Speaker 1: (00:09)
Welcome everyone to tales from the trenches. A series that matter is producing together with village MD. My name's Steven Collins, I'm a CEO of matter and we are a healthcare technology incubator and innovation hub built on a belief that collaboration between entrepreneurs and industry leaders is the best way to develop healthcare solutions. Today's program is part of our tales from the trenches series, uh, which we, uh, where we feature accomplished healthcare entrepreneurs, sharing their stories and what they've learned along their entrepreneurial journeys. We produced this series with village MD, which for those of you who aren't familiar is a Chicago based company that is innovating in value based care. Uh, they recently announced a billion dollar investment from Walgreens. They're now operating in nine markets, uh, with more than a thousand clinics. Um, our guest today is Todd park who has really one of the most incredible resumes of any healthcare technology innovator I've met.

Speaker 1: (01:09)
Todd is the co-founder and executive chairman of devoted health. Who's focused on Medicare advantage. Um, he previously founded, uh, Thena health as well as Castlight health. He was the chief technology officer for the United States under president Obama from 2012 to 2014, uh, and held that position in the department of health and human services from 2009 to 2012, uh, moderating the conversation, uh, today is Paul Martino, who is the co-founder and chief growth officer of village MD. Uh, prior to starting the company, he was a senior vice president, uh, and held a number of leadership roles at Anthem and well point. Um, he's been in the healthcare industry, uh, for more than 30 years. And with that, Paul, I handed over to you.

Speaker 2: (01:59)
Thanks so much, Steven, and appreciate the, the time today. And, um, for those of you in the audience, Steven was very kind, it's not more than 30 years in the healthcare, it's actually approaching 40. So, um, don't hold that against me, Todd, great. As always to see you, where are you this morning? This afternoon,

Speaker 3: (02:18)
Really California, Northern California. How about yourself?

Speaker 2: (02:21)
I am, uh, in, in a hotel room in the fine town of Atlanta, hot Atlanta as they call it. Right. Awesome. So, uh, it's beautiful here. I hope it's beautiful there. Rumor has it. It's beautiful in Chicago. So maybe we can, uh, we can open up the discussion by, uh, you just talking a little bit about who you are and how did you get here, uh, meaning the formative years, and then we're gonna get into your entrepreneurial track.

Speaker 3: (02:45)
Sure. Uh, first of all, it's incredibly exciting to be here, uh, and uh, always wonderful Paul to be talking with you and to be talking with entrepreneurs and innovators working to make healthcare better. That is my favorite, favorite, favorite group of people in the world.  um, so, uh, uh, background briefly in terms of, uh, journey is that, uh, uh, I was, uh, born to, um, immigrants who came to the United States from, from South Korea in the late sixties to study. Um, I was a mistake. I was not supposed to happen  uh, but, uh, um, my parents welcomed me into the world, uh, and then decided to, uh, build, uh, build a family here in the United States. Um, two years after I was born, my brother ed, uh, was born, uh, won of the most important events in my life.  across multiple dimensions. Uh, cuz ed is the most amazing brother ever. And, uh, we were really raised in a small town in Ohio, um, and, uh, that's really, uh, that's really the upbringing that, that shaped us and our values and our whole thought and, and heart pattern. Um, then, uh, uh, basically went to college, got interested in health, uh, healthcare, health economics in college. Um, got a job as a management consultant, uh, working on, uh, managed care, healthcare innovation, uh, right outta college, uh, where I met, um, Jonathan Bush, uh, who became, um, a small

Speaker 2: (04:09)
Personality. You

Speaker 3: (04:10)
Exactly. Yeah. He and I were Cub scout consultants together are working on the, uh, infant Booz Allen Hamilton managed care team. So we spent more time with each other than we spent with our significant others, um, and, uh, can fell deeply in professional love with each other. Uh, and, uh, and then decided, um, roping in my brother ed. And when he, uh, Jonathan was 27, I was 24, it was 22 and therefore just didn't know better  I had to start a company  yeah. Cause we hadn't gotten the memo, but what you really shouldn't have tried to do right. When you know nothing. Um, but, uh, we, uh, we, we, uh, we started a company called Athena health, um, that, uh, was focused on dramatically improving maternity care. I'm starting with the engine

Speaker 2: (04:56)
How'd you improve maternity? Why, what, what, what, what made you think that that would be a good place to start?

Speaker 3: (05:01)
Yeah, so the inspiration was really Jonathan's, uh, Jonathan's wife, uh, Sarah Bush, who was studying to be a certified nurse midwife in the public health system of New York city. Um, and she would just, whenever we could actually hang out with her, which was relatively rarely  cause we were working nonstop, she would, uh, she would just tell us stories, right about how maternity care worked or actually more to the point didn't work from her perspective. Uh, and they got us to really diving into maternity care in America and understanding at a systemic level, uh, why it worked and why it didn't work, uh, and seeing a massive opportunity to help it be better. Um, and Athena Health's original model was actually to be a value based care provider using present day parlance, uh, by taking global episodic risk, um, and, uh, uh, applying really a collaborative medical home for mom type model, uh, where an integrated team of physician midwife, social worker, educator, nutrition, social worker, uh, could love on a mom proactively to get them the right care place, right time such that actually complications dropped way down hospitalization, uh, complications, uh, uh, NICU stays drop way down, um, such that outcomes improved and, and costs were reduced.

Speaker 3: (06:22)
And so that was the whole point. So it was working the point is it was working, it, it was working and, and in fact, uh, uh, what we, uh, what we ended up doing, um, was to get the company going. We, um, uh, bought a very successful collaborative care practice in San Diego, California. Um, one of the leading practitioners of collaborative care, the collaborative care model for, for moms to be in the country, um, and started running it. Um, and the whole idea was to then systematize that and then export that across the country. Um, and things did not, did not go according to plan.  say more about that. They never do, and we've got out there. So what would tell, say more? Yeah, so basically, uh, you know, first of all, um, you know, look, you know, I was 24, right. You know, um, and uh, I managed to convince a health system to sell us this practice 150 person, 25 midwife seven OB practice, um, 13 offices across San Diego, California.

