It’s like Uber for Healthcare

Day 89: Wednesday

Morning, Tim!

Though not feeling poetic today, I love when I have enough energy and mental capacity to thoroughly enjoy my work.

I’ve been working on Non-Emergency Medical Transportation (NEMT) solutions recently.

A bit of background, followed by why I’m interested:

NEMT has traditionally been provided by an array of parties — ranging from taxis to shuttle buses, volunteers to high-priced ambulances. These services are needed not only for patients but for health systems, insurers, and tax-payers. Because transportation to and from an appointment can be a binary limiter on whether someone is able to receive care, the patient certainly has a stake. Importantly, though, because the patient’s health might otherwise deteriorate, health systems and insurers should also care, as handling sickness before it worsens is in almost every case less costly — even if it means multiple visits. Surgeries, scans, lab tests — they are all more expensive than a simple office visit to ensure someone maintains health. Tax-payers in turn should care, as their dollars are going to providing services and care for substantive portions of the population, both young and old.

The challenge of providing transportation fascinates me. Not only because I can throw out tons of transportation puns, getting on a good roll before someone tells me to put on the brakes because they can’t handle it and I have to stop (That derailed quickly). And not just because everyone in my line of work is talking about ‘the next Uber for healthcare’ when in fact, Uber could be the next Uber for healthcare. No, it’s in part because there are substantive operational considerations (i.e. if a patient is late to an appointment and backs up everyone else; if a patient is sitting in a bed waiting to be discharged but doesn’t yet have a ride, and so the hospital cannot use that bed; etc.). Yet the above stakeholders could also be interested for numerous other reasons — perhaps brand (look at how convenient we are!), patient experience (no one likes to wait around), or to better keep a broad population healthy and happy (taking patients to the pharmacy, community center, or beauty salon). It can be not only an issue of ‘sexy’, new solutions like Uber to make headlines to further a health system’s reputation, but also applying that same technology to address the social issues arising as barriers for those who often need care the most.


There are tons of companies flooding the space, and it’s an exciting time to be looking at this work. I think it’s most exciting because of it is so broadly applicable, with the ability to interest so many.

Until tomorrow,


Day 79: Thursday

Morning, Tim!

I have a new mentor of sorts at work. He’s a pretty amusing guy – wise in how he approaches situations, doesn’t take himself too seriously. He’s retired from a great job, and I think he does the work with my company largely because it’s intellectually engaging and he can make a difference – but he doesn’t ever (seem) to let it overwhelm him. I admire that. When we get on the phone and I ask how he is, he has always responded ‘alive!’

Not that there couldn’t be more, but it’s enough to move along the conversation and, at least honest.

I’ve been a bum of a correspondent recently. Lots going on. Unlike Bob, I have allowed myself to become overwhelmed. I hope to dig out soon.

Until then…I’m alive.

Until tomorrow,


Ps here are a few pictures of all the new geese exhibits they had at the zoo! Remarkable.

Also one close up of the sleepy bear…

Overwhelmed – thanks a lot, healthcare…

Day 68: Friday

Morning, Tim!

So I obviously missed my Wednesday post. Not that I didn’t write it — it was scribbled through tired eyes while on a plane home. Unfortunately, without internet, I was unable to actually post it.

If you’d like to torture yourself, it seems the zoom on this image allows you to read the handwriting. For less torture, please see below for what, upon reflection, is exhausted stream of consciousness.


Morning, Tim!

Obviously this is quite late. I’m on a flight back to Chicago right now, and all of my electronics are out of battery. That might seem weird since you are seeing this online — it was first written in very poor handwriting while experiencing turbulence, though.

I just spent 3 days at a healthcare IT conference. Quite the spectacle, some 40 thousand people convene to discuss how technology both new and old play a role in advancing care delivery. There were companies that helped patients schedule appointments, nurses communicate with one another, physicians dictate their notes. Still others provided security around the information, connected devices to the cloud to share data and enable care delivery in the patient’s home.

I love technology. It allows me to communicate with you seamlessly and empowers smarter, faster decisions to be made all the time. in healthcare, this translates to better patient care and opportunities to save lives. Getting to work in healthcare tech is even better than tech generally — not only is there ample room for healthcare to catch up to other industries, the passion healthcare entrepreneurs bring to helping others is truly inspiring. So I love technology.

I also hate technology.

