After 15M Patient Interactions, The Real Problem Isn't AI | with Frederick Mueller at Third Way Health, BOAC #70

0:00In the U.S. there's a lot of time spent managing the healthcare systems and processes with payers and IPAs and value-based care systems. The U.S. is actually running some of the most innovative experiments. On the patient-facing side, we're running about 15 million patient interactions. So these are calls, texts, forms, you name it, self-service. We're very exposed to the constant tension between providers, physicians, and administrators trying to build the chassis of the infrastructure to deliver care. And I think those are the two forces of providers wanting to treat every patient in the most unique way because that's ideally how healthcare should be.

0:45And administrators trying to say, we kind of need the opposite. We need to put people more in a box because otherwise we can't deliver scaled systems. Ford said we didn't need quality assurance engineers because AI was going to do it all. Now they're quietly hiring them back. Healthcare in the U.S. was a country I think would be the third largest economy in the world. Let that sink in. AI is going to be largely commoditized. It's not hard to build a voice agent. There's 15 companies that just do AI voice agents, right? But AI needs context. It needs workflows. And I think that's the element where we want to provide really transformative guidance in operations.

1:26Before we get started, this episode of the Business of a Clinic is sponsored by Virillo. Virillo is the trusted marketplace for clinic owners looking to sell and groups and clinic buyers looking to acquire high-performing clinics. There are very few specialized marketplaces in the UK that focus on this transition for clinic operators. Virillo is one of them. Learn more at virillo.co.uk. Now on to the episode. Hi, everyone. We're back for another episode of The Business of a Clinic. I'm very excited about this one because I had the chance to meet Frederick almost 15 years ago, and that's a different story.

2:01But today we are joined by Frederick Mueller, who is the co-founder and CEO of Third Way Health, which is an AI-enabled managed service solution for front office healthcare provider operations operating in the US, but with experience in both US and UK healthcare, which is not something that a lot of people can speak to. So, Frederick, thank you so much for joining could you maybe give us the two minute version of how you got here from the u.s oh wow okay wow very so i first of all i think we've come a long way from copying your statistics homework so it's always funny how these things go so a little bit about third way and us right so we provide an outsourced ai enabled solution what does this mean we plug a combination of dedicated team members and a technology platform into supporting medical practice operations.

2:54And this is everything in the front office. So we do call center. We handle patient outbound engagement, referrals, prior authorizations, document management, closing care gaps, patient self-service tooling. And most importantly, we tie all of those disparate pieces together and we make sure that the front office runs at a high quality. And most importantly for our clients, it runs on autopilot. A lot of the daily blocking and tackling is done by us. How did we come here? So that's actually a little bit of a personal segue. I actually had the pleasure of starting healthcare in London. I worked at the advisory board company.

3:31Didn't fully know if I wanted to be in healthcare, candidly. And I fell in love with it. Because I think what's unique about healthcare is that it's one of the few industries that is where, If you do a good job, you can truly remove a lot of administrative friction. You can make people's lives easier. You can literally improve how people are living their health, both patients and providers. And you can run a good business, right? And I think in that order for me, that was always really important that you can leave the world a little bit of a better place. And if you do that well, you can build a great company on it.

4:09And obviously, as we all know, healthcare has lots of problems that we can help solve together. So that's a little bit about me. Great. I think you said that you started your journey in the UK. We've spoken to a lot of people on the business of a clinic, and very few of them, I can probably count one or two tops, have genuine hands-on experience inside of the mess that is healthcare, particularly that is healthcare operations, front office operations, in both the UK and the US. Or I guess the work you were doing here was UK and Europe. So an impossible question, but what's similar, what's different?

4:44I actually had the chance to work in the UK, Europe, Middle East, Canada. And what was always interesting is we were looking at a lot of administrative workflows, both inpatient and outpatient. And my favorite thing is that every part, every organization you go around the world, they say, we are so unique in our problems. And then you, by having the benefit of a little bit more of a global lens, that things are actually not that different. I would say the biggest difference between U.S. and U.K. healthcare from an administrative perspective, what I've seen, one is the payer landscape. I think the U.K.

