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      Healthcare Rethink - Episode 29

      Healthcare technology continues to evolve at an astonishing rate, the discussion around innovating healthcare delivery models for enhanced patient experience gains urgency. A report from McKinsey showed that 74 percent of patients desire more digital healthcare solutions, highlighting the critical role that innovation will play in meeting the next generation of healthcare needs.

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      Healthcare Rethink: Hear From Leading Changemakers

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      Brian Urban (00:22):

      Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban, and today we are talking all things clinical innovation. And who better to join us for this conversation than Vice President of Clinical Innovations at Carbon Health, Dr. Ayòbámi Olúfadéjì? Welcome to the show, Ayòbámi.

      Ayòbámi Olúfadéjì (00:42):

      Thanks, Brian. It's so good to be here. Thank you for having me.

      Brian Urban (00:45):

      And this is great because we've gotten to know each other a little bit before the show, so we're definitely going to talk about you and your experiences, what timezones you're in probably right now, and all things in between. With every show, we like to get our guests familiar with our audience and vice versa. So, we want to go back before the MD, before your big Dartmouth accolades, before you started practicing and toggling entrepreneurship. Take us back to who Ayòbámi is. Take us back to the homeland, take us to Nigeria. What drove you into medicine and what drove you into innovation? Tell us a little bit more there.

      Ayòbámi Olúfadéjì (01:28):

      Yeah, no, Brian, thank you so much for having me. And like I keep saying, it's so impressive you're saying my name. It sounds almost like I'm home, so I feel comfortable. I'll start from there. But yeah, I grew up in Nigeria, as you know and as we spoke about prior, and I actually had kind of an important event when I was five years old. So, to some degree, this story is a story that many have heard before, but I lived it. I grew up poor in Lagos, and one of the things that happened when I was younger was there was a death in the community that I lived in. And after a conversation with my mom at the age of five, I actually just decided that I was going to become a doctor. It was like that simple for me. And so when other kids thought they were going to become soccer stars or musicians, Michael Jackson was big back then, my story was simple. I was like, "I'm going to become a physician." And it was really because of that need.

      (02:22):

      And I will say fast forward through undergrad, now, I had a lot of help along the way, but my first experience actually with the US health system was ironically when I was studying for the MCAT. I used to get these terrible migraines. I remember that it was a winter that I was staying on campus, and so the student health services was closed, I didn't have any way to get to the clinic, and I eventually ended up going to the emergency department. And now, the care that I received was excellent. Top tier, they got me in as soon as possible, treated my migraine. Everything was great. But I remember a month later getting a bill for like $730 and thinking, "Huh, but I have health insurance. What the heck is going on?" So, that was, I think my very first time thinking this health system, there's opportunity here and it doesn't always make sense. But yeah, that is kind of the summary, and fast forward to getting to Dartmouth, which honestly, best place. I actually have my Dartmouth hat here, Brian. You were supposed to bring yours.

      Brian Urban (03:21):

      Oh, there it is. Yes.

      Ayòbámi Olúfadéjì (03:22):

      I know, but it's right here. I'm looking at it right now. So, this whole time I wanted to become a physician, and then first year of med school actually was actually my rude awakening. I remember just feeling like, "Oh my gosh, this is a Master's in Biology," and what I was really interested in, I realized at that time was health system design. So, yeah, it was a kind of interesting experience for me. I remember that I figured, okay, well this MD is not going to be enough, there's other things I need too. And I still remember going to the Master's of Healthcare Delivery Science program at Dartmouth and telling them, "Hey, I'm interested in your program," and they laughed actually. I'm not going to say how young I was when I started med school, but I was very young and the gentleman told me like, "Hey man, you got to take a beat," basically is what he said.

      (04:14):

      But what he did do for me was he introduced me to someone who has been one of my biggest mentors through my life. His name is Mike Zubkoff, and he ran the MD-MBA program at Dartmouth, and that was kind of how the journey started changing. So, I can go into more detail, but that's basically it. So, got to Dartmouth, realized I needed something else. Met Dr. Zubkoff, who helped me chart the course, ended up leaving there with the MBA degree as well. And yeah, the journey has been much more interesting since then, yeah.

