Virtual Care Models are Reshaping Healthcare

Brian Urban:
Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban, and today we are talking to the CEO and leader of all things at Vori Health. Dr. Ryan Grant. Dr. Grant, thank you for joining our show. 

Dr. Ryan Grant:
Thanks so much for having me. 

Brian Urban:
This is going to be fun. We haven't had too much time to get to know each other. We've gone on and off the calendar here, but I'm very thankful we got you in what I think is your continued busy season, the latter part of 2023. So, hey, with every conversation, Ryan, we'd like to get to know our guests a little bit more. So let's go back before Dr. Grant, before the md, maybe before some of your training at Yale and your work at Geisinger, how did you get into musculoskeletal health and what drove you into medicine in the first place? 

Dr. Ryan Grant:
That's a great question. Going all the way back as a kid was always fascinated with medicine, was one of those kids who would like the medical shows, loved thinking about anatomy, loved working with my hands, and that eventually led me down the medical school route and sort of fell in love with surgery and being able to help people get better, at least in the operating room. Went and became a neurosurgeon, became fellowship trained in complex and minimally invasive spine surgery, which is what got me into the musculoskeletal orthopedic spine realm. Originally thought I would do most of my time doing brain surgery, but actually fell more in love with spine surgery, but then started to uncover lots of problems in the sector and so wanted to dedicate my time to pulling the human race forward in a different way. 

Brian Urban:
Interesting that you kind of went off brain into spine, I mean all connected at the end of it, but very interesting path that you've had. And so I guess mash, maybe mash, Doogie Hauser, what were the shows 

Dr. Ryan Grant:
Now you have, you'd have Life in the er, more of the documentary type shows in terms of reality tv back in what would've been like the 1980s. So rudimentary reality TV back then, 

Brian Urban:
The early starts of it, really interesting. Wasn't sure if it was a blend of entertainment with Neil Patrick Harris there or if it was the other end. So good to know, but really interesting. It seems like a lot of the different physicians we have on our show, chief Medical Officers alike have some sort of family tie into it. Very young childhood curiosity, and it seems like that's quite similar for yourself. So let's talk a little bit about Vori Health. One thing I'm really curious of, Ryan here is did you ever think you'd have well over 20,000 LinkedIn followers being a surgical spine physician by background and having a startup that's grown to be successful, do you ever think you'd have so many followers in a virtual sense, let alone a physical community? 

Dr. Ryan Grant:
That's a great question. Never planned it that way. More of just do what you think is right, make sure that you're following your purpose and the rest will follow from there. 

Brian Urban:
Well, it's clearly worked because you're spreading your message far and wide. I know you were on a panel recently about designing hybrid care with a couple other interesting panelists there. Hone Health Oshi. I think that's really creative because a lot of what your model is is virtual care. So I wanted to get to know Vori Health a little bit more. So the virtual care team I saw is really the front door and that kind of kicks off the care journey for an individual. Can you tell us a little bit more about the model and really maybe even before that, how did you come to just work on Vori Health and create it and put it to life? 

Dr. Ryan Grant:
No, that's a great question. Starting with that, that I would take a step way back. What are we trying to solve? So we are in the orthopedics spine realm, which is back, neck, hip, knee and foot shoulder issues. Low back pain is still the number one cause of global disability across the planet according to the World Health Organization, literally number one in facting men and women equally. And we really are trying to tackle the broken care model. So I'll be the first to admit as a fellowship trained spine surgeon, if you want, depending on who you want to quote, either Harvard Business Review from 2019 or recent Forbes articles from 2023, the average US health system does over 50% non-evidence based spine surgery five zero. So you can go back to World War II about how this developed over time. Nobody's trying to be malicious, but we have sort of lost our way as a medical sector where we heavily overutilized surgery, we heavily overutilized injections and we heavy overutilized imaging and surgery is not on its risk. 

Dr. Ryan Grant:
So if surgery was risk-free, sure, maybe go do as much as you want, but people get hurt from surgery, people die from surgery. So making sure that we're really doing appropriate surgery is top of my own values. Surgery is necessary, but it has to just be used responsibly. And for lack of better analogy, I would say that the country's drunk on procedures and needs to be used responsibly. So we wanted to start over. We wanted to make sure that people are getting the access to the right types of clinicians, that those clinicians are practicing appropriate evidence-based medicine that drives up quality of life and drives down the inappropriate surgical realm. And then those who do meet criteria for surgery, make sure they can get to them. So what bore health is is we're a national medical practice, so we employ the non-operative appropriate physicians who work with physical therapists and health coaches and nurse navigators to take care of any back, neck, kidney, hand, foot, shoulder issue, whether it's new pain, old pain, failed back surgery, get those people better and then help them navigate the system. 