Speaker 3: (07:27)
Right. Um, I thought I was like the greatest deal name of all time. Right? Turns out no  turns out basically, uh, you know, this health system was extremely eager, uh, to sell this practice, uh, because running on its own two feet, uh, it turns out that it was losing a lot of money, uh, which was so obscured by kind of the complex finances of it when embedded inside a health system. But when it was running on, on two feet, it, it was losing a lot of money. Um, and, uh, that gradually became apparent to us as the revenue we were collecting didn't match the  revenue. We thought we were supposed to be getting . Uh, and it would actually all have been fixed if we in fact, had been able to get global risk contracts with payers. Um, and we went to payers and said, look, we have the superior model, uh, take whatever you've been spending historically on cost per pregnancy and cut 10% off.

Speaker 3: (08:24)
Right. And just book 10% savings, pay us this global episodic payment and we'll handle it from there. And, um, what we discovered was that payer said, look, I believe your model's better. Um, I believe that, you know, you are delivering on it, um, and can deliver on it, um, and can continue to deliver on it, but I'm not gonna change the way I pay just for you. Right. Um, I, I'm not gonna actually alter how I pay for healthcare for you. Uh, and so no. Um, and so a practice that actually would've been doing very, very well under a global episodic risk payment, uh, model while delivering significant savings to the healthcare system, uh, as it grew, um, just became a really unviable, independent medical practice, um, losing like a million dollars a year. Um, and so that's what, uh, Jonathan ed and I were left with.

Speaker 3: (09:22)
Um, and what then happened was we said, okay, look right. You know, this is a huge portion of the public health safety net for women in San Diego, right. We're not gonna be the captains on the ship when this ship goes down, right. We will not actually be at the helm responsible for this ending. And so we're gonna actually pull all the stops and fight with everything in our power to make sure that we save this practice. Uh, and so we first said, okay, well, there's no software running these doctor's offices. That's crazy. So let's go get software to run these doctor's offices. Um, we looked at 400, literally different practice management billing systems. They were all terrible and none of them were internet based. This is 1998. So we said, okay, well, this is a really crazy situation. We're just going to build our own.

Speaker 3: (10:12)
Um, so we ended up building the first internet based cloud-based software platform to run doctor's offices in the way that we wanted to run them. We integrated a billing service into it and combined the software and this next generation building service to net net cut the cost of billing in half, uh, radically increase speed of payment and cut that debt. Um, and did that to basically just save this practice, um, what then happened, um, is it can make incredible long story short, is that the doctors and midwives, uh, who we were working for working with said to us, as we were thinking about future of the business, they said, you know, Todd and ed and Jonathan, like you're lovely young people. Right. Um, but you know, running medical offices, isn't exactly your strong suit. Like you're okay with it, but not particularly good at it.

Speaker 3: (11:01)
Right. Uh, and you know, don't you hate when they do that  and they said, yeah, you could go buy more of these practices and run them. But again, like, why would you do that? Cuz you're not particularly great at it. Um, but this software and this billing service that you've built is incredible, right? It is actually taking our biggest single hassle, which is wrestling with insurance companies and making that wrestling go away and giving us the time and the emotional energy and the financial resources to really focus on what we love to do, which is care for patients. So we suggest that as you think about expanding and working with our sisters and brothers in medicine, that you drop the whole run, the practices thing , and instead provide your software and your billing service as a suite of services to help people rock and roll. Um, and, and truthfully, it took me a long time to get there. Like my brain got there in like five, right. My heart took a lot longer to get there because my office was in one of our birth centers or because here a baby being born every 78 hours to the ventilation system, a and I loved being that close to care. Right. I loved actually being in the middle of care,

Speaker 2: (12:08)
But did you feel like you were copping out by just pursuing and you were given up on the actual patient care side of it?

Speaker 3: (12:14)
Um, I, I, I, I, I, I, I, I did, uh, you know, I think emotionally, um, and, uh, and, um, I said, look, you know, I wanna be in the baby business, right. Not a dot communist medical billing service. Right. You know? Um, uh, but, uh, I, I, I, I, I, I eventually through a lot of conversations with him, utilizing the doctors, got to the place where I realized that our mission of helping healthcare make the way it should, uh, making healthcare work the way it should, um, uh, was actually best fulfilled by us if we did the thing that we could do that was most helpful to the doctors of Midwest, right. Which is supplier software, supplier billing, service, help inject temporal financial, emotional energy into their lives. So they could be the best they could be. Um, and, uh, but I, you know, we have in our Athena archives, like 26 versions of our first VC pitch.

Speaker 3: (13:05)
Right. And it starts with, uh, you know, baby company. Right. And it ends with dot communist, medical billing, uh, you know, and software company. Um, and then there's these like really weird variations in between , as we were like neither fish nor foul and some kind of communis do. Um, uh, but, uh, uh, you know, eventually I realized that that this was the way that we could be most helpful. And so we ified right into a software as a service and building service company, um, and then attracted a bunch of venture capital then just took off from there.

Speaker 2: (13:35)
So say a little bit about that, Todd, because this group that's, that's probably listening and, or at least a portion of them are all thinking about capital access to capital. How do I do it? What, how did you think about it when you were starting a Dean?

Speaker 3: (13:49)
Yeah. Um, so, um, you know, yeah. I mean, when you're first an entrepreneur, right. I mean, you know, it's, uh, just, I mean, bluntly, right. I mean, it's a, uh, it's an exercise, uh, suffused by sheer terror most of the time. Right? Yeah. Uh, you like to think that you're cool and come and collected and

Speaker 2: (14:14)
Strategic, and they're gonna buy this story.  cool.

