more because we won't have to sit in icky waiting rooms under sort of terrible fluorescent lights with smelly disinfectant all around us, reading magazines that 100 people have looked at. You know the people magazine from 1999? Right. We will have the ability to actually show up for care when we need it to be treated like a member, like an individual member of a system rather than a number floating past. We will get care that is just in time, that is intelligently connected to all the other things we need so that a prescription and appointment can be booked and ordered right within the context of that appointment. It's going to feel more humane, it's going to feel more personal and it's certainly going to feel more convenient. And we, we get really, really excited about that. So those sorts of investments are the ones that we want to really get behind and invest in. I did want to offer one other thing on this, which is it's difficult for the traditional healthcare entrepreneur and management team, I think, to be simultaneously ambitious and focused in the sense that we know that focus, focus, focus really, really matters in bringing a great product to market. And yet there's not a single product in healthcare that does everything that you need to do on behalf of the patient. There's no sort of whole patient care product that's out there. And so the challenge for Grand Rounds and for me, is how do we go sufficiently broadly to be capturing enough of what really matters to the member and to the patient, while keeping the highest focus and the highest leverage on the things that really matter. And so for us, that is about the member experience, that is about using data, and it is about clinical expertise. And so those are the three domains we flex in. And when we test ideas against those three criteria, we often find things that don't match right now. And so we're going to deprioritize until later or partner. And that's how we think about it.

Say you're going to a new customer, a potential new customer. You know, everyone's really sensitive about the kind of money they're spending right now, but they know that they need to get this managed and they know they need to manage their healthcare costs. But how do you demonstrate roi?

The employer is the purchaser. They are the one who is going to underwrite our fee structure and our ability to do what we're going to do. But really, it's up to the member as to how it gets used and when they use it, and to what effect. In sort of the consumer world or in the software world, which I came from, we would call that B2B2C. What's even more different about healthcare is the financial transaction that ultimately translates into value created. In other words, like, the point at which a user consumes a unit of healthcare is unlike anything else in the American economy, where the consumer, AKA the patient and the provider, AKA the doctor, shake hands, a sort of care is delivered and neither one of them knows what it cost, which is really weird. I mean, this would be like you going and buying a car and the car dealership didn't know how much they sold it to you for, and you didn't know what you paid for it. And yet it's your car. It's really weird. And so because of that very strange structure in healthcare, employers are trying to get their heads around what are we spending, what are those units of consumption actually getting us? And so when we go and talk to an employer about what we're trying to achieve. We're looking for three things. We are looking for clinical outcomes, we are looking for financial outcomes in the sense of avoiding wasted care. And thirdly, we're looking for a member experience that's consistent with their culture. Those are our aims. That's what we are trying to do in order to build that case to the employer. Now to the member, they are not feeling well, they may be scared, they may be tired, they may be all of the above. And they are just looking to make the pain and suffering go away. And our sort of single minded focus is making the pain and the suffering go away. That is the way we engage people in healthcare, that we think the best stories in healthcare are crafted from great medical teams solving problems on behalf of their members. So we try to like identify all those points of friction for the member and reduce them and reduce them and reduce them. The member does care about the financial impact, but only to a point because they don't necessarily see the full cost of the care that they actually consume. So it's really about getting them to better care. The better care translates into reduced cost exposure.

Do you do pilots with companies ahead of time? Like how long does it take to get everything set up?

Yeah, my team knows that I pilot is sort of like a four letter word for me a little bit. Mostly because of the way that it has sort of been historically used where if somebody was piloting something it was really their, the project they didn't really care a whole lot about and they weren't going to put a, they weren't going to commit a lot of time or capital towards. And I think that that just sort of makes it unlikely that it's going to be successful for either party. So we tend to go all in on an employer population. We tend to say no to things like, well, we only want our executive team to get access to this or we only want the sort of workforce that's doing this thing to get access to this. We don't sort of like those setups and we frankly don't think they're going to achieve the population outcomes that people want. We tend to go all in now. We're a big company now and so we have the ability to sort of, we have a bunch of data that can kind of prove that we will be successful in those situations. At the very earliest stages when we were fighting for our first few enterprise contracts, we wrote much more rigorous performance guarantees in the sense of, hey, look, we're going to give you a lot more flexibility as the employer, if you don't think we're up to the challenge. This is the classic thing that you have to do as an entrepreneur when you're trying to earn a spot in a marketplace. You have to back up your theory and your projections with stiffer financial commitments. And we were absolutely able to do that. Now we're starting to flip it in the other direction where it's, hey, there's a presumption we're going to be successful at the beginning. That's a shared presumption. And now let's make sure that as we're more and more successful, let's share in the upside that we can create together. And I love being there because it's very aligning with the employer as to what you're trying to create together.