Brian Urban:
That depiction right there is very helpful because you use the term I think, which is foreign to the space, non-operative team. So these are individuals that aren't actually doing any kind of invasive procedures, but they're way upstream working with an individual through their pain, maybe through their maybe challenged flexibility movements, et cetera. So you're trying to go way upstream. And we talked before about spend and utilization and I think it's a fine analogy. I mean our traditional way of doing medicine and having medicine paid for is still in a very old model. The construct in the US is still stagnant in that way. So you're going way upstream. And I guess what have you seen the adoption been like because you're trying to bend this cost curve, you're trying to save people from unnecessary procedures and having them have a better quality of life Right now, I would understand without doing a surgical procedure, that's maybe not necessary. So what's the adoption been like with the model? Because it's virtual in nature, but still there can be a warm sense of caring and engagement. So what's that been like for a lot of your patients? 

Dr. Ryan Grant:
No, that's a great question. On our first visit, people have a very different experience. So if you interview or talk to any of the patients, they'll tell you it's very different in a way that they get to meet with more than one provider. At the same time, it's very much focused on what's the patient trying to achieve. So on somebody's first visit, they'll meet with a physician and a physical therapist and are we sure this person doesn't have cancer? Are we sure they're not going paralyzed? We make sure we do a safety check. Those are things that we can do that some of the other offerings can't do. We're a hundred percent confident on that, which you can do relatively quickly virtually is then to flip into, Nancy comes in with 10 out of 10 back pain. Nobody comes with a physician just for pain. 

Dr. Ryan Grant:
Nobody comes to medical attention just for that. There's something more in their life that's bothering them, whether they can't do an activity or they have fear, they're worried about something. So for example, Nancy, who comes with terrible back pain when you actually interview her in a different way than I was taught in medicine, you find out that the most important thing in her life is walking her kid to school. So her care plan is literally walking Tommy to school. She feels she can't do that because her back hurts. This is really all about Tommy. Then we make sure we teach people where pain comes from. If you don't teach people where pain comes from, they forever look for it. A well-known myth across the planet is people think the amount of arthritis you have correlates with the amount of pain you have. They don't correlate. 

Dr. Ryan Grant:
So severe arthritis doesn't mean you have severe pain, and if you're over 30, we will find arthritis in every single one of your joints. That's normal. The average person doesn't understand what normal is. I can guarantee anybody listening to this or anybody who's over 30 next year will have more gray hair, more wrinkles and more arthritis in every joint. That's just being human. And so people get these images where they're like, oh my God, I have bone spurs. Everybody ends up with bone spurs and there's all sorts of things that scare people. So making sure people understand what's normal. And then most of the musculoskeletal orthopedic surgeries, back, neck, hip, knee, shoulder are really quality of life operations, not necessity. So one of the things we think about, we do what's called a lot of shared decision making with patients is the analogy would be a facelift. 

Dr. Ryan Grant:
Nobody needs a facelift. That is a quality of operation about do your wrinkles bother you better enough to escalate to injections or escalate to best practice facelift procedures. Nobody needs surgery for pain. That's a conversation with the individual. If they do not get better, is your quality of life impaired enough that being cut open is worth it to you? The chance an average physician has that conversation with the patient in the normal setting is close to zero. And you'll find that 25% of people who are offered surgery if you just talk to them, do not want surgery at all. And so just having those quality of life operation procedures, making sure people are getting the right care team at the right time, making sure it's focused about Nancy and her kid, teaching people where pain comes from, giving them that synchronous and asynchronous care team. We have cool technology like computer vision, motion tracking, that when you're not working with providers and follow an exercise, physical therapy regimen, follow progress, and then you have that whole medical community around you. And then if you meet criteria for in-person care, we can help navigate you to some of our own offerings or strategic networks throughout the United States to really meet people where they're, 

Brian Urban:
I love that you gave the example earlier here in your explanation of a goal being centered around an individual's daily life. So what was important in that example, you're mentioning Nancy or son, Tommy was being able to walk with him to a school, to a place, et cetera. That makes it real. I think a lot of the, in terms of the maturity of health coaching being put into models or prehab being put into pre-surgery was having very specific these smart goals but not maybe aligned to that person, but aligned more to the next steps of a procedure or care journey. This sounds more personal, it's more personalized. I think the virtual care team that you're talking about, it has more of that synchronous asynchronous team mentality. I also really like that you pointed out a couple things here, Dr. Grant, in terms of the shared life decision making, that's huge. 