Speaker 3: (14:17)
And really, really anyone who says that that's how they did it. Right. Either got incredibly lucky or is just in a massive fit of self deception. Right. And so we, uh, you know, basically had this idea, but that was a pretty good idea. We raised angel money. Uh, we bought this practice, uh, got parachute in the middle right. Of giant fire fight, then fought like hell to get out of the fire fight, right. Building software building services to get ourselves outta the fire fight. Right. Um, and, uh, uh, and we were just focused on folks, really not just surviving honestly. Right. Uh, and building something of true value. Uh, and, um, you know, once we actually crystallized that we had built something that was truly helpful. Um, and once our minds and hearts aligned that, that's what we really wanted to do. Um, we then actually, uh, did begin to engage, uh, venture capitalists, um, and, um, uh, that was a very interesting process.

Speaker 3: (15:20)
Um, uh, and, you know, I, I think, you know, I think that probably the best way to distill it is that, um, let me put this way. So the, the, the lead investor in our initial venture capital round is a guy named Brian Roberts, um, from Benwalk he was an associate at the time. Um, he, uh, did an incredible amount of diligence on us at 19 rounds total. Cause I count every time he called me back is another rank, right? He's the only VC who went to one of our medical office to actually watch people, use the software, um, and did an enormous amount of research. And then he, as the young associate went to the partnership at bedrock and said, I think we should invest in this company, Athena health. And the partnership said, you're crazy. Right? You wanna invest in a, in a, in a, in a health care it company, right.

Speaker 3: (16:08)
I mean, that's just a wasteland of upper proportions. Right. And you wanna invest with, with, with, with who, right. Basically like these, these are kids, like they've run laps in their life, but really nothing else. Right. And if you add up Jonathan Todd's age, collectively, that equals like the age of acceptable CEO. Right. So the, the, the Benra partnership said like no, and Brian went back and did more diligence and came back and said, um, I actually think this is a bet that we should, we should make, I think this is actually something that could be really, really big. And the Vera partnership said, well, okay, kid, it's on your head, right. We're only viewing this because you're putting your entire career on the line, uh, to invest in this company. Um, Brian's first investment was Illumina. His second investment was Athena. Um, he's now the managing partner of Vero. ,

Speaker 2: (16:50)
He's gonna say he's,

Speaker 3: (16:52)
He's rightful American healthcare VCs of all time. Um, but the, the moral, the story is that we were really not an obvious Ben. We were really, really, really not. Right. Um, and Brian saw something in us. Uh, I'm not sure exactly what , but he saw something in us of what we had done, because our software was a really basic pro tip at the time. Right. You know, I mean, and, and so, you know, and, and our whole setup was an incredibly premial state. Um, but he saw something that he believed in and decided to bet his career on. Um, and I think that's what truly great venture capitalists really do. Um, and it turned out, it turned out to be, it turned out to be a great bet. Um, so,

Speaker 2: (17:37)
So you, you, you getting the company going, you've got a guy that's willing to bet on you, a guy that's willing to risk his career on you, the company's getting going, the company's taken off, and then eventually there's gotta be the seminal moment where you collectively say, maybe we should take the company public.

Speaker 3: (17:55)
Yeah. So, um, you know, that was another, it's another interesting and interesting, uh, discussion set. So, you know, we spent, uh, you know, really, you know, better part of a decade, right, as a private company, uh, we spent a long time as a private company, right. By, by, by a lot of standards. Um, and we were just really methodically focused on building the business. Um, we added an electronic health record, which thrilled us cause we, we get, we then got back closer to clinical care. We added patient communications, um, and, uh, uh, other new software and services that basically got us closer and closer, uh, again, to, to, to clinical care. Um, and, uh, just help further our mission of helping make healthcare work the way it should. Um, we actually, frankly, weren't thinking a lot right about, about I P O at all. Um, uh, uh, and, um, um, you know, it, it, it, it then became a thing that we begin to think about, right. Um, as a way to actually really, um, increase our profile, right. Build our brand right. Among the, the doctor universe, um, uh, gain capital to be able to continue to rock and roll. Um, but it wasn't something that we ever viewed in kinda, uh, what's the word, um, something that was disproportionately important, to be honest with you. Right. Um, it wasn't,

Speaker 2: (19:16)
It was, or wasn't disproportionately important.

Speaker 3: (19:18)
It was not, yeah. It was not something that we ever really viewed as disproportionately important. It wasn't the end point. Yeah. Um, uh, it was a particular gate through which to travel, um, and then keep doing the work. Um, so, um, so, you know, we, we, we just didn't, we just didn't, we didn't treat it as an APO company transforming thing. In fact, we very much hoped it would be, it would, it would not be company transforming. We were extremely worried about what it might do to the culture and execution pattern of the company, uh, if we, if we were a public company. Um, and so, uh, and so we spent a bunch of time thinking through that. Uh, and I think cuz we prepared very sly for that. Um, being public didn't really change the fundamental character and, and an orientation of Athena, which was, which was great.

Speaker 3: (20:06)
Um, uh, but you know, it was, it was, it was, it was, it was also a bit of a surreal process actually. Right. I mean, so we, um, I mean there's a whole bunch I can say about that. Right. But, but I mean, you know, we were, we were, we were flying around the country. Right. You know, in, in a, in a, in a, in, in these private jets. Right. And we were, Jonathan were saying to ourselves, like, we don't wanna pay for this. Like why, why are we in these? Why are we in these jets? Right. You know? Um, and so

Speaker 2: (20:33)
We're clear row 1 23 seat B is where I still sit on great am United airlines. So just so you. Exactly,

Speaker 3: (20:41)
Exactly. Right. You know? Um, and, and so, uh, and so, you know, we, we, we, uh, we, we just, um, know the process was just, just weird for us because we, we used to sitting in like the middle seat right. Of, of United airlines. Right. And so, um, and, uh, um, you know, and then we went, we went, we went, we went public actually, um, on the NASDAQ and, uh, you know, obviously it's a, that's a virtual market. Right. But there's a show site in times square. Right. Right. Then you saw like, Thena healths banner up on this giant kind of cylindrical electronic billboard. And we got walked into this conference room, uh, for watching us start trading at 11 o'clock. Um, and, um, uh, you know, we, we waited for that moment, um, with dread actually, honestly. Right. Um, and, uh, and then our stocks started trading, um, and, um, the price was way the heck above what our IPO price was.