5:24system in some respects is a lot more straightforward because you have NHS and you have private pay and a lot of cash pay, quite frankly. In the US, there's a lot of time spent managing the healthcare systems and processes with payers and IPAs and value-based care systems. And in many ways, actually, I think the US systems and the approaches to moving away from this sort of fee-for-service game that is healthcare reimbursement, the US actually is running some of the most innovative experiments, but it's more streamlined. like in the UK, so there's less time spent on insurance-related matters, as far as I can see.

6:06I think operationally, whether you're on a clinic, whether you're on an emergency department, whether you're on a hospital, at the end of the day, you've got to get a patient in, you've got to get them treated, and you've got to let them go if that's an inpatient environment. And that's not that different where you go around the world. I think the other big difference in the UK is, I would say, the US has a more diverse tech ecosystem. There's more technology, which is great. At the same time, it's also really fragmented as a result, specifically in the clinic space. And there's dozens of different EHRs and integrations and making data move across all these different systems is very difficult.

6:48For me, those are actually the biggest differences in how clinics operate. So I guess the short answer is it's actually not that different. People come in, they do something, they go out. And payment, honestly, payment and maybe data flow is the biggest differences that I can see at the end of the day. We have a very similar conversation. We work with different kinds of healthcare providers and MSKs, based dentistry, medical aesthetics, dermatology, whatever it might be. And they'll always ask the question, do you work with other practices like ours? You have a physical space and patients need to visit you and they need to leave.

7:26So yes, here's the answer. To give a sense of scale and reach, I know Third Way has, how many years has the company been running now? Four. Four years running now. How big is a dangerous question because you can answer in a lot of ways, but how big is it in terms of patient reach? How many patients do you, have you seen historically or do you see, do you support? How do we put in context? Because I think a lot of providers, when you're a provider, your numbers look big, but then you speak to a third-party provider, such as yourself, a partner to these healthcare providers, and then you get a totally different sense of what scale actually looks like.

8:00So how many patients are moving in and around the third-way experience? Yeah, that's super interesting. And just for a little bit of context, Ryan, so there's essentially two sides of third-way. We basically run medical practice front offices on 16 specialties. and then we also support payers and payer-like entities this is where the u.s gets a little bit more complex with managing the reimbursement side so we get a look on the other side of one is taking care of providing the care and then it's reimbursing and managing care and we support both aspects on the patient facing side i think on an average year now we're running about 15 million patient interactions, right?

8:39So these are calls, texts, forms, you name it, self-service. It's across around 2 ,000 providers. We've gotten quite scaled there. And then across the payer side, we support almost 4 million lives on the backend from the administrative side. So patients making sure that they find the right doctor, they get their doctors getting reimbursed for their care. There's a whole world of administrative processes, and we see both of those. So 15 million patient interactions. So you've learned something, presumably. It's important, 15 million patient interactions. I'm sure that that list, even today, continues to get longer.

9:23If you could only know three things that you know now that you feel like would have made a world of difference when you started, that you've only discovered because you've done 15 million plus, and that's per year, tens of millions of patient interactions, what are the three things that have become surfaced consistently top of the list? Wow, this is really interesting. We only know this because we've done 50 million patient interactions. What are those things? There's like the things that maybe other people would not necessarily know. That's so interesting. I think one of my biggest insights is that it's almost more philosophical is we've we're very exposed to the constant tension between providers physicians but other mid-levels advanced practitioners providing care and administrators trying to build the chassis the infrastructure to deliver care.

10:18What that means is providers, by and large, want to treat, deliver healthcare in the way that they feel is best for patients. And providers, physicians go through years and years of study of doing that. They're very smart, capable people, right? Like it's, I have the biggest respect for that. That is in conflict with the administrators who would like to say, look, I'm trying to run a scaled system. I'm trying to take advantage of technology. I'm trying to orient and adapt to reimbursement pressures, to inflation, to staffing challenges, all those things. What you need is some standardization, right?