      Brian Urban (04:43):

      Yeah, and it keeps getting more interesting because you are an outlier in a lot of ways, not just because of your age, but in part because of your background and your passion and compassion to want to go into practicing medicine, and your first experience with receiving care and then the process, procedures following that. Probably quite an interesting and eye-opening opportunity for you, and it's great to hear one of your mentors, Mike. What a wonderful guy. I think he's helped so many great entrepreneurial physicians make an impact, and you're a great example of that. So, it's safe to say you're a health techie now, I would say, but you're still a practicing physician. So, how do you balance this? Or is it just a natural blend that just is together and you don't want to separate the two?

      Ayòbámi Olúfadéjì (05:36):

      Yeah, in Nigeria, we have this joke about being a tech bro and a tech sis, and so not only I'm a tech bro now, and it's quite interesting to me. The truth of the matter is I consider myself incredibly lucky and incredibly blessed to be able to do it in this way. There are days when I'm actually like, I'm done with maybe an exec meeting, and I know that the next day I'm going back to the ER to practice medicine, and for me, it actually truly is the best of both worlds, if you will. I think my personality as an ER physician, there is that saying, jack of all trades, master of one, or what have you. And so I think for me, just in my personality, I was always going to have a diverse set of experiences. I was always going to be wanting to do just more than whatever was expected of whatever career path that I chose.

      (06:28):

      And so, yeah, now I think the balance has actually been a real value add to me as an individual, but also a real value add to the programs that we develop at Carbon and the care that I've been involved in for patients, and also just thinking about health systems in general. I currently practice in the emergency department a couple of times a month, and then also in the Beth Israel Urgent Care system and also at the Carbon Healthcare Urgent Care system. So, one of the beauties of that is it is still, even though it's a couple shifts a month, it is still such a diverse set of experiences, from retail urgent care to academic, advanced urgent care to Level I trauma emergency department, and I just find that for the Carbon part of this journey, it really allows me to practice what we preach.

      (07:15):

      There are a lot of times, there's something I call innovation fatigue, which is where you're trying to innovate so much, everybody gets really tired. And every now and then, it's helpful for me to go in the clinic and try to practice and just see how cumbersome it might be to want to do all these new things. And so that helps me be more realistic about what we roll out. But then what I learned from Beth Israel in our urgent care there, in an advanced academic urgent care, it is very interesting. We have high standards of clinical protocols, and I can bring that down into the work that we do at Carbon. And then just being in the emergency department is a fun place, man. It is as wild-

      Brian Urban (07:48):

      Never heard it described like that, [inaudible 00:07:50].

      Ayòbámi Olúfadéjì (07:49):

      No, exactly. It is as wild, wacky, crazy, all the fun. And I think for me, I really consider it a privilege to be able to be there for patients in some of the people's most critical moments of their lives, and that is a blessing that I do not take for granted, that I still have kind of a skillset that could be used useful to patients in that way. So, no, for me, I absolutely love it. It is such a huge variety of experiences that I adore. So yeah.

      Brian Urban (08:20):

      Wow. And now I can see it's not a balance. It all kind of puzzle-fits together.

      Ayòbámi Olúfadéjì (08:26):

      Yes, exactly.

      Brian Urban (08:27):

      I love how you said that you're taking a lot of things that you're working through at Carbon, whether it's development or actually applying some of the innovation that's going out to patients, and you're taking it into the actual setting as well. I'm sure it's in different manners, but that's amazing. So, it really does fit together. It's great, I mean, you have no visible gray hair right now, but it's-

      Ayòbámi Olúfadéjì (08:48):

      Oh, let me tell you, Brian.

      Brian Urban (08:50):

      [inaudible 00:08:51].

      Ayòbámi Olúfadéjì (08:55):

      Oh man, the gray is in my soul. But it's okay. Yeah, yeah.