Brian Urban:
I think the little percent that you put out there, 25% is people want to avoid surgery. Is it worth being cut open? Those are very important questions and very important phrasings, probably the words that are used within your culture at vori as well. So I think this gives our audience a very good understanding of what you're doing and how you're starting to do it. So I did want to talk in terms of how you work alongside physicians outside of your team. So it sounds like you integrate your model within a healthcare system to be able to offset unnecessary costs or improve the care journey, engagement, et cetera. Can you tell us about maybe how that's worked with healthcare as partners in your strategic network that you were mentioning as well? 

Dr. Ryan Grant:
No, that's a great question. So given our big focus on getting upstream to the patient, remember we partner with primary care providers. One of the number one things that people go to their primary care provider or physician or clinician for is back, neck, kidney, shoulder issues. Primary care providers at large are usually over wore way too many patients on their roster looking for help. So we can be that preferred partner to help them co-manage or take care of patients together, particularly if the primary care provider is a value-based care partner, meaning that they're at risk financially for their outcomes, that can be a very great partnership. Not everybody has a primary care provider in the United States. A lot of people don't. And so we have to also make sure that we can be a full standalone. So we also partner with health plans like Blue Crosses and United Healthcare as well as self-insurance employers who pay for their own health insurance to help take care of members to drive up quality appropriateness. 

Dr. Ryan Grant:
And then if you drive down inappropriate surgery and inappropriate imaging, you can actually save the health plans money. And then I don't own or build imaging centers. So there are some patients who do meet criteria for imaging and do go onto the surgical arms. So I do send patients onto imaging centers. We can also order labs if they're appropriate. Some people do meet criteria and should have in-person physical therapy or in-person care. So we'll also navigate them into a strategic network for that. Some things can only be done in person. A lot of things can be done virtually, but not everything. And then as a surgeon myself, I'm not antis surgery, I'm anti inappropriate surgery. So two and half percent of our patients, which can a magnitude lower than what you see in a traditional market, go on to be referred to a surgeon. And so we'll send people into either health systems or preferred surgical networks to go on to that last leg if it makes sense to them. And that's sort of how we integrate in terms of on the non-operative side, we're not a great partner to health systems in that way because we drive down unnecessary surgery and health systems make a lot of their revenue off of these procedures. But we can be a great partner to send patients to them who do meet criteria for surgery, particularly if it's net new patients to a system. 

Brian Urban:
That's very helpful. And I can see the big play in value for health plans in terms of app prioritizing spend for people going to primary care for pain related to those orthopedic challenges that you're mentioning. So I did find it pretty interesting. You don't own an imaging center, you don't have a strong affiliation with an imaging center unless it's necessary, of course. So that actually speaks a lot to your mission of trying to take down the unnecessary utilization of certain things, imaging, pain, medications, things like that, unnecessary. So I find that very admirable because I would think it'd probably be an easy play if you wanted to gobble up or build your own imaging center and you can just have a lot going to there. So it speaks a lot to your mission and what you believe. So I loved hearing that. 

Dr. Ryan Grant:
No, appreciate that. Yeah, a common myth across the planet imaging is usually not very helpful in the musculoskeletal orthopedic world. For most of the non-operative or upstream care, it's usually not diagnostic. So what's imaging really good for? If our medical team is concerned about cancer, imaging is great to look for cancer. If somebody is in a car accident and or had an athletic injury and you're looking for a broken bone or a fracture or something like that, imaging is a great modality to look for that you're concerned about an infection. Imaging is very helpful to look for an infection or somebody comes in with a neurological deficit, which means they're going paralyzed or they're having true neurological issue where they can't move their arm, their leg, there's something wrong. You're looking for a pinched spinal cord, compressed spinal cord or pinched nerve imaging is great for that imaging. 

Dr. Ryan Grant:
Just looking for rudimentally rudimentary causes of back pain is not very helpful. So for example, if you go to some of the original studies on what's a chance an X-ray or an MRI explain somebody's lower back pain, the correlations under 15 one 5%, it's a terrible correlation. And knowing that everybody over 30 or 40 or 50 is going to have arthritis from mild, moderate to severe, you already know that. And so most the musculoskeletal issues for back and neck pain tend to be a more of a minor mechanical disturbance. The analogy would be a car, if your car steering wheel is off one degree and then you go on the expressway at 75 miles an hour, the whole car violently shakes. If I take a picture of your car, I can't figure that out until it's actually mechanically done that. So imaging's very helpful for the things I mentioned. Or if people do not get better through a program like ours, now you're using imaging to plan a potential surgery, but it's not very helpful upstream in the beginning to make a diagnosis. 