11:00And I think those are the two forces of, like exaggerating a little bit here, but providers wanting to treat every patient in a most unique way, because that's ideally how healthcare should be, right? And administrators trying to say, we kind of need the opposite. We need to put people more in a box because otherwise we can't deliver scaled systems. Because what we've seen is, I think I read some stat, like 30 % of appointments have online self-booking availability, right? Like self-booking is a great technology analogy because it's been around for over 10 years. It's not complicated, right? The reason why there's not more self-booking is because of this push and pull of providers saying there's like, really, there's a lot of rules, and then there's shadow rules.

11:45And if you want to want your to fill your schedule and your day and leave flexibility to get patients in that you know, really need to see you, you can't, there's no way you can put that in a self booking rules system. Which on the other hand, self booking is great, patients like it, it's good for access, right. And the reason why we haven't seen more success with this is not because of the technology, it's because of things that have nothing to do with technology, right? It's trying to really figure out what's our common ground of how we streamline rules and govern rules and give flexibility to providers and give flexibility to administrators.

12:20And so I think on a philosophical side, like we see this a lot, right? Because you could automate all sorts of things, you could standardize all sorts of things. But at the same time, you are, we as a system aren't winning if we put providers in a box, because that's not what they want. And then that's not how best care is delivered either. And I think honestly, after all of those interactions and our lessons learned, what we're left with is a profound understanding. I don't think anyone has found a solution, right? I can, because there isn't an easy solution as much as we, as people like easy solutions to complex problems.

12:59But this, I think it's, and it's truly the right way to find that balance is very much case by case, right? And I talked to lots of people who say, hey, what is the best run medical group? What's the most high performant medical group? And a lot of the time, it boils down to trust, right? Like, trust between administrators and providers, between patients and providers, trust with using technology. And again, like, that is very much the underpinning of this sort of philosophical fight, so to speak, or those two opposing forces. And we really get to learn about that on a day-to-day basis. I feel myself being pulled to a question which is, first of all, some of the things you said are very familiar, given the work that we do.

13:45But equally, those are lessons that are very hard learned. And you probably have some scars the first time. which we won't ask about. But I guess it makes me think about the, in the last 12, 24 months, there's been a massive influx of magical AI coming to save the day. And some of those lessons that you just described, they need very careful handling. Sometimes that handling is not a button. Sometimes it's people. Sometimes it probably is a button. And I'm curious how that learning has shaped, maybe so two questions, how has it shaped your approach to technology in this people plus technology to your point, where you have a platform capability and you have a people capability, how has it shaped the decisions you've made around technology?

14:38And then similarly, how does that stack up to maybe other people with big swooping claims about, yeah, all your problems are gone because the technology has arrived and suddenly it's AI of this and AI of that. You were around, you saw this problem, you were in this space four years ago, more than four years ago, up in your background. So the beginnings of the third-way story were probably pre the, in some ways, explosion of this. So how has that, like, how have those come together in your business and what you're building? And similarly now, like, out of nowhere, all this competition of AI agent for your front office, there's no shortage of people claiming to do that, but do they actually do it or where does it fall short and what's the providers be thinking about?

15:22That's such a good question. And it's actually, there's multiple really important points. I think along the same lines of observing and appreciating this sort of finding the balance between provider autonomy and administrative effectiveness, right? We have seen that for any technology to work well, it needs to be in sync with what's happening in operations. and there are i think on average every for every provider that we see in our system we get 0.5 changes per week right so we support 2 000 providers so that's a thousand changes and that could be someone's outside they're covering for colleague they want to try something else with their schedule right like there's it's always in flux right to massive degree of volume and so So the, and it's not just the preference, it might be, here's how we want to handle this type of question, right?