      Brian Urban (09:00):

      Well, what's so interesting is Carbon Health entering this landscape of virtual care. So, I want to get into Carbon a little bit more. You're urgent care, you're primary care, you specialize in women's care, LGBTQ+ as well, and you're in 13 states with a lot of different submarkets as well. Man, you all are expanding at a very reasonable rate. You're not going over your skis here, to use maybe a New Hampshire terminology. You're staying very balanced in your expansion. So, as you add more services and features to your tech, how are you continuing to consider the patient safety, the patient advocacy side of virtual care?

      Ayòbámi Olúfadéjì (09:48):

      Yeah, no, I think for us at Carbon, it's really important that we keep that top of mind. I think, and I alluded to this earlier, saying that many times such a diversity of express, but one of the things I've had the pleasure of doing at Carbon is helping us enter new markets. And every now and then you have to go to some of these town council meetings where they're like, "Who are you, and why on Earth are you here? And why are you some other retail urgent care?" But I think we hold ourselves really to high standards of academic excellence, and I think whether it's me, whether it's our CMO, whether it's our National Director for Urgent Care and our National Medical Directors, everyone actually has a strong background in academic medicine, strong backgrounds in rigorous clinical practice. And so when we think about patient advocacy, I think our thought process actually is that we are trying to build, and I'll talk about this some more, but it is really thinking about the definition of a patient-centered medical home.

      (10:47):

      And that term is a buzzword. I think a lot of people use it [inaudible 00:10:51], but I think at Carbon we are very, very, very focused on the patient. We think about how to make sure that patient care is top of the class. We try to make sure that the patient experience truly actually is intact. And so for us, yeah, I think it's been measured in our growth. I think we always return to the patient. I think that has been helpful to be kind of our north star. Even when we think about our tech, and to be very honest, to some, we've had to adjust this to make sure that the provider experience is just as balanced, but we've really, really focused on just making sure that the care and the care delivery is excellent for our patients. So, that is kind of our approach here.

      (11:29):

      And I'll also say strategically speaking, we have this idea of an omnichannel approach to medicine, which is why you could say we have so many service lines. I think what we're building here is this idea that all that a patient should need for the foundation of their care, they can come to Carbon. They're plugged into Carbon, and if they need women's health, or it's LGBTQ care, or it's care for patients who live with diabetes, or it's mental healthcare, we as Carbon are trying to make sure that the wraparound services that are necessary for the foundation of improved patient outcomes and better living is actually provided by our team here. And so that is our philosophy and how we approach it.

      Brian Urban (12:07):

      I love that you hit on patient centricity, because without being able to truly understand the individuals that you all are serving in a virtual setting, none of this works. What I found so interesting is it seems like your growth place was in California. You have a lot of different sub-service areas in that state by cities. So, in terms of virtual care, not an actual physical provider network, sometimes it's a little bit different with contracting. You had said also you were going to a lot of local meetings to be a part of the grassroots side of things too. So, can you help me understand how your growth in California maybe fueled your growth through the Midwest and even the East Coast? It seems like everything started in California, unless I have it backwards, but it looks like everything-

      Ayòbámi Olúfadéjì (13:00):

      You're exactly right, you're exactly right. Actually, my first job at Carbon was Regional Medical Director for New Markets. And so I joined Carbon two and a half years ago when we had grown a lot in California, and I spent my first year at Carbon basically helping us enter new markets. At one point, I helped manage 10 new states. And so really I was there, right? It was I drove the bus to move the supplies to open the clinics in Florida. I did a lot of that. And I do think that we learnt a lot from taking care, as you just described.

      (13:35):

      One thing I think that's very interesting about California is the sub-regions, they are so different. We think of our regions, broadly speaking, NorCal, SoCal, but even when you dive deeper into that, you understand that there are populations where, and you can use payers to kind of think about this, but there's places where there's a huge Medicaid population or there's a huge Medicare population, or it's completely commercial, and you know you can kind of use that as surrogates to understand how you can approach certain populations and think about contracting in different markets.