Brian Urban:
I love how you put it in that context. Your analogies have been spot on today, by the way. I know you've practiced these ones. These are very good. I find it interesting that you mentioned the biomechanics side of the world and the common myths of pain and the origins of pain. So your broader view in your philosophy with a lot of the evidence that you've shared in terms of statistics here from other references is extremely helpful because it speaks not only to your expertise and your craft, but also I think just the broad misunderstandings as well. You actually took me back to maybe 2006, seven, I had a biomechanics class. It was interesting. I didn't continue on with it at that time, but I think I revisited it later in my academia. But it's interesting because we don't quite, we think bone spurs arthritis pain is really bad. 

Brian Urban:
There's something inherently wrong with us. The only way to correct it is seeking a surgeon or seeking a treatment that might be invasive. I love that. Your model has education at the foundation, do you think, or do you see, I guess the majority of your patients being uneducated in terms of just general health and wellness or a general body biomechanics and how things are used and what is normal and what is not normal? On quotes, there is the majority of your virtual care team starting at that foundation level of literacy in terms of the body and normal ranges of movement, et cetera. 

Dr. Ryan Grant:
Yeah, you have to teach people what normal is. It's not well known by the average person in the United States, but average person is anybody from uneducated to multiple doctorates, average primary care providers. Also not well-educated in this realm. Imaging has been overhyped for a long, long time. We're addicted to American society uses imaging like Instagram. Everybody wants a picture. The patient thinks they need a picture to look for the cause, and it's just, it's misunderstood. So walking people through what imaging is helpful for or not helpful to remove their fear, and the analogy is anybody's house, even if it's brand new, will start to have cracks in the foundation. Most of them are, that's normal. It's settling. You don't need to rebuild the entire house from little cracks in the basement's foundation, those same things happen to all of our joints. Nobody freaks out when they, well, maybe they do when they see a 50 year old with some wrinkles that's just, oh my god, a 50 year old in the store with some wrinkles. That's completely normal and expected. The public is not used to knowing that, oh wow, I'm going to also have, if I have wrinkles, I'm going to have bone spurs. That's just being human and walking people through that. The bone spurs are not an indication for surgery. It doesn't mean that you necessarily have to do anything about them. And if you get better, the imaging is completely meaningless. If you got better, it doesn't matter what the image shows. 

Brian Urban:
I think that's probably the baseline for maybe a lot of patients that you see. And that probably creates a lot of the trust, the high level of engagement that Vori Health sees as well. And then that gets passed downstream too. As you're working with health plans, it probably off lifts a lot of administrative or literacy types of conversations that maybe a care management team or dietician, et cetera might have. One thing I was curious about, your model is, and I looked obviously at your site, saw some of the demonstrations you had there, dietetics nutrition, is that a part of your upstream work or are you touching that and your team touching that in any way maybe in the future? I'm curious of where that might fit in. 

Dr. Ryan Grant:
No, that's a great question. So yeah, the full type of care team is you have the non-operative physician expert, which is usually a physical medicine rehabilitation physician or non-operative sports medicine medical doctor. Then you have a doctor of physical therapy, which is more on the functional side, who works in conjunction with the medical doctor. Then you have health coach navigators to help bring in a biopsychosocial spiritual model there. It's traditional medicine is very heavily focused on just biology. Look for picture, look for imaging, look for this. Versus a lot of times people's pain can be from fear, from worry. You got to educate them how they think about the world greatly influences how they do. And then on the dietetic side, in terms of nutrition, up to 30, 35% of musculoskeletal issues have a weight component, particularly in the United States. If you're a hundred pounds overweight, your knees will hurt. 

Dr. Ryan Grant:
It's the overloaded pickup truck, they'll hurt. What's the first thing that pregnant women complain about is how much their back hurts. So if you have a similar body habit like that, like a man who has a body habit is with a large belly, your back will hurt and it's overloaded. Then a lot of the foods we eat, particularly in western culture, are heavily inflammatory. So for example, we've had patients present to us with diffuse joint pain every joint, and some of them you find it's a gluten intolerance, it's a wheat allergy, and they stop wheat and all their pain goes away. So it came with a musculoskeletal pain problem, but it was a nutritional issue causing it. And so what you put in your mouth is heavily dependent on how you feel. Lots of people on this call have consumed alcohol before you consume too much. You don't feel very good the next day. And if you eat a lot of sweets or very heavy fats at a wedding or something, you might not feel good the next day. And if you do that all the time, it definitely changes your joints, how you feel, your energy. A lot of people don't think about the nutritional components of any disease or medical process at large. 