16:24So there's the front office of all the administrative processes, in some respect, is actually the one that has some of the most, is most in flux. And so what this means is, technologies are the good old, the good adage is, if you automate a broken process, like you don't have to gain anything. if you you can't just slap technology on this evolution because what will happen is technology goes stale the next day so what is really important is that you want to start to govern changes right and when we actually look at sort of automation maturity it's there's different levels from either you have nothing defined you have a standard defined that's actually big most groups aren't even there yet to be honest and then you have a standard you can govern you can measure to you can actually see what changes lead to what effect.

17:12The reality is most of the groups we talk to and we see around the world, quite frankly, aren't are level zero, right? And so again, I don't think what we end up seeing, absent any type of process, maturity and governance, is that technology can automate, but it generally is limited. So we were just at a conference with That's a bunch of health system medical executives last week. Seems like the resolution rate for what we hear on AI is around 30 % for calls, right? So 30 % of calls are automated. Now, what's interesting is when you then actually look under the hood, it's not just a report of a call is automated, it's how good actually was the experience, right?

17:56Because if you can automate lots of things and actually a bad experience because it's just asking the patient to repeat or you can automate if you have 20 sites and the patient can flexibly choose between 20 sites, you can resolve a call by telling the patient to call back at a different site. But if they want to book for it, I profoundly think that that is impacted by a lot of automation coming into the space and running up against the same problem that we're seeing of you need to have some sort of process governance. You can't just automate everything away. And AI at the end of the day is just another technology.

18:35That's probably the biggest observation and lesson learned. How we approach that is, and for us, this means a lot of the technology is not about the automation itself. It's about the governance of the processes and defining and understanding changes and really creating a seamless link between what's happening in the clinic level that's changing on a day-to-day basis and like how that shows up in technology. And if you decide what you want to show up in technology, which is actually that translation layer where we spent a lot of our time. The other part really is, again, it's a philosophical question.

19:09Yes, you can automate a lot, but do you really create a better experience, right? Because again, there's also a balance between administrative effectiveness, putting providers in a box, and what the patient sees. Because you could automate lots of patient interactions. And I would argue that's just not great healthcare. And we are trying to find that balance, I think, very much in partnership with our clients, because we operate a little bit differently than your typical vendor. But it's a fascinating point in time, because the entire industry is just trying to figure this out right now. It's interesting.

19:41I think the US healthcare market is more mature, certainly, than the UK. And what we sometimes find is that, to your point, the pursuit of AI only or agent only AI receptionist, which is the flavor of the month, it's very good as an augmentation, not necessarily as a replacement and very good might even be in quotes. So we have a dental group leader that we spoke with on the show recently who said, putting in place an AI receptionist, I said, you know, how deep have you gone on your diligence? Have you really said, listen, I'm not disillusioned at all. I know exactly what this is and is not. It's a great way for me to answer calls out of hours.

20:22It's a great way for me to handle overflow or some edge case thing where I currently can't provide a human first experience. And so I'm happy for it to be second best. But I'm in no way under the impression that me putting this technology solution in place suddenly lets me downsize my team by 50 % or reallocate my team 50%. So it was interesting to hear her perspective, because that then juxtaposed that against other practice leaders that we've spoken with, where they are very much going in saying, I'm looking for a headcount compressor. But then they're coming up exactly to that friction, whether it's 30%, 25%, 40%, like it's not enough to actually move the needle.

21:02Have you found that in? yeah oh man so many thoughts so one i think i've i talked to a practice and i think they're actually quite emblematic and they said they have they're very happy with there's one of the agentic ai platforms and they're very happy with them dermatology group in new york but they haven't really saved that many staff right and it's not also a linear question it's not like if you automate 20 of calls you need 20 less people i think that's a fallacy and so i think the I think this is where we are at the point and what we're seeing in the market. A year and a half ago, there was a lot of excitement.

21:41Practices were getting into AI. A lot of them tried it out because it just seems to be like the thing that you should try. And groups are having mixed results. And there's some sort of awakening, right? And before all the talk was about AI exterminating us all, it was about ROI, right? With AI. And I think that's exactly the point where we're at. I think what's so fascinating is a little bit, we are learning. We're learning as individuals. I think certainly we're seeing that. And there's lots of out-of-industry examples of AI, all these companies laying off people. Facebook said they didn't, or Meta said they didn't need managers.