There's actually a lot of different point solutions or companies that offer one piece of all of this, but they really specialize in it. I've seen a huge increase and then decrease and then increase in health tech companies like that over time. What's going on in that realm right now? Because I know in other industries there's kind of this idea like, well, it's okay to have point solutions and then they can all kind of stitch together. It doesn't have to be all in one, but it just, it doesn't work quite that way in healthcare. Can you walk us through that?

I mean, in this sense, your healthcare benefits are really different than other enterprise software. If you and I use Gmail every day to do our work, or we use Slack every day, it's, it's very much encoded in our workflow. Of course it's going to be top of mind to use those platforms. But if I'm accessing a health benefit once a year, trying to be top of mind on a very narrow and specific thing I think is challenging. And so what you're seeing is a lot of the platforms take an approach where we want to help aggregate all the demand for great solutions and then pass the ball to those expert clinical providers. Right. We help people on navigation around the topic of fertility, but we don't do all the very specific things that we know are really highly valuable in the, in the fertility vertical. The best thing we can do is partner with a company like a progeny to make sure that all of those fertility benefits are met or ovia or, you know, any of the other ones that are in that space. And there are many, that's sort of how we think about that. And I think going forward, the platforms will probably find they can do a more effective job in driving the right engagement to the right members at the right time than the individual point solutions will. Simply because trying to get the attention from the benefits team and communications departments inside of these companies is really quite challenging.

What do we still really need? What other opportunities are there for products that you'd like to develop or to see other companies develop that would help all of you work out together better, that would serve employers and individuals better? Where are these places that just still haven't had enough attention?

I think what we want to do is become synonymous with the easiest and frankly highest quality way that you will experience healthcare. You know, to the point that when you go to a new employer, if you've had a grand rounds personal healthcare assistant to this person that's dedicated to you and this app that's dedicated to you, you will absolutely want to make sure that your new company has that as a benefit. Right. The feedback we get when people view sort of all of their medical records for the first time because they've never had an easy way to get them or seeing all of their claims on a timeline that very easily explains sort of how and where they've experienced healthcare means that you want to carry that in your pocket everywhere else you go. And so maybe you were covered by one employer and your new employer doesn't have it and you want to make sure your account can be activated under that new employer. I think that's sort of the pull through nature of a tool and an experience like a grain rounds want the ability to also pass you through to the rest of your healthcare ecosystem. Back to your point solutions question. We see the ability to sort of send your data with you out to a really well selected fertility vendor and make sure that that fertility vendor can send data back to the platform and that you get an experience that feels as seamless as when you use your Google G suite tools and can sort of easily move between your calendar and your mail as well as other connections within the Google suite that is possible. It's never been achieved in healthcare benefits. I think that day is fast approaching. I think there is still a ton of opportunity if we were to sort of flip the lens a little bit and look at the provider side. So provider just big term for hospitals and doctors and labs and anybody who's actually providing a medical service. If we flip the lens there, what you would see is sort of of real lack of software and infrastructure around the collaboration between those groups in order to make virtual care a reality. So I would love to see that I'd love to see sort of more plumbing and infrastructure in a major platform in that space. I'd also say that generally speaking, and while I think there are some really cool companies coming up in the behavioral health space, there's more work that needs to be done in behavioral health and in particular to tie behavioral health into clinical and other medical health. And then the last thing I'd say is that I'm super interested in and pretty optimistic around a lot of the conversational AIs and better patient care. I think that AI has shown up in medicine in a variety of ways. But the one that I'm probably most bullish on is the notion that you can lower the cost of care by having lots of straightforward cases managed through diagnostic decision trees and therapeutic decision trees. And interestingly enough, and I wouldn't have been able to tell you this had there six months ago if you asked me, but I've seen it now, I think a lot of patients actually prefer that. They prefer sort of the non judgmental nature of talking to a speedy AI or in a chat experience. Now ultimately they want to flip over to a very empathetic human being who can sort of relate to them as an individual. But for sort of that quick encounter when you're trying to get to the bottom of something. I think the AIs actually have a really interesting opportunity to set in front of them.

Now thinking about, you had mentioned it a little bit earlier that you are very focused on equity inequality. A lot of people are losing their jobs right now and might be losing employer sponsored healthcare. What's the role for companies like yours? You ever see doing a direct to consumer play anything like that? Like how would that even work?