Phones and tablets abound, alerts all over the place. An amazing amount of opportunity — yet as with everything that comes to mind, the greatest of strengths can also be the greatest of weaknesses. The ability to connect anyone at any time allows a a father to video chat and say goodnight to his kids — so too does it enable a man to get caught up in work, unable to de-tether while home as that same child yearns for attention, guidance, and love. Technology enables the spread of information, empowering scientists to collaborate on wonderful breakthroughs — so too does it enable groups to congregate and self-reinforce radical beliefs that bring harm to others. Technology can help focus, it can be the largest distraction. It can educate or inundate, facilitate encouragement or discrimination. But it doesn’t do any of this itself. It is a tool, used by people, often exacerbating the existing intuitions — booth virtues and vices.

I hope to have kids someday. I’m not sure what to do with technology. TO disallow is to deny the world these kids will be born into, disadvantage them in a world where these skills will be table-stakes. Yet, there seems a certain sadness that comes with this, a weariness weighing on a heavy heart and off-put mind. What about play and creativity, about bodily movement? We are physical beings — is using only our minds a hindrance to what our development might otherwise be? How can they use these tools for good — to help others — and not be addicted and lose themselves?

How do I do that?

Until tomorrow,

Until Monday,


Costing a leg

Day 54: Thursday

Morning, Tim!

Silly Josephine…

Tim as you well know I work in healthcare. Thinking about healthcare as a business feels kind of grimy at times — you are making money off of those who desperately need help, many times in order to live. That said, having worked with a lot of Catholic hospital systems, the usual saying goes “No margin no mission”. In order to operate, in order to help all of those people, they need to have the financial backing to do so. They certainly have a lot of write-offs each year, essentially donating care back to communities; but it’s no news that in the U.S., healthcare is expensive, and many people are paying all they can afford in medical bills.

I’m not sure how I’m supposed to think about making money off of others’ misfortune. In one hand, I’m helping them extend life; in the other, the cost of that extension is often a poor quality of life, constantly fretting about bills and work.

I recently came across some articles about financially backing legal cases. I asked a friend of mine with a law degree to explain in a bit more detail, but the gist is that there are many wrongs done to people – e.g. abuse, discrimination, etc. – done by a corporation that has quite a bit of money. If the individual were to sue, there are legal ways for the corporation to spend those dollars quickly prolonging and “drowning” the individual, making it effectively impossible to sue in many cases. There are some lawyers who will work on a contingency basis, not getting paid until the individual does — but they typically have caps far smaller than would be necessary to take on a corporation.

The linked article discusses financially backing some of these cases. Now I certainly don’t have enough money to bankroll anyone’s legal case, but the idea still intrigues me. If real harm was done, shouldn’t there be some recompense paid? The same problem we saw above begins to arise, though – in order to operate like this, the financial backer would need some form of compensation, thus taking a portion of what would go to the individual. There’s this feeling of doing good while simultaneously lessening the good done.

I’m not sure there’s any way around it within healthcare. Hopefully make it cheaper to deliver care, I suppose. It’s just unfortunate that there’s a cost to doing good.

Until tomorrow,


Defend your base (Drawing challenge; business models)

Day 33: Tuesday

Morning, Tim!

Thank  you for the beautiful imagery yesterday. I could be referencing either your poem, the star across Milan, or perhaps (and here’s the frontrunner…)

The choir members are hilarious.  They’re all adults, some of them quite elderly, but they act like little children […] This meant that yesterday, instead of just chatting during mass, they also told each other to be quiet in between conversations.

This is perfectly like children. It’s kind of a beautiful thing.

Tim have you ever ridden a Segway? I’m going to ride this one to now discuss business models…

So working with early stage companies I come across a variety of ways businesses provide value, ranging from “outsource the humans to other humans” to providing new datasets (e.g. by monitoring something previously not monitored [patients/staff/supplies/etc.]) to making existing datasets useful (e.g. predictive analytics; visual dashboards), among many, many others. It’s a great chance to think about where there are gaps in the market — where there are meaningful problems that there are no real solution for. It has also provided an interesting case study on business models.

Walking through some history, you had mom and pop stores selling things locally — groceries, shovels, bicycles, flowers. Enter Walmart, who truly displaced many of these locally owned stores and sold the same goods. So how did they succeed? They had more shelf space then anybody else, and became a one stop shop — the stores were much larger than what they were displacing and each sold “everything”, at least in that seemingly at that period in time. Having the convenience of going to one store for your cereal, orange juice, and kid’s Christmas present was only part of the story, though. Because Walmart had such scale, they were able to negotiate with suppliers to lower prices; not only could you get Cheerio’s and a rocking horse, but you could do so cheaper than you would be able to anywhere else. That’s part of why Amazon is so interesting current day – by putting your inventory online, you have effectively infinite shelf-space; and by having  (free) Prime 2-day (or 1-day/same-day/2-hour depending on location) delivery, you also begin to chip away at the immediacy constraints of traditional retail. Among many other reasons, it’s why Amazon has an interesting business model.