22:19Ford said we didn't need quality assurance engineers because AI was going to do it all. Now they're quietly hiring them back. Klarna, right? So they hired back the customer service team. I think we're seeing that. I think the other part that's very interesting is there's an element of trust for patients. We see, depending on audience, can be a significant number of patients who hear AI and say, agent, right? I don't want to deal with that. And so first of all, I think it's important that clinics are thinking about how do I provide a great experience to my patient? And ultimately, the patient has to decide the modality.

22:56I think the second part with patience, though, is building of trust that AI can be good for some things. If I just need to cancel my appointment, need to make an appointment, I think the beautiful thing about AI in a call center component is that you're removing this linearity of every caller is in a queue and there's a certain number of agents. And no matter if you have a grave emergency or a simple question, you're all in the same queue. Because I think the patient should pick. okay this is a simple thing i want to ask ai to do this and if i have something complex like i would much prefer handle have a person handle that but you can remove that like single cue concept with ai if you do it well but that only works if you find a way to actually take the patient along the ride shouldn't trick them into it you need to make sure that they know it works and i as a personal example i in the u.s i use a lot delta airlines and delta asks me every single time if i I want to text someone.

23:54I've tried it once. Didn't work well at all. Never using it again. Now, I'm sure it's gotten better. There's probably, even I as a consumer probably need some education and it's better. Now, and again, it goes back to there's not that many practices are following these concepts, which again, have nothing to do with the technology, right? It's all about your processes. It's about building trust in the process that works. And I just don't know how successful technology will be if that is not done well. Now, what's interesting is automation in the same way that people say in the U.S., oh, you work in healthcare.

24:34Great. Can you help me with my insurance? And you're like, healthcare is a$5 trillion industry. Healthcare in the U.S. was a country I think would be the third largest economy in the world. Let that sink in. And I'm like, healthcare is really big. I just happened to focus on this small segment, which is probably$150 billion. So that's not that small, but it's very small as a portion of the total. So all automation, right? Like all automation is not the same. And what I mean by this is everywhere you go, you have AI for ambient scribes. It's great because you're not really touching as much of the process, right?

25:08It's AI to scribe and you got to make sure that's done well. That is a very different type of automation then it is taking a highly complex process that is between a provider and a patient, right? Or scheduling. And so I think there's, again, that AI for eligibility verification is fundamentally solving a data problem where there's less subjectivity and less judgment involved. AI is great with those things, right? So I think there's also, we as an industry are still learning that it's not one size fits all. The same way healthcare is one size fits all and automation isn't at all. And so there's some things that are just great for automation.

25:46And I think the front office and specifically like how you interact, how you schedule, how you tow that line between patients and providers and administrative efficiency, that's a difficult line to tow. Okay. Following that line. Yeah. That's difficult to tow. I imagine that on a personal level, I don't know if this is true. I would imagine for myself, perhaps on a personal level if I had spent, we're a year into this magical AI thing now or a year plus, let's call it three years, but I spent three years living and breathing the pain in this tension, the mess, really being hands-on and caring and having the scars from doing that.

26:34And then suddenly company X, company Y, company Z, everyone's popping up with, It's all easy. It's all magic. It's all, I would simultaneously, maybe I'd have the feeling of, let's just wait and see how this all plays out. But also I'd be able to experience some frustration that, hold on, these people just raised$400 million at a whatever, whatever, you know, crazy numbers based on very little because maybe they haven't seen the fullness of their cycle yet. Or there's, how has it been on a personal level for you to start something on the cusp of this technological moment and then to have everyone else like rush in and say, hey, we're here, the party can start now.