Speaker 3: (21:36)
And we said, well, we're in the wrong room clearly. Right. This is not our stock. Right. This is someone else's stock . Um, and, and then that's, I think patient explained to us that it was in factor our stock. Um, and, uh, and the company ended up being worth like, well, over a billion dollars. Right. Yeah. Um, which again just was really weird to us. Like all of this was really, really strange. Yeah. Um, and what we wanted to do more than anything was just say, okay, great. Like we're through this particular portal, we're through this particular milestone and we're just gonna get back to work. Um, and, uh, and, and keep working our hearts out, right. To build something that's truly useful. Um, and help doctors and nurses like be the best they can be.

Speaker 2: (22:14)
So, so this is, uh, the first part of your professional journey. I, I wanna get back to your family and minute it, but before that let's keep going on the professional. So then you're, you're, you're now a public company. You're a highly successful company.  much like, uh, you said, you know, you think you got it wrong. That can't be about us who's company is that

Speaker 3: (22:34)
I know Zoe. Exactly.

Speaker 2: (22:35)
Right. And so then what happened? You decided to leave or what, what happened?

Speaker 3: (22:40)
Yeah, so, uh, I, I stayed with Athena for another year, uh, to basically make sure that the culture, uh, wouldn't change hadn't changed. Uh, and after a year I was convinced that the culture actually had not been fundamentally changed, um, by being in public company. Um, and so at that point, um, I decided to keep a longstanding promise. I made my wife and, uh, and stay married. Um,  good idea by, by retiring from Athena and, and, uh, uh, and staying on its board. Uh, but then actually, uh, moving, uh, from Boston to, to here to Northern California. Uh, cause I met my wife when we were 17 and I promised her that, um, we would raise a family near her mom and dad, uh, here in Northern California and Athena health is based in, in Boston. And my wife would, would, would appeal to remind me, particularly during the nine months of Boston that are really cold, um, that Boston is not Northern California  and when are we gonna Northern California?

Speaker 3: (23:38)
Um, and so I finally decided to keep my promise and we, we moved in Northern California, um, and I stayed connected right to my first professional child, Athena, uh, and to this day, love her desperately. Um, but we had a baby, my, my wife and I, an actual baby was posted with a professional baby that was Athena, um, Alex, um, and Amy was happy for the first time really ever, I think, uh, with me, uh, I'd found my level, um, uh, along the way. Um, I got persuaded, uh, by another close friend, Giovan Ola, um, and Brian Roberts to start a second company called ate health. Um, very, very exciting, uh, concept, um, uh, to bring a transparency, uh, to the healthcare shopping experience and create an online benefit management platform, uh, for healthcare. Uh, that could be incredibly powerful. Um, uh, but I helped start Castlight, but it mostly got built by other people, uh, because a year and a half into being in California and my wife being happy and I got drafted  by, by the, by the us government. Um, and, uh, and then made probably the most unexpected transition of my, of my, of my professional life, um, uh, which I can, I'm happy to talk more about. Um,

Speaker 2: (24:52)
Yeah, so just a, a quick question. And then I do wanna get into that because, uh, not often do 24 year old kids, 22 year old kids ride this up, get this level of success, move to California and a year and a half later get tapped on the shoulder, but before we go there, uh, where was ed all this time? You said that was the Mo one of the most important days in your life. Where did he go? What happened with that?

Speaker 3: (25:16)
Yeah, so ed, uh, was the founding engineer at Athena, um, and, uh, um, uh, was still at Athena, um, and stayed with Athena, like for the better part of another decade, actually another full decade actually. Um, uh, after I retired from the magic team, um, and, uh, he's just the most extraordinary person. He's just the most extraordinary person. Um, and, uh, you know, we we'll get to, we'll get to devoted, uh, in a bit, right. But motivated for me, uh, in starting devoted was the opportunity to reunite with my brother and work with him again. Um, cuz he's just the most incredible, incredible human being.

Speaker 2: (25:56)
So we'll, we will come back to that. So, so you get a tap, the phone call I imagine. And what, what was, what, what happened, how did that even come about?

Speaker 3: (26:05)
Um, so, um, so, uh, can the, the long story short is that, um, like, uh, many, many, many, many other Americans, um, I got involved in politics as a citizen for the first time, uh, because of the 2008 presidential election. Um, and, uh, uh, was, uh, uh, doing everything I could, um, on behalf of, um, Senator Obama's presidential campaign, um, then, uh, uh, then Senator Obama became president elect Obama. Um, and I said, okay, this is great. Like I am no longer going to be involved in politics. , you know, the mission I believe in, has been, has been executed. This is awesome. Right. And, um, I was there in Chicago on election night. Um, I remember president elect Obama coming out and everyone else was delirious with excitement, um, in that park, except for him  he was incredibly sober and he said something that I will never forget, um, which, uh, he said far more eloquently than I'm gonna relate it, uh, now, uh, but the gestalt was, uh, look, all this is great, but we actually haven't done anything yet.

Speaker 3: (27:19)
Like whether we actually are able to be truly helpful to the country, um, is, uh, a function of what we decide to do going forward. And it's really not a function of me. It's a function of all of you and whether you continue to dedicate yourselves to and sacrifice for change, uh, and remember not being able to not being able to sleep that night. Um, and, uh, and thinking that, of course he was right. Um, and so the next day I just basically called someone and said, look, you know, I would be delighted to help in way possibly can. Um, I cannot move from California, right? I'm gonna get divorced if I do. Um, I cannot come to DC, but if I could help in any, any, any small way, I'd be delighted to help. And so, um, I got put in touch with a think tank called the center for American progress, which was doing a lot of work, uh, to be helpful to the Obama administration, um, in DC.