Yeah, well, two sort of two big chunky questions I think embedded in there. So I'll take the second one first, which is have we thought about a consumer product? Well, we have and we did. We started the company and consumer which was consistent again with my experience and worldview. I'll just say this for people who are listening. May this be the proverbial one thing you take away from this podcast. Be very, very careful about starting a consumer healthcare product. The biggest problem is consumers don't actually pay for healthcare in the United States and so their sort of spending capacity on healthcare products as individuals is much lower than you'd think. Now there are some interesting exceptions coming up in this space, right? So the Roman and hims and hers and doing some of this direct sort of work. It's interesting, but I think the addressable market there is ultimately pretty capped by what people would expect to pay themselves versus expect their employer to pay on a pure consumer product. I think it's unlikely you'll see us doing a lot there. Having said that, as a consumer, you can use Grand Rent, we have the existing consumer products, so you can come in, slap your credit card down and get access to any of the services I've described. And we do see that it's actually interestingly much more of an international clientele. So people who use that service in any given year come from about 100 different countries, which is pretty cool. The unemployment market and how that's moving. What I would predict there, what we would like to do is have sort of COBRA style benefits so that people can extend their relationship with Grand Rounds. Today already, if you leave your employer and you have a Grand Rounds account, all of your sort of access to your data, your clinical transcripts and your care messages all persist. So that sort of work that you've done exists and you can use the platform for all of those reasons. It does not currently let you start a new case if you're not covered by your employer. So you can't start a new piece of a medical visit. But we're working, working sort of swiftly to figure out how we would do that. And then to the first part of what you said, which is sort of the thing that I'm frankly most passionate about, you know, in so many things in society today, but certainly in healthcare, you're just seeing long term inequality represented in the products that we've built and the decisions we've made. And healthcare is certainly no different, right for underrepresented minorities, specifically African Americans. You know, we see health outcomes unfortunately largely driven by issues related to access. Not only access to medical providers, but access to foods and medicines that are healthy and safe to use. We have made a commitment to making sure that our matching platforms or the work that we do to get people to care takes into consideration not just quality but people's preference when it comes to how I match with the provider. There's some interesting studies out there that basically show that in the case of the sort of black community, if we were more effective, if we, the medical community were more effective in just helping them find a provider that they thought would listen to them, them, that the results in the health outcomes for those populations would be dramatically better. We're in a place to help solve that. We are absolutely in a place to help solve that. Not just because we're a diverse team thinking about the problem, but because we have millions of covered lives that frankly, you know, are stocking the shelves at a Walmart, are driving a distribution truck for Target, are sort of manning the garden department at Lowe's and lots of jobs in between. And so we know that we have a role and an opportunity to play there on the literacy and the matching associated with underrepresented communities. And we have been historically very interested in it. We're even more motivated by the call of the day. We often talk about building the 1% solution for the 99% and that's really sort of what we're after. Building that incredibly high quality, high touch, compassionate and intelligent healthcare experience and giving it to people who stand most to gain because they're the ones that are sort of most disconnected and disassociated with the healthcare system today.

Thinking about moving forward, we are in an election year. What's going to change on the health insurance landscape? What are you thinking about there?

Yeah, so I think there was a lot of discussion sort of in the Democratic primary season around the role of something like a Medicare for all. And anybody who was closely studying the proposals for from the candidates at that time found that there was no commonality really between what they were proposing. Medicare for all was a catch all term for frankly much more medical inclusivity and having one standard set of benefits that everybody could count on and rely on than there were specifics that were highly divergent after that. What I would say is that debate started a conversation that my customers, the largest employers in America, paid a lot of attention to. And while I think no specific proposal is likely to come out of that debate nor will be tackled in this sort of next couple years on the congressional or presidential docket, I do think we have identified this need to use Medicare style dynamics in a employee community to get better care. And let me explain quickly what I mean by that. In Medicare, sort of there's an all in approach to getting care where the participant pays a certain amount for certain benefits on the plan and of course the US government pays the majority of it. Well, if you substitute the employer for the US Government and then say there's now a sort of defined set of benefits that every employee can reasonably expect to get and that the risk for over utilization or bad healthcare outcomes is borne frankly by plan provider, in this case a vendor like a Grand Rounds, I think you will see an amazing new set of opportunities to service that market very differently where companies like Grand Rounds and others are taking more risk on behalf of those members to deliver really terrific outcomes and I do think that conversation has legs. And I think that we should anticipate that over the next five to 10 years and potentially even faster, employers are going to want to engage in those conversations because, you know, it's a strange artifact of the American system. But if employers were to redesign the system today, they would have no role. And paying for health care for Americans, it's kind of strange that we do that. We're the only country in the world that does that. But it is what it is. And now they need to figure out a way to sort of cap those costs and deliver a consistent benefit across all employers. And I do think this Medicare for All debate started a conversation that will be picked up by many of these large employers. Great.

Awesome. Well, thank you so much, Owen. It's been great chatting with you today.

Yeah, you bet. You too. Bye. Bye.