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27:51To learn more, visit us at coherenthq.com. Now back to the episode. Yeah, it's a great question. There's a lot of noise in the market. And I think what I take such great comfort in is when I hear our, we talk to our clients, the administrators, we look at the value that we deliver on the front lines. And at the end of the day, few AI is just a, it is a profound technological capability, but it is a component as part of in a bucket of like many components that are bundled into a solution and we deliver like real value to our clients and they're very appreciative of that so i think no that is always for me at the end of the day if you want to build a great company you got to make sure that the service you provide works and delivers the intended results and i think we're getting to a scale where I spend my time like on amazing shows like this, right?

28:59And you're a little bit removed. And it's always really, I find it so centering to look back and see, okay, what we're doing makes the world like slightly a better place. Now, I think what we're also hearing and what's very interesting is organizations are saying, gosh, I've tried AI. And because of everything, it's very hard. I used to have 100 people in my call center, now I have 80. And the biggest challenges that drive organizations to work with Third Way is, hey, my staff is turning over 40 to 50 % a year. We just did a survey and like, that's correct as a result from our survey, which folks can find on our website of, this was of 100 executives that run medical practices from 50 to 100 providers and 100 executives that run groups larger than 100 providers.

29:43So we tried to look at how's that, what are they feeling? And 86 % said they're not sustainably staffed, right? like that is the biggest problem and that problem doesn't go away because if you need if you automate i don't know if you automate 40 of your workforce away so to speak or you supplement work that used to be done like people with technology you still have 60 people that are turning where you have 40 50 turnover year over year and that's really difficult and again like that's the part that makes it very hard and technology can solve for that but i think there are more broader solutions needed.

30:19And that's ultimately why we earn the right a lot to win with organizations. And so look, healthcare is a big enough world. I'm very happy that there are some organizations who are great at using technology, and they find a lot of value in it. And the technology is cool. Like, I think why people are getting drawn into this is no one could imagine two and a half years ago, that you can have a really complex discussion with an AI agent. And it's like, right, like, That is incredible. And I think that deserves to be celebrated. And I also believe that if a practice finds value in that and it's solving their problem the way they want to be solved, amazing.

30:55I think, again, we see a lot of organizations that are still fighting on a very different level for whom technology alone is not the right fix. And those tend to be the organizations for whom we're a great fit. Let's say we sit back down together in five years, three years, two years. You pick a time in the future. Given the trajectory that Third Way is on right now, given the learnings, the positioning in the market, relationship at the hold of your providers, what does the future look like internally, externally? How does the business change with the market? given what you know. Yeah, fantastic.

31:32Look, we started Third Way with the vision to say, we want to be the end-to-end administrative operations solution for practices. And there was nothing like our model at the time in the front office, blending people and technology together as a managed services solution. But our goal is not to stop there. There are many, plenty of other administrative processes and workflows that we don't do today. And where we consistently get asked if we can help support those, and we would, we certainly, that's our ambition. So I think if in a world where everything goes according to plan, we can provide a much more broad scope of services than even what we do today.

32:19And again, bundle that into an easy, seamless solution so that we can do our part, right? On average, our clients save 40 % of their costs, they end up increasing their revenues, because we help them close more care gaps, see more patients, keep their schedules busier, have patients coming back to them, all the things that you guys are doing as well, right? And we think we can build on that. And that's where we'd like to go. I think from a technology side, I believe healthcare, AI is going to be largely commoditized, right? You already see this. It's not hard to build a voice agent. There's 15 companies that just do AI voice agents, right?

32:57The technology is going to be commoditized, but AI needs context. AI needs workflows. And I think that's the element where we want to provide really transformative guidance and operations. If you had to do the same thing, but looking backward, and you had this earlier when you said there's this tension between provider and administrator, and how do you allow for that flexibility but also balance it with standardization. I'm always curious in the journey, and we've had many here already and we don't operate at that scale, at least at this stage. There are many things that if we could go back, we would have done them differently.