Speaker 3: (28:10)
And I became a, you know, part-time volunteer senior fellow. Um, and then I got poached  so I got poached. Um, and, and, and, and, and, uh, and I, I would, I'll just say the Obama administration is a phenomenal recruiter.  relentless, incredibly focused, and they do not take no foreign an answer. Um, and so I got asked, uh, to, um, uh, to take on a new role called CTO of the us department health and human services, uh, which is all so, so there was not that role previously there wasn't, there was someone who was called the CTO, but who was working for someone called the CIO, who was running all the internal tech at a, at a teachers, but this was a new job that wasn't focused on the internal tech of HHS. Um, it was focused, um, on, um, basically being a policy advisor to the secretary and deputy secretary on how to craft policy and evolve policy, uh, to help, um, basically catalyze, uh, uh, tech and data and innovation to make healthcare better.

Speaker 3: (29:15)
Um, so they call it their entrepreneur residence, uh, job, a different kind of EER, right. Uh, but you know, they're EER, right. Uh, and, uh, um, I, I initially said, no, I can't do it. I can't, I can't move from California. Right. Um, and, um, and, and, and come to DC to do this. Um, but they were, they were incredibly persuasive. And what they really actually, uh, got me with was I asked, well, what, what, what would you want this person to do? And they said, well, like we're sitting on the acres and acres and acres and acres, cubic hectares, cubic miles of data, right. And CMS and FDA, NIH, CDC. And we don't get the sense that we're actually, um, basically maximizing, uh, social return on taxpayer investment in this data. So we'd love for you to come and figure out what to do with this data. Right. Um, and I kind of delved into that, so, wow. Right. I mean, they knew exactly how to get me, which is to, in source of view with the cabinet of data. Right. They generate huge value. Yeah. Um, and so I remember then like flying back and, and talking to Amy, um, and saying the thought maybe we should go to DC. Um, and then she didn't talk to me for, for four days. Yeah. School

Speaker 2: (30:27)
Conversation easy. Right. No, no friction there

Speaker 3: (30:30)
, but I'll never forget what she said after, after four days of not talking to me, which was, uh, if they're really creating a job like that, she said, it's your national duty to go do that job? Um, I said, well, I, I can't go without you and Alex, she said, I'll go back to the east coast, which I don't like away from my parents with the baby right. For a year. So we can actually serve, serve the country, serve the country together. Um, and you know, I think, you know, both Amy and I, uh, as children of immigrants, um, and who've experienced, uh, an extraordinary adventure here in the United States. I mean, at the end of the day, right. You know, this country has given, given me and given her everything, everything, um, and in no other country is our life is our story possible. And so, uh, ultimately when our country asks us to serve, of course we would drop everything. And of course we would do that. Of course we would do that. Um, uh, and so we did, uh, now that ended up actually being seven years  and Amy signed up for one. Um, so you stayed

Speaker 2: (31:45)
In, you stayed in DC seven years on

Speaker 3: (31:47)
A, for five, for five years. And then basically served the last two years of my pub TruD public service, um, in, uh, from Silicon valley, but was shelving back and forth constantly. So Amy doesn't really consider that being home. Um, and so, so that was along with Amy bargain for it. Right. But, uh, but it was still, uh, you know, um, like, you know, I would definitely say right, the most extraordinary professional experience of my life. Right. And she would say one of the most extraordinary experiences of our family's life and really, really, really deeply, deeply, deeply meaningful. Um, and so, uh, so I, I, I stored this job of HHS CTO and, um, uh, you know, the initial hypothesis that HGS had was, uh, you know, basically monetized from a social value standpoint, um, this data by, uh, having it, just build a bunch of apps that you lost data.

Speaker 3: (32:41)
I said, well, you could do that, right, but that's not necessarily the right way to go here.  why don't we actually do what the yo government did with weather data and GPS back in the day, right. By taking these public resources, then opening them up, um, for everyone else to use. So all the other smart people in the world can combine the data with their data and their knowledge and their capabilities to come with new insights and services and products, um, that, uh, you know, H just wouldn't even have thought up, let alone, like had the resource to be able to build pro again, scale. Um, and so we launched an initiative, uh, to help the initiative to open up this data. Um, and we started an event called the health data za  to, uh, yeah, yeah. Beautiful to basically promulgate publicize the data and people are doing with it.

Speaker 3: (33:28)
Um, and the thing just took off, um, like, uh, like wildfire, uh, and, uh, after two years they said, okay, this thing is now outta control in a great way. Right. Uh, it doesn't need me anymore. It's off to the races and I'm gonna make my wife happy and go home a year late. Right. But still like two years. Right. Um, uh, uh, and, and make her happy again. Um, and then the white house called and said, um, we'd like you to actually do the same job you've been doing at HHS, but now do it for, uh, president Obama across all domains, um, as, as the, as the us CTO. Um, and I said, no, basically, uh, for like six months. Um, but they are, cause I really wanna stay married  and, uh, well, that was the little thing in the way. Yeah, that was a small thing in the way.

Speaker 3: (34:20)
Right. But again, kinda walk story short, the white house is a relentless and incredibly focused and effective recruiter, um, uh, and convinced Amy me to, to stay, um, until the end of the first term. Um, and, uh, uh, and then president Obama asked me and more importantly, Amy, uh, to extend further. And so we did, um, and, um, and, uh, you know, Amy, the, the, the, that, that experience was just incredible, incredible, you know, and, and I don't wanna make the job sound like two grand. I mean, a title like CTO of the United States, like sounds a little grandiose. I mean, so, um, actually when I, when I got appointed, my friends would call me and say, I hear you, the CTO of the United States, I'm an American, my Xbox is broken. Can you help me fix it?  I'll try. Right. So I'll send the cable guy over.

Speaker 3: (35:12)
Exactly, exactly. Uh, uh, but really the job was to be, uh, president Obama's, uh, personal geeking residents and tech policy advisor. Right. And so, um, so the, the job was to work on tech policy issues, like internet policy, net neutrality, uh, wireless spectrum allocation, you know, entrepreneurship policy. Um, and, and, and these are issues that many people might find a bit of a sneer. Right. You know, but, but president Obama and I loved this stuff  and have a chance to work with a president who loves this stuff. Right. Uh, cause it's very high leverage policy stuff, right. Was just incredible. Right. Working on open data across multiple domains, not just healthcare. Um, and so it was just an extraordinary experience. Um, uh, but I would say probably the most meaningful, uh, uh, portion of that experience. Um, and certainly the most stressful and intense, um, had nothing to do with tech policy.