      (14:07):

      And so I think, yeah, that experience, the fact that California in its own right is just a very diverse place to deliver care and with diverse patient populations, I think really equipped us to get into Kansas and Missouri. And also I think we had experience in California with working with health system partners, and so in that same vein, we had tried. And so even though Carbon was just in California, the point I'm trying to make is that there had just been a lot of experiments, whether with health system partners, with different payers, with different patient populations, with virtual versus in-clinic, versus primary care versus virtual urgent care, we had done a lot of experimentation with our model in California to figure out and understand what would make sense as we rolled out to all these other states that we are now in.

      Brian Urban (14:54):

      It's great that you started on the market development side and then worked your way into innovation, because clearly you've seen what had to work and what you had to improve upon or create. So, the innovation side seems like a very natural evolution for you at Carbon. So, it's interesting, the payer side that you had mentioned, especially in California, you look from California, you look to the Midwest, you look at Florida, it's just so different I'd say in terms of risk, provider relations, payer relations, just so very different. Can you help me understand how payers have adopted your model of care, or have seen some of the nuance to your care models and found it maybe valuable and started to put maybe different pay-for-performance measures in, things like that? I'm just curious of how it's so different across the country in each sub-market.

      Ayòbámi Olúfadéjì (15:51):

      Yeah. So, I will say it is very different across the board, and I think that there are some payers who are stuck in their standard ways and still want facts, certain claims set in the traditional way. And then there are some, and I will give a shout-out to the Blue Cross Blue Shield group in Massachusetts who actually partnered with us to start our virtual-first private care, which I could get into in more detail. But I will say one thing is for certain, though, and I will say in as much as there are people who are lagging behind and there are people who are, if you want to say progressive in that way when you think about the payer space, there has been a shift in the last two years. And everyone will say this, so I'm not going to belabor it, but with COVID and virtual care creating its own space, I will say that even everyone who is slower or everyone who's faster is all moving in that direction, to where they understand that we can deliver care virtually, and the outcomes can be just as good.

      (16:52):

      And I will say actually outcomes obviously take some time to get to, but the patient experience is excellent, right? We've run a virtual primary care offering in Massachusetts now for the last, I don't know, seven months. It's based out of Massachusetts, but we cover an additional 10 states. And the NPS from that service line is 97%. I mean, that is mind-blowing, and we've had 25% of patients who actually filled out the survey. So, one in four patients are telling us that the experience is actually 10 out of 10, over and over, and over and over, and over again. And so I think for us, we found that that patient experience is excellent. We found that patients are way more engaged in their care. People are scheduling their follow-ups before the visit is over. They're tying themselves better to the healthcare experience because it's no longer as cumbersome for them to seek care as it once was when you had to schedule the appointment and drive to the clinic. You know that if you needed your care team, you could book an appointment within a day and be seen virtually.

      (17:51):

      And so I think from our perspective, and we started by talking about payers, I think payers understand that this is changing. I think the outcomes, some of the long-term outcomes, we do have to see it. There's no silver bullet to seeing this. We're in a relationship now with Blue Cross, and we'll start to share our data as we have it. But I do think that the fact that patients are way more engaged, the fact that the access to care is better, I think is going to be a net positive overall just for care delivery, and I think payers understand that just as well now.

      Brian Urban (18:24):

      And I love that you're raising up Blue Cross Blue Shield Massachusetts because they're a smaller Blue and just in terms of geography, maybe by volume as well for the lives they serve, but for other larger Blue Cross Blue Shield entities, even private plans, they're just behemoths, the United and Humanas of the world. It's interesting, in my payer days in terms of contracting and market development, it was a very localized approach in everywhere, but it wasn't strung across in a uniform way of pushing everyone toward value-based care, or pushing everyone toward, "Hey, let's lead with the experience, and we'll study and find the outcomes and kind of create benchmarks off of that and find new models to deliver." It wasn't like that, and that was just like seven years ago or six years ago, and then it's just light speed now. So, I do love to hear that payers have been adopting just better innovation and thinking about the experience first and then how you get to the outcomes.