33:33But there was also one or two things that if we could go back, we really would have done those things differently. And I'm curious, given the benefit of hindsight, were there any sort of key moments where you said, you know what, We didn't really play that one the right way. We should have, you know, you got out alive. You made it through. It was bumpy. You should have gone right. You went left. You should have said no to a certain request. You said yes. We're going to have certain sort of sinkholes that either you experienced or I guess maybe more relevant for some of the audience is that you see providers step into in this journey of trying to improve efficiency, improve that front office.

34:12do you see people make those mistakes that are like oh here comes this one again or likewise that you guys have had to correct out of build new muscle memory change the way the water moves in terms of how your organization is behaving that's such a great question on a personal level as you as anyone that's crazy enough to try to build their own company there's the road is littered with lessons learned let's put it this way and but we're fortunately here to because we have learned from them on the provider side and more relevant for this audience i i think things we see that are really important is doing good diligence on technology i think that's very hard because it's ultimately and it goes back to this concept for us as a company that lets people in technology together is automation and efficiency gain from automation is not a technology problem.

35:10I think one of our biggest lessons was, we thought it was in the beginning, you just need to automate, you need to have more features. And the reality is, if you're working in a highly fluid environment, it's a process and a governance problem that like where technology is an input, but not the panacea solution. And I think by that same token, it's very difficult to properly value these technologies, right? You need to talk to users. You need to understand and really challenge yourself if you can actually operate the technology. You need to understand if you become operationally reliant on this, are my systems good enough, right?

35:51We have clients where their EHR is upgrading and it breaks the API, right like that's fine when you used to send appointment reminders and that's not fine but like appointment reminders are moderately correlated to no-shows and that is less of an operational impact if you're now operational reliant on some of these ai processes and your api breaks down what are you going to do right i think it just goes to it is becoming more and more important to actually figure out what is the right technology and how do i evaluate it and i think that's the biggest sort of pitfall that we see organizations are doing and some are doing it really well but by and large it's a really difficult decision and field to maneuver let's let me talk about that for a second the you use the word ehr here we see a lot of ehr and pms is the sort of interchangeable language yeah let me talk about that for a minute so i'm sure we wrote them to use about it so the number of times i've had conversations with health care providers who tell me that their EHR or their PMS will do it.

36:53We do it. We can send that from here. Oh yeah, our PMS does that. Our EHR does that. And the number of times I hang my head in frustration at the category error across what is effectively CRM and patient support and what is effectively a clinical record or system of record around a certain appointment history. Let me just open that one up for a minute. There's a lot in there. So do you want to go? In a situation where maybe let's start with what is the difference? So what is an EHR, PMS not? Sure. Look, and we believe in the broadest sense, the EHR governs the care that the patient receives, care plans, prescriptions, diagnoses, so on and so forth, clinical notes and then the practice management system effectively is a is scheduling and billing right and many times sometimes the way we see it the EHR has both sometimes it is these are separate systems I think the interesting thing on your comment of my EHR my PMS can do it honestly I think in many respects probably true right but it goes back to it goes back to how someone's like practices being honest with themselves on how good they are at actually using the technology and i think a great analogy is is microsoft excel i i think i'm decent with technology and i i probably use two percent of the features that are microsoft excel you can write the full programs in there right there's if you if everyone was an excel whiz and used 100 of features you probably wouldn't need that many other tools that you buy out in the market.

38:40However, most people use less than 2%. It's way less than 2%, right? And I think it goes back to AI. It goes back to any existing system. The number of times that we have clients that have just even, they're using their own EHRs wrong. And that stuff comes up when you're dealing with an API and they're using Jimmy Rig workarounds. And that just goes back to organizations need to understand how do I actually use the technology? Is that my core skill set? Or do I want others to do it? Because, yeah, I'm sure you could probably configure like a good practice management system. You could do a lot.

39:19It should not be a CRM in my opinion. But you could probably have to do a lot of the stuff that you might hire a vendor for. The difference really in thinking that we try to educate a lot of our clients and prospective clients is to say, yes, you could do it, but can you? And like, how much time and effort does that require on an ongoing basis? And you have to trade that off with having someone that does it for you, right? I think that's, for me, that's such a, it's a parallel to AI, but it's in general, it's just, it's why organizations need to decide between I'm going to do it on my own or I'm going to have a partner do it for me.