So that’s the kind of business model stuff that’s going through my head (except a lot more detailed and nerdy) when I’m at work talking with these companies. Take yesterday for example. Doctors are highly trained, and thus are “expensive” labor in total dollars. Wanting to keep tabs on patients and visits, when Doctors take notes about visits they are effectively acting as highly trained, very expensive scribes. To help alleviate this problem, there was dictation software — you could speak faster than you could write, and so notes could be gathered quickly. Alternatively, if you put an actual medical scribe in the room, you could have notes taken in real-time, saving the doctors time entirely but now paying another person. The business model continues to move forward — if you put the scribe remotely and simply have an audio and/or visual stream coming to them they could do some from a call center; you could put that call center in a labor market where it is cheaper and also gain the efficiencies in staffing to obviate the down-town it would take an in-person scribe to e.g. switch rooms. Finally, the direction that is exciting, is in the automation of the scribing all-together. To add color, this would be technology that takes the audio and/or visual stream, parses the audio, and then algorithmically places the necessary snippets of information into the relevant fields within the system. What is really exciting about this model is the lack of marginal cost (put too simply: the cost to serve the next customer). Because it is software (outside the very small tech investment to capture the audio stream), no human is being hired to do scribing, and so you no longer scale linearly with costs and revenues, but instead have a high fixed cost up front (to get the algorithm right and have servers to process the necessary information) and then distribute it over every new customer you have.

whew. That was a really large text wall. I doubt anyone has read this far, but I’m going to include a picture and a game as a reward if anyone has.

So Tim here’s how the game works:

  1.  I’m going to draw a base (See below).
  2. You then draw a base. Then draw something to attack my base.
  3. I then draw something to defend my base, and attack your base.
  4. You then draw something to defend your base, and attack my base.
  5. Repeat steps 3 & 4 (as reasonable)


  1. There are no rules (I kid. I just like it how it sounds intense when people say this…)
  2. Be creative

Zak’s Base


Until tomorrow,


p.s. the title of this post was supposed to somehow capture the fun nature of the game and also the very dry nature of my post about business models. I’m imagining someone shouting “Defend our base!” in each case…and in the case of someone shouting it in business in reference to protecting, for example, their customer base, that person would be…annoying.

Blessed, with Responsibility

Day 30: Friday

Morning, Tim!

Depending on how you count it, we’ve been at it for a month! I figured I’d count it this way so that I could note it before you did (though you could have made a claim regarding “But February only has…” A missed opportunity…).

[…] Close our eyes and imagine somewhere we would like to be if we could be anywhere in the world.  When we opened our eyes he asked if the place anyone had imagined was room 312 YC high school.  I was the only one who raised their hand.  Maybe I was over thinking things, but if I really wanted to be somewhere else, wouldn’t I just get up and leave?

Decisions are a challenging thing. To be fair to your 14 year old classmates, I wonder if they really did have the power to go where they’d like. Perhaps some thought “man, I’d love to be at tacobell!” (depending on the hour of your class, perhaps Starbucks…). But others probably imagined the word Italy (it’s probably hard to imaging if you haven’t gone) or somewhere foreign – and where was a 14 year old to get the means to travel to Italy? Even getting up and leaving wouldn’t get them there. And so of course they sat in class, for that’s what they were told to do, many with the hope that life would be a long conditional. “If I do this [e.g. sit in school like I’m told], I’ll get to do that [e.g. go on vacation where I’d like, or perhaps even live there depending on my willingness to dream…]”

Or you could be an odd boy, realizing this train of thought, and….suggested that this was the place you wanted to be. I was that boy too…

Leaving your work would be an administrative decision that you make about the infrastructure of your life.  We don’t make those kind of decisions on a daily basis.

You don’t state it explicitly, but your discussion of decisions, infrastructure life decisions in particular, seems to lean toward an inability in at least some cases to truly make these changes. There are people who can make them (e.g. Jim Koch founded Sam Adams brewery after being fed up with consulting – but it was precisely because he was a management consultant that he was in a position to quit). In cases such as these, he describes them as scary but not dangerous; not dangerous because the other option was dangerous – looking back at 65 and wondering why he spent his whole life doing management consulting when that’s not what he wanted to do. I can appreciate this line of thought – I have been blessed with opportunities; while I work hard, I also know I’m lucky to be in the position I am.

In other cases, though, it is dangerous to make those infrastructure changes. For a single mom with three kids, there isn’t much room for adventure in the job market, nor to simply “get up and leave” because the consequences mount so high – hungry kids, an unpaid mortgage, utility bills mounting. Or, much worse, someone in a war-torn country who can’t leave because they literally can’t. They have nowhere to take refuge, no country to take them in.