      (19:30):

      So, let's talk about that first virtual clinic that's been stood up with support of Massachusetts Blue Cross Blue Shield. Tell us about the relationship and how it's expanded. It seems like it's growing some really nice fruit here.

      Ayòbámi Olúfadéjì (19:45):

      Yeah, no, it is been amazing. So, at the start of this year, we got into that relationship with Blue Cross. We stood up a virtual primary care, virtual-first primary care offering, and we started with four PCPs, so it's basically a part of PCPs. And we also, a couple of things that I thought were really unique about our model was two things. One is that we also embedded mental healthcare within primary care, which I absolutely love, and I could talk about for days and days and days. Matter of fact, it's called a collaborative care model, I think started out of Washington, and so it's been around for about a decade or so, and it's been slowly growing and now we have it at Carbon. And just the outcomes that we have from that are completely mind-blowing. Some of the stories from the patients, exciting.

      (20:29):

      I think what we've also built in is we've built in a virtual endocrinologist service at Carbon, and so our virtual endocrinology allows us to escalate patients who need any endo issues, but primarily for patients who have diabetes. And so we see outcomes of how that's been improved. But yeah, no, so it's a value-based care agreement, and details are the details, but that is essentially what we've signed with Blue Cross of Massachusetts. And it's been great actually to have a payer who supports that movement. We've seen thousands of patients now over the last seven or so months, and it's been amazing to just see that, one, we have good relationships with payers, two, we understand we're aligned, right? Because we're both aligned, one, on trying to improve outcomes for patients and increasing access to care, and then two, I think from a reimbursement perspective, I think we're all aligned in understanding that we will try our best and really stretch ourselves to make sure that the care for these patient is holistic and ideally less expensive than what they will get otherwise.

      (21:30):

      And so yeah, I mean some of the outcomes that we have, for example, is 90 or so percent of our patients get seen within a week of when they want to book a visit. So, with having the four providers in there, we've allowed ourselves to open schedules. I also really think that one thing that is really interesting that we've not yet capitalized on but I think that we have the early beginnings, are everyone who joins this primary care team or primary care service is also assigned what we call a care guide. And this care guide is really the person who works with you to make sure that your appointments are scheduled, tries to make sure that your outside records are done, that your lab orders are in, things of that nature. And we've started to see sparks, where patients actually know their care guide by name, and so are saying like, "Oh, thank you for the care that X provided me."

      (22:19):

      And many times, X is actually not their provider, it's not the clinician, it is the care guide assigned to their case or the care guide assigned to them. And I actually really think that that model of having someone who's not necessarily a physician, but someone who really is your healthcare advocate is something that I think that we can capitalize on it and actually grow it. So, I'm excited to see some of the first fruits of that coming to bear. But no, it's been an amazing experience just working with a payer partner that understands working with a healthcare team, and our provider teams are really, really excited about making a difference, and patient care has been excellent from what we can tell so far.

      Brian Urban (22:56):

      I love hearing that, because I think the theme that I was so used to being inside a payer for a long time was the primary care physicians are the quarterback of care, and they're going to guide everything, and sometimes, administrative things would fall under that as well. And you're a physician still, and by background. That can't happen. So, the care guide being someone that is more maybe a higher IQ in administrative processes and that, I don't know, I don't know if they're a nurse, a science background, there was a lot of care managers back in the day that would juggle the healthcare side care coordination and also the administrative side. But it sounds like this care guide just has a higher IQ for administrative processes and just being logistically sound. Is that what the care guide is?

      Ayòbámi Olúfadéjì (23:44):

      Yeah, I think the first thing actually is that they're kind. They're kind and they love taking care of patients. I mean, I had the privilege of interviewing all four of them that we hired, and that was actually kind of the foundation, where we're saying, "Can we find people who care about others?" And then we can train them on how to click the referral and pull that in and send the referral request for the medication. That stuff can be trained, but I think fundamentally it's like are they kind, do they care about other people, and can they show that in their work and be effervescent every day? And so yeah, that's essentially what they are. They're a higher IQ admin, but they actually really do a lot of care coordination, and then also we've trained them to do things like motivational interviewing. We've trained them to help patients work with their goals.