Speaker 3: (36:12)
Um, it was when, um, on October 1st, 2013, the federally facilitated health insurance marketplace, um, healthcare went live, um, and, uh, went incredibly badly. Yeah. Um, uh, and, uh, uh, uh, uh, you know, CMS, the agency, uh, in, in charge of he, of, uh, was working its heart out to try to fix it. Um, sorry, working, its hard out to try to fix it. Um, you know, hopefully that's not the white house.  exactly  um, and, uh, um, uh, the progress was not, was not, was not moving at a rapid clip. And so, um, uh, so president Obama asked me and um, my teammate, Jeff science, if we would lead a, uh, turnaround mission basically, um, to go to CMS and work with them to seek, to fix the, the, the website. Um, so, uh, recruited a set of, uh, Intrepid teammates and then went in, um, and, uh, that is a whole other story we, you get into, uh, but kinda long story short, uh, in six weeks, uh, we working with CMS regular to take the website from enrolling, uh, just a small number of people a day in health insurance to enrolling over a hundred thousand people a day, um, in health insurance.

Speaker 3: (37:35)
Um, and then by the end of the open enrollment period, um, uh, enrolled 1.5 million, more people in healthcare than, uh, even the most optimistic projection had projected, uh, even for the site, um, had such a terrible start. Um, and so, uh, it, it, it was a ridiculously stressful and intense experience, um, and also profoundly, profoundly meaningful, profoundly meaningful, um, uh, to basically, you know, keep team spirits up and, and just motivate just the endless amount of backbreaking work 24 7 to actually get the site fixed and then to actually further reinforce it so that it would actually hold, uh, when most Americans came at the last second to enroll at the end enrollment, um, we would read letters, um, that people had written the president, um, uh, thanking, um, thanking him for saving their life mm-hmm , uh, by them to healthcare, you know, uh, and, uh, and it was those stories of Americans' lives who were saved and transformed.

Speaker 3: (38:44)
Um, that really was the fuel that enabled us to just keep running right. Incredibly high speed, um, to, to fix this thing. Um, so then, uh, uh, after coming home, uh, to my regular job, um, from the, uh, fixed healthcare, like a mission, um, I actually kind of found it hard to focus again on like net neutrality  et cetera, as exciting as itself is. And so, uh, president Obama and I, and, uh, a few other Intrepid souls, um, co-founded a new elite tech special forces unit of the us government called the us digital service inspired by the rescue health dot go. And the whole idea was to get, um, uh, maybe a few dozen additional people, um, uh, who are fantastic technologists, engineers, product managers, designers to come do two to four year crews of duty, uh, working for the us digital service, kinda like at peace Corp for geeks, right.

Speaker 3: (39:42)
That we then send small teams across the Pentagon, the VA, right, the immigration service, you know, et cetera, uh, to, uh, reboot transform upgrade, um, uh, uh, tech enabled services delivered by the us go, um, without, you know, maybe a few dozen other people, right, would actually leave their multimillion dollar stock options packages at Google and come do this, um, uh, working in the heart right of the VA, uh, doing incredibly difficult work. Um, but in the signal of the fundamental goodness of human beings, um, about 200 people actually signed up to cut. Um, and the us steel service, uh, became, uh, hugely impactful, um, across a bunch of domains and the us government, uh, improving service for citizens, improving national defense, et cetera. Um, and actually was enthusiastically continued in the Trump administration and continues now in Biden administration and has become a, a, a really increasingly powerful access, uh, of improvement in how our government actually functions and delivers.

Speaker 3: (40:46)
And so, um, and so that, that, that, that was, that was, that was an incredible experience as well. Um, and, uh, so then basically five years into being in DC, um, my wife came to me and it's when you're life partner speaks quietly too. Uh, when she speaks in a quiet voice, that's when you have to pay the most attention. Right. So I get that too. Yeah. You said, look, you know, we've been here five years. Um, I am now returning home with our now two children, and I invite you to, to, to come with me if you wish to be my husband on a going forward basis.  uh, and I said, oh, I, I, I do wish to be your husband on a go forward basis. Um, and, uh, um, um, I then had, uh, 40 minute conversation with, with, with president Obama, uh, in the oval, uh, where he was saying, you know, Todd, you can't go, you cannot go.

Speaker 3: (41:37)
You need to be here with me till the very end. And I said, I would, I would love, I would love that. I would love that, but I'm gonna get behead and divorced  or divorced and headed. Right. Um, and, uh, uh, and so we, we, we talked for a while, uh, and he, he then finally said, okay, Todd, I want you to stay married. Uh, and I love Amy. I wanted to be happy. Um, and so I'll let you go home as long as you agree to keep working for me from there. Um, and, uh, uh, and so, um, he figured out a way to basically create this position of white house tech advisor based in Silicon valley. Um, and, uh, and so I, I, I, I took that, um, that role and kept working for him, uh, for the next, uh, two years until the end of the, uh, two plus years until the end of the second term.

Speaker 3: (42:27)
Uh, cause what we really wanted me to do was keep building the us digital service, uh, and keep recruiting more people to come join, uh, the us digital service and also help on other issues where it was very useful for me to be in Silicon valley. Um, and I, I, I, I, I, I was able to stay married because in fact did technically move home with my wife. Um, uh, but I was in DC constantly, um, because you just have to be, um, in, in that kind of work. Uh, so Amy doesn't really count, uh, that period as me being home. Uh, but she did gimme enough credit to not divorce me.  um, and so

Speaker 2: (43:02)
There's a question from, from the audience that's talking about innovation and people generally don't think of, you know, governments innovating, uh, and, and what has happened is, has been amazing in healthcare. And I think it will continue to do amazing things in healthcare, you know, the folks and we know the folks and I think the innovation will continue. And so the question is, how do you, how do you balance the public private partnerships to drive more innovation and then a follow on question? How do you know which partners to trust, right? You were an innovator, you started an organization, Brian Roberts bet on you, you bet on Ben rock that worked out you're in the government and then I wanna get to devoted.