Brian Urban:
Yeah, especially in western culture, like you were mentioning, you can't get more preventative than that. That speaks so wholly to a very specific part of your model in terms of individual education, individual investigation, I think it's overlooked your point with a gluten allergy, that can be a huge inflammatory effect on the body, not just a systemic feel, but also then ongoing and accumulates your ability to do things. So that's extremely helpful. That's the nugget I was hoping to hit and the biosocial psycho approach as well. Extremely important in medicine. So I actually really maybe off the wall question for you. So thinking back to your residency, going back into your medical education, was there a point in your education or maybe some of your early application of your work that you thought, man, there was a missed opportunity? In my academia, I did not learn as much as I should have about bioenergetics or exercise or prehab or rehab, physical therapy, different things that aren't traditional medicine. Looking back on it now, do you think that should have been more incorporated and then looking in the future, do you think that will be more incorporated as more of that biosocial psychological piece of medicine? What do you think? 

Dr. Ryan Grant:
That's a loaded question of, lemme get my crystal ball out, but if I take medical school residency, fellowship, so that together, that was 12 years of education, I think at most, and this might be overstating three hours of nutritional education in those 12 years, three hours, three, maybe it might've been closer to one. There is not a heavy focus, at least when I trained on the nutritional aspect. And to be blunt, a lot of the physicians I know, if they don't know it, then it's voodoo or magic. That's what that tends to be, the attitude. So while nutrition could be part of this, it's crazy. And so that is not a big part. It's moving that way slowly. Like 20 years ago, regenerative medicine or stem cells for joints was considered crazy, but now it's starting to have you start to see some clinical trials being set at the Mayo Clinic and let's learn about it. 

Dr. Ryan Grant:
And so you see some attitude softening in terms of biopsychosocial holistic models, I would say they're really in their infancy. In most of the medical schools, the do specialty has done a much better job of a holistic lens. That was a whole reason that that specialty really stood up as a separate break off from the MD allopathic schools in the United States was, I forget the gentleman's name, the original physician who was like, we only take care of biology. We don't take care of the person. I'm building a whole new medical doctorate. And that's where the DO schools come from in the United States was a more holistic approach. A lot of that has been incorporated into the current medical schools, but we still have a long way to go of how do you talk to patients? Are you really patient-centric? The health system and medical schools are at large still physician centric. 

Dr. Ryan Grant:
And what I mean by that is it's heavy paternalism. Even if you look at the digital health or the newest 2023 offerings out there, we still ask what is the patient's adherence to what the physician's care plan? That's how you talk to a child versus what's the patient's participation? There we go. Or what are their obstacles to why they can't participate? Nobody asks those questions. And so what's the patient's compliance with the physician? It's a very paternalistic model still across the country. And so it's rare that you find somebody really in a true a hundred percent patient-centric lens. It's usually a physician-centric lens. That's how we get taught. And then the other comment is I was never taught what a physical therapist does ever. If you actually audit a physician, take from orthopedics to primary care, what does a physical therapist actually do? And if you're writing a referral to them, what would you ask them to do? They have no idea. Literally no idea. Wow. 

Brian Urban:
You work so closely with And you have, which is wild. Yeah, 

Dr. Ryan Grant:
Well, yeah. Well, you would refer to them in the traditional sector, but do you actually know what they're going to do? No, it's a magical box. So you don't really learn what they do. And I'll be the first to admit, again, as that board certified fellowship trained spine surgeon, I was never formally taught non-operative conservative care. 

Brian Urban:
Wow. 

Dr. Ryan Grant:
I was taught surgery. 