      (24:26):

      And so we have this logging that is built in our app, and so basically you can log your blood pressure, you can log your exercise, you can log actually how you're feeling, you can log pain, different things like that. And so if you're on such a plan that says, "Hey, I want to lose X, Y, Z weight, or I want to work out X, Y, Z times," that care guide is able to use that data, check back in with you, do some motivational interviewing to make sure that we're all meeting your, that the team is coming together to help you meet your health goals.

      Brian Urban (24:54):

      I love that it's a virtual community that's being built around a patient's needs.

      Ayòbámi Olúfadéjì (24:59):

      Yes.

      Brian Urban (25:00):

      And I want to get into maybe your perspective on virtual care being adopted outside the US, and I should have asked this to begin with. So, what timezone are you in? Are you in East Coast? [inaudible 00:25:11], where are you right now?

      Ayòbámi Olúfadéjì (25:17):

      I happen to be on the East Coast, best coast, timezone today.

      Brian Urban (25:20):

      Oh, East Coast. Very nice, yes. All right. I just wanted to check because I never know if you're five hours ahead of me, same time, or if you're behind me. I never know. Well, you're a big traveler, obviously. You go home a lot, you care for your family, but you also do travel for your work and probably also for leisure I would suspect as well, all the miles that you get. So, looking at virtual care specifically, do you see this being adopted in different ways? I mean very different payment, single payment systems outside the US, but is it being adopted maybe in niche ways, mental health, diet outside the US?

      Ayòbámi Olúfadéjì (26:00):

      Yeah. The places I'll talk about are London, England, so I could talk a little bit about there, and then obviously Nigeria, which is where I spend a decent amount of my time as well. I think what I'm observing happening in the UK, because I have a number of friends who are physicians there, is that the NHS moves slowly. I don't think that's surprising to anybody, but I will say that they're moving in a systematic way. And so obviously with COVID, they started to do a number, I think I've read that 85% or so of primary care visits were all in person prior to COVID, and that number now is down to in the 60s. But I think what has been actually really interesting to see is that they have a well-articulated plan for what they want to get done. The NHS now has an app that has already been downloaded by over 50% of the population in the UK, I think it is. I mean in England, sorry.

      (26:57):

      It is so interesting to me, that I don't think there's any health system that can boast that in the US, to say, "Our app has been downloaded by half of the country." And then another 70% of people have logins, so they're using the web version of the app. And so I think because it's a single payer system, because a lot of the healthcare is provided by the government in the UK, I think the NHS is onto something and they have a lot of strategic plans in place to try to get those numbers up. I think the app downloads is a great example of that. The number of people who have signed up for some telemedicine services in some capacity.

      (27:32):

      I think what's also really interesting is they have about 50 what they call virtual wards, which are basically hospital at home systems, and I can't remember the exact number, but it's over 20,000 beds that they've actually stood up for patients who can get healthcare at home. So, I think slow but steady, and I think they might win the race, as that saying goes, just because of having a single payer and making sure that everybody is aligned.

      (27:55):

      Nigeria, on the other hand, I think you have spurts here and there where people are excited about the model, but I think that we have challenges with payment models in Nigeria. 70% or 80% of healthcare spend is out of pocket. And so you have people who are really, it takes consumerism to the next level, and now I know people who have started companies that offer virtual primary care visits for the equivalent of like $20 a visit and now it's like $15 a visit. And so you're having your margin squeezed out because you're competing truly on an open market for an individual's pocket. And so I think, yeah, my thought process is as far as Nigeria is concerned, there will be adoption. It will take some time. We have to figure out economic models that make it work. But those are kind of the experiences that I'm always thinking in my head about how we juxtapose the US to some of these other countries where healthcare is transformed, transforming anyway, as well.