Speaker 3: (43:40)
Yeah. So, um, uh, so such an interesting question. There's so many different angles. One could, could take with that. Um, I think that, um, uh, with respect to, um, uh, come back through, through, through two different lenses. So when it comes to the government facilitating private sector innovation, um, the technique that I found that worked the best was open innovation, right? So in other words, like, you know, it's not the government going out and recruiting particular partners to do particular things, although that I suppose could work as well, depending on what it is you're doing. It's more, the government actually creating a platform on which innovation can happen. That's accessible to everyone, right? So, uh, making weather data available, making GPS available, making, uh, uh, you know, all kinds of, uh, scientific biomedical data and, uh, uh, O other kinds of healthcare system and public health related data available, um, to everyone, um, such that anyone can grab it and then anyone can actually ideate and dream with it and combine it with other ingredients to create something amazing.

Speaker 3: (44:53)
Um, um, there's, uh, uh, there, there's a wonderful law called Joyce's law that was coined by, uh, bill joy, uh, who founded some Microsystems and, uh, Joyce's law states this, um, no matter who you are, you have to remember that most of the smartest people in the world do not work for you,  they work for other people or work for themselves. Right. And so a phenomenal recipe, I think, um, for innovation is to keep Joy's long mind and say, if you view a government, right. You know, sure. You've got like a ton of smart people at NIH and C and CMS, et cetera. Right. But, um, the thing that would be much more impactful by words, magnitude, uh, so not just of your own smart people using your data to do stuff, but to open up your data and your knowledge, so that all the other smart people in the world, we vastly unnumbered, you, um, can actually innovate on that basis.

Speaker 3: (45:47)
And so I'm a huge fan of, of the public sector, creating platforms for innovation, and then facilitating open innovation, um, with respect to, um, uh, innovation inside the government, uh, to do things like create, uh, like this platform for innovation and, uh, create the us digital service, et cetera. Um, what I found is that, um, it's interesting, cause I was, I was interviewed by federal news radio, uh, you know, early on in my tenure in the us government. And, um, they're asking like, you know, can you describe kind of what it's like, right. To be an entrepreneur like now working, uh, as a bureaucrat  uh, and I said, well, actually it's, it's, it's, it's, it's pretty similar, uh, because, uh, I've been asked to assume the role of a, of a change agent. Um, and what I've found is that, um, you know, the recipe, uh, for making change happen in the public sector is actually very similar to making change happen as entrepreneur, meaning you come with an idea, um, you recruit a terrific team.

Speaker 3: (46:47)
Uh, you basically try that idea to a sufficient degree to understand what works about what doesn't work about it, you refine it, right. And then you raise additional capital, whether it be human capital to join the effort or political capital to advance the idea or financial capital to fund the idea, um, and you iterate it, um, and take it to the next level. Right. And then, uh, and then, and then, and then, and then, you know, keep, keep raising more rounds of various kinds of capital, um, and, uh, and, and grow the phenomenon from there. Um, and, uh, and I remember the, the interviewer saying, well, you know, so is changing government like that easy, uh, you know, like, like, like, like building a company  I said, well, just to be clear, building a company is unbelievably hard.  so change it is, is unbelievably hard. Right. But, but there's a pattern, um, that is, uh, is, is, is, is, is, is, is one that is, uh, more likely to lead a success if you adopt it. That is common across, across both.

Speaker 2: (47:53)
So take us to devoted you're you're eventually stepping out of the government. Uh, and then you have an idea.

Speaker 3: (48:01)
Yeah. Um, so, um, so, uh, um, I, uh, I, I stepped out a public service in January, 2017 and, um, uh, my wife had, uh, made us buy a six week, uh, vacation overseas, um, to, uh, prebi it like a year prior to guarantee that I would actually leave . Um, and, uh, uh, and so spent six weeks just reconnecting with my family, uh, and, uh, and, and resting deeply. Um, and, uh, you know, I had, I had, I had an incredible clear thought, which was, um, uh, I, I wanted to start what became devoted, uh, and I wanted to work with my brother again, I wanted to work with Brian Roberts, um, and, uh, Bob Kocher, um, and Ben rock, um, again, and, um, uh, and I had a very clear sense of what the mission of the company would be, um, like an incredibly clear sense of what the mission of the company would be.

Speaker 3: (49:02)
And this is one of the, the, the, the, the, the, the, the downsides actually, if you can call it that a public service is that once you work on public service scale missions, with the depth of meaning of public service missions, it sets a whole new bar for what meaningful work really is. Right.  um, and so we had this phenomenon where us digital service, um, engineers and product managers and designers would go back to their previous job that they had thought was doing something really important. Um, and they just didn't think it was that important anymore.  and so, um, and so, um, devoted, isn't, it what's that it's

Speaker 2: (49:46)
A big risk.

Speaker 3: (49:47)
Um, and so, you know, but, but on the other end, like, you know, uh, you know, I love, I love having that high of a bar, right? Like, I, I, I love actually, uh, being exposed to work of that depth of meaning and scale, right. Because it really does challenge you to then keep doing work at that level of meaning and scale. Right. And not settle for anything less, because life is short. You don't know how long you have on this earth. Right? So you, you, you might as well go flat out and, and, and do as much as you can to be as helpful as you can. Um, and so DeVos mission was the only mission I could think of that didn't feel like a let down  after public service. Um, and, uh, and the mission was to dramatically improve the health and wellbeing of seniors to start eventually everyone in America to start.

Speaker 3: (50:33)
I mean, eventually, you know, go everywhere by caring for each and every person, like they're literally our own family. Um, and, uh, and, and, and, and that, that, that impulse to care for everyone like their own family, it wasn't a slogan that our marketing department, and then after the fact to make the sound off, like that was the whole reason why ed and I started the company, um, like devoted has what we call our prime directive, which is the secret standing order that guides everything we do. And the prime director says this when undertaking any action, when making any decision, visualize in your mind, the faces of members of your family, that you love desperately, and then ask yourself if this action, if this decision were to impact them, what would you do? Um, then open your eyes, right? And then go do the thing in the moment that you would do for your own mother, your father, your sister, your brother, your daughter, your son.