39:55Yeah, it's interesting. And I think the Excel example is a great one because like you, I probably use 2 % of the features, but what I often find is that is considerably more than most people who are not spending all day in Excel. And similarly, when I then meet someone who actually knows how to use Excel, I come to realize how incredibly poor my use of Excel is. So I think that makes sense. And I think the other thing that stands out is going back to what you were saying earlier, 15 million patient fractions a year. I guess this is one of the other big differences. Do I DIY it or do I work with a partner is that when you DIY it, it is more likely than not you are needing to build your way to 15 million interactions of knowledge.

40:36And the likelihood is that most of that knowledge is lost in the transition of your team that are whoever you hire to do it internally. By the time that you actually can compound that knowledge, it walks out the door. Whereas I guess when working with Third Way, what you're basically saying to a group or to a provider is you're saying, you can maybe do some of this but what you don't know is the 50 million interactions that we've already learned from and we're bringing that to the party you get the benefit of all of the knowledge that we as an organization have accrued and retained because it's our core business and now we're showing up to your front door with the recipe and the like all we need to do is set it up because there's some nuances in your environment but otherwise we've got 50 million interactions to reference with respect to how this should be done.

41:22I think the other difference, though, also is in any event, anywhere that a practice might think about working with a specialized partner, it could be IT, it could be HR, right? Like, we at Third Way, we wake up every single day and think about how do you optimize governing processes and engage providers and optimize, like, figure out a scheduling. We do this, we live and breathe that. And that, of course, gives us a level of insight and depth just by way of spending our waking hours solving one problem that if you're running a clinic yourself, you have 50 problems that you want to figure out and you will never be able to go as deep on any one particular problem.

42:09And again, there are folks who are very good with technology and great with IT, and they don't never need an outsourced IT team. It also doesn't make sense for some folks, depending on how big they are. But, right, I think it's this difference between depth versus breadth. And obviously, that's the benefit of Harnessed Well that organizations get from someone that just focuses on doing one thing. Frederick, I'm conscious of time, and you've been very generous with your time. A closing question for me is, going back to the UK-US. What is something from your time in the UK that you have found yourself bringing into your US thinking?

42:46And I guess similarly, actually, maybe that's not true, because when you came to the UK to work in healthcare, that was your first foray into healthcare. So there maybe wasn't as much for you back. But if you can answer it, vice versa, to the extent that you're familiar with the reality in UK healthcare today, what is something in the US? If each market could trade one nugget of wisdom, what would that trade look like? Look, I think there's a lot of good on the UK single payer system that removes a lot of administrative complexity. And that's there were talks, and they keep popping up around Medicare for all single payer systems, obviously very hard to change a$5 trillion industry.

43:24But at the end of the day, it's just interesting to see the reduced level of administrative complexity. And I think that's certainly something that the US can learn from the UK. I think what the UK can learn from the US is, I think the US is doing a ton on care innovation, right? Like, I think when I was at the in the UK, the UK, the NHS was always a little bit behind where the US was on simple value based care 1.0 stuff, readmissions penalties and the like, the US keeps pushing, what I think is pushing the bar on trying new things. And those are not all successful, but I think there's an element of innovation and innovative models that the UK delivery model could also benefit from.

44:08So those would be my two things. Frederick, thank you so much. Thank you. Thank you for sharing the third way story. And as I said, it's been a journey for us. Frederick and I played on a inframural soccer, football together in college, and now 15 years later, we're both doing stuff in healthcare. So thank you for sharing this story. Really great to have you. Yeah. Thank you. Appreciate it. Thank you. Thank you so much for joining us on this episode of The Business of a Clinic. We hope you had a good time. We hope it was helpful. If you can think of anyone who should join the conversation, feel free to nominate them, send them our way.

44:37We'd love to invite them to participate. If you like what you saw, give us a like, share, comment. We hope we'll see you again next time. Thanks so much.