      Brian Urban (28:56):

      It's interesting to see the cross between England, Nigeria. That's an amazing amount of out-of-pocket spend volume, and then in the US you just have an amazing amount of medical debt, and it's just the way that it's put into a business model is so different across the globe, I think is what you're pointing out here, and I just love your perspective. So, I had to get a little bit of the global perspective in terms of virtual care. So, looking at Carbon Health, I want to go into the future here. Three-plus years, what is Carbon Health's greatest contribution going to be to the ecosystem or to the patients that they serve?

      Ayòbámi Olúfadéjì (29:43):

      Yeah, no, it's a great question, and when you say our greatest contribution I'm like, "Oh God, I hope we do have." But no, we're doing really well at Carbon. I think there are a few things. The first is this idea of, I keep saying it, we're really, really patient centered. I think the Carbon Health app is really built for patients, and I think that there is going to be, and lots of health systems now have their version of a patient site or patient portal or what have you, and I think that is great, but it's literally going to be the difference between an iPhone and a Nokia 3310. We are going to really, really, really, really smash it out the water. I think we're [inaudible 00:30:22]. Exactly, yeah, it's a phone, but the levels are going to be, we're going to blow it out the water, and I think really thinking about how you think about a patient, put that patient experience in an app and clean it through the way so that the patient can get all the things they need for their care, I think that is the foundation. We truly believe that app is the door.

      (30:41):

      And then I think this idea that I discussed earlier where a lot of the things that a patient needs for the foundation of their care, I think we will start to find that a lot more models are becoming like that. Because I think what we have today is we have big health systems, and then we have retail urgent care brands or retail primary care brands. And I think at Carbon, we're truly trying to figure out, I mean today for all intents and purposes, we're probably closer on the retail urgent care, retail primary care brand chain, but how do we really think about care coordination for our patients? Like I said, we have the care guides now that we're testing out and learning from that. How do we think about some low-hanging fruit for specialty care?

      (31:20):

      We have endocrinology that is built in-house, we have mental health that is integrated into primary care. So, I do think that what we're going to show in three years or so is proof of concept of what it means to build an advanced primary care practice, what it means to have services in-house that provide the foundation of care for an individual, and then go from there and basically be pointed to as the company that designed and developed that. So, that's the second one. And then last one I will say is we love technology at Carbon. I believe, and it can be fact-checked, but we are the first company to integrate AI into our provider app. Exactly. No, I got to say it, I got to let the people know. So, we're the first company to integrate AI into our provider app, the native provider app, so not some other service that was bought out. And I think what we are bullish about at Carbon now, in addition to the patients, is actually starting to think about how we make the provider experience better, and how do we reduce what is called pajama time and how do we make it easier for people to get patient records, and how is it easy to reach out to patients and to get information back to patients?

      (32:30):

      Now we have logging that is built in, and I can talk about many examples where because a patient is logging their blood pressure at home, their primary care provider is doing a better job of fine-tuning their blood pressure medications. I mean, I have lots of examples that would give me goosebumps of where a patient has been out of control for a while, we start logging, they titrate their medication, two to three weeks later, they're now in range. And these are some of the beautiful things that we're able to do because we really think about how to provide care using the app and using technology. And so I think, yeah, those would be the three frontiers that everyone will know that we came and we tried to change the landscape.

      Brian Urban (33:05):

      And none of those are trends. All of those are emerging and they're going to continue to grow.

      Ayòbámi Olúfadéjì (33:11):

      Yeah, exactly.

      Brian Urban (33:11):

      Not only by adoption, but also I think you're going to see these huge, massive healthcare systems slowly start to make a decision between do I get acquired, do I fail, or do I start to actually innovate and apply that quickly? So, you are all becoming a very big influence across the market, not just technology, but the actual model itself. So, such a great, great conversation. I feel a follow-up coming on. I'm excited to have you on some of our executive round tables as well, Ayòbámi, and my Dartmouth brother, I thank you for being on this little podcast. It was great.

      Ayòbámi Olúfadéjì (33:50):

      It was my absolute pleasure. Yeah, no, thank you for having me. I really enjoyed the conversation.

      Brian Urban (33:55):

      And for more exciting excerpts and insights, please visit us at finthrive.com.

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