Obviously you know all of this; I’m merely reflecting on decisions, infrastructure choices in particular. Reflecting on the choices I deliberate over…

I feel blessed to be able to even have the options I have in my choices. I also wonder what responsibility comes along with those options…

Until Monday,


p.s. I hope you chose to join the choir. Also if you do, I’ll anticipate a good picture of you doing some handshaking…

Negotiations; A medical pickup line

Day 20: Friday

Morning, Tim!

I appreciated the continuation of thought around ramifications of second languages — not only do they bring about risk-taking and utilitarian morality, but also what level of trust do you put in the second-language words (or third language — unbeknownst to you Jerry speaks fluent German with me, a common language among conures). I’d default to a more Wittgenstein lens that suggests a look at context, but some people just like to joke around so it’s harder to tell. For instance, Jerry’s German is pretty good, but his pun game is the Wurst.

Tim, I’ve compiled a couple of lists recently (so have you!), and I hope you’ve appreciated them. I’m going to go back to the well and try another list, this time on just two things I learned in my course on negotiation.

  • Learning 1: Know your Reservation Price. Don’t guess. Don’t assume it will be easy to figure out.
    • Explanation: Your Reservation Price is the one where a deal is no longer worth it — you’d rather walk away from the table. You understand it by doing a lot of prepwork — what are all the issues at hand, and where do I draw the line. Testing combinations to figure out “Yep — it’s at least this or I walk away” is tough, but preparing ahead of time helps set what you should target, how the negotiation should go, and perhaps help you avoid an emotional swing at the negotiation table
    • Example: Say you are in the market to purchase a home. You find a home you love, but it’s a touch out of your price range, the owners can’t actually complete the sale for a couple months, and there are some things about it you’d like fixed. At what point do you walk away to find a different house? That’s your reservation price. (Also, you probably made a mistake and weren’t looking at the right houses, because you couldn’t walk away from these!)
  • Learning 2: Retain a catalogue or checklist of cognitive biases. Before, during, and after a negotiation, check to see which are likely to play a role.
    • Explanation: We all have cognitive biases. In some ways, this is more stylistic (e.g. a tendency toward passively accepting rather than negotiating a more aggressive solution) while others are more structural (e.g. in taking risks, you are likely to experience loss aversion) and still others are based on our unique past (e.g. My friend has a friend who knew a girl who went on a date and the guy didn’t call but then they ended up together in the end…so i believe this could happen to me too when the guy doesn’t call! [note: this may be a movie plot…)

    • Example: I already gave several  in the explanation above, what more do you expect? Kidding. In buying a car — wait. This is a lot of purchasing in one day. Let’s make it a used car. In buying a used car, you may care about how many miles on the car (often as an indication of just how used it really is). You may look at the miles on one car and say “Wow that’s got below 100k miles!” (say, 48, 672) and look at the next and think “blech. This one already has over 50,000 miles! (say, 50, 112). You’re likely experiencing left digit bias (where the far left number you read over-impacts your perception); this is why you see prices ending in .99 at the supermarket! 

This was probably a less exciting list than one full of puns. Inspired by your title, I’ll end on an awesome pickup line I intend to use to flirt with my wife later today.

Are you my appendix? Because I don’t understand how you work, but this feeling in my stomach makes me want to take you out.

Until Monday,


p.s. My guess on the response to said pick-up line will be some form of “hardy-har. Yet another pun…” with a follow-up helping me understand what the appendix does. 😉

Confirmation bias; sources of information

Day 12: Tuesday

Morning, Tim!

Cleverness has your way with words. I could mean no one has your way with words (which is likely taken as a compliment but, taken literally is just a truism) or I could mean a large bearded man, a legend, a king has a way with words that is similar to your way with words. I’ll let you decide, Tim.

I wanted to follow up a bit on my fake news letter, and not only because I just enjoyed a wonderful cup of Indian Nimbu tea (which isn’t really relevant, but I’ve started drinking tea again and have a strong desire to continue advertising that fact to you). Specifically, I wanted to bring into question how you get your information. Being historically loose, a while back information would come by word of mouth, written letters, and, if noteworthy enough, a newspaper. Because of the distribution costs, the ‘local’ paper tended toward a monopoly, which made sense for their business model; selling ads meant they wanted the most readers, and being a trustworthy source that got the paper on the doorstep in a timely manner, covering what needed to be known in the day ensured that. Fast forward, you have TV producers vying to be the source of truth through morning and nightly news casts. Then, in the age of the internet, company’s began to reproduce the content they had on paper in little bits so everyone could read. Now-a-days, a TON of people get their news by scrolling through a feed of paid placement, shared content, and created content (Facebook, in case you hadn’t guessed or clicked on my link, Tim…). But before there was Facebook, Google dominated (and still does) by being a different kind of source. Rather than being a push, where the user is passive in the receiving of information, Google requires the user to be an active participant, pulling the information (quick aside, that’s why their ads do so well; it’s why Amazon paid so much to become the place people ended up when they needed to buy something and why ultimately they have become the (trusted) starting place [even more so than search engines] for all things intended for purchase.)