Brian Urban:
Yeah, I love what you said. I mean, very honest. I love everything that you explained. Extremely helpful and a very similar story to a lot of other physicians that we've talked to, non-operative physicians, a lot of medical practitioners. But looking ahead, I think it is changing a little bit. It's still very slow. Geisel School of Medicine, Dartmouth, they have a medical humanities program they're starting to pull in. I'm sure Yale does as well. I'm not sure if some of the other schools across the country, but it seems like it's slowly building its way in, but it's still requiring literally a completely different program to be attached onto it. So it's another MS or an MPH or some kind of blend of something With the md, which is even more workload, there's a breaking point, but I'm sure there's a balance that can be found. So we don't go toward a breaking point of capacity. But is that what you see happening, or do you wish that, I would imagine looking at what you've developed now, you probably could have developed V at maybe earlier in your career, or it could have been maybe earlier in decades, even before you, if that cohesion was put in place in academia. Do you think that's going to happen? And do you think in terms of trends, we're going to see more of these types of virtual healthcare startups be successful like yours because of that? 

Dr. Ryan Grant:
No, it's a great question. So I think on the academic side, the US healthcare systems and medical school is very good at drug innovation, clinical trials, those types of new procedure, new imaging modality. That's what they're very good at in terms of innovation, in terms of care delivery, that's not a great place to actually innovate on how you actually practice medicine. If it doesn't involve an image, a procedure, or a new drug or a new lab, that's where they really are good at. So if you look at all the new care models or changes the way of care delivery, almost all of them across the United States have been done in the private sector. So you see startups go build a new care model or is a care model play. You mentioned Oshi Health on the GI side, that's a care model play. Oak Street Health, which was just acquired by CVS, is a care model. 

Dr. Ryan Grant:
Play Village MD is a care model. Play one medical senior is a care model, play TIA in the women's health space as a care model play. But all of these care model plays are really much in the private sector. You do see some stuff from centers of Medicare for ACO reach programs to try to incentivize the current incumbents, but the big transformative care model plays are really done in the private sector and then try to come back and integrate into the traditional system. And so I think you'll see a mixture of both. The really large health systems are classic innovators, dilemma, multi-billion dollar enterprises trying to transform and overhaul their ways is you don't really see that in any industries. So you'll see a lot of this care innovation, I think a mixture of the two. And you're starting to see some of these startups actually starting to stand up fellowships and academic training. And then you'll going to start to see people integrate, I think the two types of learnings. And then you see folks like Walmart standing up in medical school, and you'll see Walmart doing Walmart health clinics and trying to attract physicians over there to practice differently to help their bottom line, their patients, their members, et cetera. So you see innovation from multiple different sides. I think over time and whoever is able to drive the most value and we'll be able to redefine how things are. 

Brian Urban:
Yeah, it's going to be very interesting. That's a great point. With Walmart, I have a different opinion on how that might play out, but if it's helping patients, it's helping improve access, quality of care, engagement, all good things, and it's moving things forward in a more affordable way as well. I hope it helps the healthcare economy and our society at large. So a lot of crazy emerging trends that you pulled out there. So Dr. Grant, such an insightful conversation. Let me take a big step into the future for Vori. Looking down maybe five plus years, you've had a lot of early success. You're making a lot of great noise and you're representing the space so very well. What is Vori Health's biggest contribution to healthcare over the next five plus years? 

Dr. Ryan Grant:
That's a great question. I would love if other people copied us. Wow. It would be we want to push a new care model into society. I would be naive the think that Vori Health is going to touch or influence every single patient or human being across United States and beyond. And so we want others to be able to help pull the human race forward as well. And then hopefully we continue to make enough of an impact over time where people start to change the way they reimburse. So it's very hard to deliver appropriate evidence-based care if no one pays for it. Because the purpose of a business isn't to just make money, but money is oxygen to a business. It's required to become self-sustaining. And so United States still at large has a philosophy of being not a healthcare system, but of a disease care, taking care of things after the effect, paying for things that help prevent disease. Getting people better non-operatively that doesn't involve a procedure is not of a strong mindset in the US fabric yet. So for example, people will jump on, should we pay for Ozempic, a drug that can do weight loss, trying to pay for non-operative physical therapy can be a headwind. 

Dr. Ryan Grant:
Health plans don't think that way. And so the US culture is very much focused and has always been focused on gadgets. So imaging procedures, drugs, silver bullets, quick fixes, care model delivery that does preventative care and helps get people preventing disease is still not a priority of the United States. 

Brian Urban:
I hope there's more Dr. Ryan grants out in the world building more care models like vori, and if we see that shift, that's where I think a lot of our healthcare economy starts to have its next evolution. And I'm excited for that. That's a hopeful outlook. Dr. Grant, so great to be able to dive deep on our little conversation here today. Thank you for joining our show. 

Dr. Ryan Grant:
Thank you so much for having me. 

Brian Urban:
And for more exciting insights and excerpts, please visit us@finthrive.com.