Speaker 3: (51:26)
Um, and, uh, and if, if, if, if, if woman would think macroscopically, well, you know, what would you want for healthcare for your mom and dad? Uh, what everyone would want, right, is the best healthcare in the world, right? None of us would sell for anything less. And, uh, best caring world is all of us in healthcare know, can be defined by, by a very precise algorithm, very precise formula, right? It is the right care, including very importantly, nonclinical support delivering the right place at the right time in a highly consistent, coordinated, proactive way. Um, and as, as the healthcare, no, like American healthcare infamously generally doesn't tend to roll that way. Right. It is for a whole bunch of reasons, right. Um, historically, unfortunately in Senti, misaligned information, poor, uh, disorganized, confusing, fragmented, reactive, and non prevention oriented. Um, but there are heroic local organizations like Kaiser Permanente, Northern California, or CareMore in Southern California, right.

Speaker 3: (52:24)
Or Chen me in south Florida or, or village family practice, right. In Houston, Texas. Right. That through hero local heroics actually figured out a way to get people the right care, right place, right time, and a highly consistent, proactive, coordinated way, and demonstrate conclusively that two things happen when you do that, right. One outcome significantly improve, and two cost significantly decrease, cuz there're two sides of the same coin, right? If someone has diabetes and congestive heart failure and hypertension, right. If you take fantastic proactive care of them and get them the right care, right place, right time, including nonclinical support, they both stay as well as possible. And they don't go to the hospital repeatedly. Um, so devoted in a nutshell is combining the wisdom of the ages and the experience and learnings. Um, along those lines, combining that with what technology is capable of doing in the early 21st century, um, to be a company engineered from the ground up to scale that kind of right care right place. Right. Best caring world, the kind of care you want for your mom and dad everywhere.

Speaker 2: (53:29)
So Todd, do you feel if you get the mission right. You can get the other stuff, right. It's about the purpose.

Speaker 3: (53:36)
Absolutely. I, I think that's absolutely right. You know, and, uh, and I think that, you know, um, um, it's getting the mission, right. And then being unbelievably, relentlessly focused on following that mission all the way through. Right. And not making compromises along the way.  the name of expediency. Yeah. Um, and, um, uh, you know, like one of the benefits of being a middle-aged entrepreneur, right. Um, there are few , but one of them, right. Is that, um, the level of access that ed and I have now in our lives to human financial relationship, intellectual capital is several orders of magnitude greater than when I was 24. And he was 22.  got it. Uh, because to actually follow Dee's mission all the way through, in an uncompromising way, right. The play you actually then run right. Is a play that is 100 X easily. We're ambitious in Athena. Right. Right. Um, and it, it's just, it's just not a mission that ed and I were capable of mobilizing the resources to do. Right,

Speaker 2: (54:57)
Right,

Speaker 3: (54:58)
Right. You know, um, but, but now, now we are, and he and I, and now 800 of our closest friends,  that devoted. Um, we think of devoted as the great mission of our lives, the rest of our lives. And we also think of each prior experience we've had as both meaningful unto itself and also preparation to now do this thing. Um, without each of the experiences that I've had that Ed's had, that all of our teammates have had devoted would not be, would not be possible. Um, and, uh, we have been able to assemble the resources, knowledge, experience, et cetera, to finally do this thing that we've been, I think whether we realize or not been dreaming about our entire lives.

Speaker 2: (55:45)
So Todd we're we're at the bottom of the hour, we've got a bunch of entrepreneurs who are hung on for an hour to listen to us. What advice would you give them? If you could tell 'em one thing, what would it be?

Speaker 3: (55:58)
Wow. Um, well first I would say, God bless you. And thank you so much for digging into making healthcare better. Um, you are an incredibly powerful, underlying reason why I believe American healthcare will keep getting better. Um, and this, this, I think the second thing I would say is that, um, uh, really embrace your mission and via the power of your mission. Uh, focus on building the superpower of persistence of persistence. Like if I had to pick one feature in a teammate to have, and I could only pick one. It would be the literal inability to give up the little inability to give up. Cuz changing healthcare is so hard, right? Uh, it's so hard and so difficult and it requires such iterative persistent action from such a long timeframe, right? That it requires superhuman levels of endurance and persistence. Um, but I think there's a magical synergy here, um, which is, um, uh, it is reflected in one of Steve jobs, uh, and great sayings, which is that what really powers great entrepreneurs is.

Speaker 3: (57:19)
They can't stand the idea of the world not having what they are building. And so, you know, truly mission driven entrepreneurs, um, are the ones that have the most superhuman levels of resilience and endurance and persistence. Um, if people are in it for the sock options, like the 10th time they get punched really hard in the face. They say, look, you know, there's a lot easier ways to make money in this world. I'm gonna go do that. Right. Right. Or they're glowing right up. Right. In a, in a publication, right. The 15th time they get their femur snapped in half. They say, you know what? This is just too much pain. Just not worth it. Right. Right. The people who are gonna keep going right. Are the ones who cannot stand the idea of the world, not having what they're building. Right. Yeah. Who are oriented.

Speaker 3: (58:03)
And my experience with those people is that they are unstoppable. They are termin matrixes slash terminators of unstoppable unstop for a movement. Right. Um, and uh, they will get knocked down, keep getting up, uh, knocked down, keep getting up at a level that is way beyond what norm human would do. And that is, that is critical to actually ultimately building something that truly does dramatically improve our healthcare system. Um, so don't, don't give up embrace remission and you won't give up. Um, and God bless you. And may the force be with you as you do the work that you are doing

Speaker 2: (58:43)
Ladies and gentlemen, thanks for your attendance this afternoon. And Todd, thank you so much.

Speaker 3: (58:48)
God bless everyone.