How does this all relate to fake news, you ask? A few different ways. First, in today’s world, when distribution costs are 0 because of the internet, the newspaper monopolies of old suddenly are competing with everyone globally — a content creator in London, Hong Kong, a tiny little farm town, and you, Tim, are all competing for the eye-space of the same readers.

In a pull world, the incentives align to be the best source of truth, the source that someone can go to reliably time and time again. They’d bookmark you, or in the case of Amazon, this would bear itself out by how people start their shopping. In a push world, however, incentives are different; because the ads are being sold and pushed directly to you, it’s competing for eye-space not by being the best, but by drawing in your attention. It means you have click-bait headlines, and news which is polarizing in order to get a reaction. If you strongly agree, great! Share it as truth (whether it’s real news or fake news, confirmation bias often provides nice blinders). If you strongly disagree? Great! Share again, but this time with commentary about how wrong it is. For the content producer (and Facebook as a source where people go to get information pushed to them), the incentives are to gain the most attention, sustaining that for longer and longer periods of time. Facebook doesn’t have an opinion on what is “right” or on what “should” have that attention; so long as it’s on their platform, they are making money, be it a photo album from vacation to Italy, a link to some quotations, or some clickbait about this Awesome Blog That Writes About Crazy Topics You Won’t Believe!!! But while Facebook isn’t incentivized to have an opinion on what you focus attention on, it has created the platform which enables others to polarize, much of which is getting attention in recent news about filter bubbles and fake content.

One quick note before signing off an already lengthy letter. There is a bunch of talk about the bad that could and does come of this (people reading, believing, and sharing things that aren’t true but that shape their opinion; people reading only things they agree with because they are surrounded by people like them, and thus beginning to think another point of view unfathomable; etc.). On the bright side, living in a world where distribution costs are 0, it means theoretically all those people focusing their attention on Facebook could be reading articles about the New York Times and their wonderful journalism…or they could be reading some quickly written letter to my brother-in-law. And it also means that they could be reading about something that wouldn’t otherwise be covered — a niche like a post about quiche, or perhaps a deeper dive at social issues that wouldn’t otherwise be covered because  they are taboo, difficult to read about, or those covering them simply do not understand the issues.C4C4E4A9-363E-4112-97D0-11964D9AC29F.jpg

Until tomorrow,



Thily Fin Information

Day 1: Monday

Good morning Zak,

As you know, today marks the beginning of our new blogging project.  We needed to start as soon as possible before we both came to our senses.  Beginning today, you and I will be posting our personal correspondences to Thily Fin on alternating week days: I post today, Wednesday, and Friday, you post Tuesday and Thursday this week, etc.

Under your advisement, I have taken it upon myself to write our first entry.  This is obviously a very easy task, since all I have to do is write the worst entry I can so that expectations will be as low as possible.  That’s why the opening of every great piece of literature is always the least memorable part:

“Midway through the journey of our lives, I found myself in a dark woods, for the right way had been lost…

“When Gregor Samsa woke up one morning from unsettling dreams, he found himself changed into a monstrous vermin…

“In the beginning God created the heavens and the earth…

You can only go uphill from there, Zak.

It’s easy to feel self-conscious about “creative” writing.  I think that’s because it’s something no one really expects of you.  Like, Zak, you wouldn’t feel self-conscious about turning in a financial report to your boss. (I assume that’s the kind of thing you do when you have a real job.)  That’s because every part of that report would be meeting very clear expectations, and whatever you included would either be right or wrong.  But if somehow that report form had an extra blank box in which you were supposed to enter the “thily fin information,” you might be a little bit anxious.

I’m guessing it would show up right before “total liabilities expected for the coming fiscal year.”  Maybe you would decide to draw a picture.  Maybe you’d write a story about an internally conflicted cashew.  Whatever you decided to do, you probably would wish that your boss had been a little more specific about what he was looking for.

The thily fin box, though, is probably one of the more memorable blank little boxes that could show up on a financial reporting form.

Until tomorrow,