184. Fixing Credentialing and the Future of Physician Autonomy | Leah Houston, MD

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Welcome to Medicine Redefined, a
podcast focusing on helping you

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reclaim ownership of your
health.

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I'm Doctor Darsha.
And I'm Doctor Ultima Shraja,

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we're your hosts here to
challenge conventional practices

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and uncover the stories behind
pioneers shaping the future of

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medicine.
Our conversations not only focus

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on the individual level to
dissect common practices for

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health optimization, but also.
Zoom out to enhance systemic

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change.
Join us as we look to break the

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status quo, move the needle
forward and put the help back in

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healthcare.
Our guest today is Doctor Leah

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Houston.
Dr. Leah Houston is an emergency

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medicine physician,
entrepreneur, and thought leader

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and healthcare innovation.
She earned her medical degree

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from Albany Medical College and
completed her emergency medicine

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residency at Albany Medical
Center.

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After nearly a decade practicing
emergency medicine across 11

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health systems in three states,
Doctor Houston shifted her focus

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to physician autonomy and
digital privacy, driven by her

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first hand experience with the
burdensome credentialing process

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and a disturbing episode of
credential fraud.

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Doctor Houston is the founder
and CEO of H PEC, a company

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dedicated to restoring privacy
and trust in medicine by solving

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the credentialing challenge for
physicians.

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H PEC began as a decentralized
identity and credentialing app

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and has since evolved to
Evercred, an AI powered web

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platform that streamlines
credentialing and onboarding for

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health professionals using
domain trained large language

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models.
Her ultimate mission is

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restoring physician autonomy by
allowing doctors to own and

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control the professional data,
breaking free from constraints

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that keep them trapped in
unsatisfactory employment

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situations.
So in this episode, we cover and

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explore some of the barriers
physicians face with complex

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licensing, credentialing, and
reimbursement systems,

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especially for local doctors
moving between States and

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hospitals.
We talked about the behind the

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scenes of medical billing
credential fraud and how current

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systems both protect and hinder
provider mobility.

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We also have a discussion on
emerging solutions driven

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agents, decentralized identity
wallets, and block chain

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applications aiming to
streamline credential

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verification and payments.
Additionally, we have a

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conversation about limits and
concerns of digital tools,

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security and data ownership of
Meta for medical professionals.

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Lastly, we'll leave you with
some practical recommendations

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and the future vision for a more
efficient physician empowered

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healthcare industry.
Now, without further delay,

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please enjoy this awesome
discussion with Doctor Leah

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Houston.
Doctor Leah Houston, welcome to

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the show.
Thank you for having me.

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So I have had personal
experience with identity theft

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about two years ago, very
stressful time.

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But my situation is a little bit
boring in the sense that, you

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know, somebody just tried to
apply for a credit card, Wells

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Fargo, and it got flagged
appropriately to the channels.

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And then I had to take all the
appropriate measures, security

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monitoring, all that good stuff.
Even though I'm, I'm very

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vigilant in terms of putting all
the appropriate protections, but

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I was a, a victim of that.
And the time around that was

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highly, highly stressful.
And subsequent to that, just

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like constantly being hyper
vigilant.

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You, my friend, you had a
slightly different experience.

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So why don't you tell the
listeners with respect to, you

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know, that type of story that
that you had?

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And then we can kind of get into
how that led to where you are

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today.
So.

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Yeah.
So as an emergency doctor, I

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chose to do locums to have more
control over my career.

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And so I worked out 10 or 12
different hospital systems and

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different places at different
times, different States and

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licensed in three different
states.

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And one of the systems, when I
stopped working there, they

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continued to bill under my name.
And I had also decided I wasn't

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going to be working in that
state anymore, so I let my

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license lapse.
And because my license had

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lapsed, that's the only way I
actually found out because it

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alerted the Center for Medicare
and Medicaid.

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Hey, this doctor's practicing
medicine without a license.

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But I wasn't.
They were just using my

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Medicare, Medicaid Pecos, P10
numbers to bill.

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And yeah, it led me to be unable
to work for five months.

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It was a long legal battle.
I had to basically, you know,

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confront the hospital and prove
that I was physically working in

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another place on the same day as
they claimed I was working

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there, which would have been
physically impossible.

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So, yeah, it kind of alerted me
to this issue of, you know,

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credential fraud and Medicare,
Medicaid fraud in general.

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Wow.
You know, my my gut is and and

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kind of like the the theme of
the show is that we always want

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to point out the inefficiency of
the system, but there's this

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concept of most generous
interpretation.

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So I'm going to apply it here.
And I'm going to ask, do you

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think that this was maybe
billers and coders in the back

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end?
They just weren't aware that

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you're no longer there?
As you investigated a little bit

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further, was it truly a
nefarious thing that people were

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aware that you're no longer
there and for whatever reason

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they were doing that?
What was that about?

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Well, I've used the term RVU
factory before and that we as

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doctors are RVU factory workers
turning out RV us.

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And so the way things are built,
you know, if we as the doctors

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do it, they make more money.
So we physically do the chest

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compressions or if we are the
ones that actually place the

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Foley, they make more money.
So in the emergency department

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we could be supervising non
physician practitioners who are

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working in fast track.
And I believe that the billers

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and coders in this situation
were instructed to say that I

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was doing it so that the
hospital could make more money.

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Now, we were considering
approaching that during this

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experience, but we would have
had to prove that they were

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purposefully doing it.
And so that was difficult.

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But, you know, I mean, why else
would they?

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I mean, it's kind of like the
patients who always I lost my

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medications, all all my pills
fell down the sink.

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And it's always the Adderall
that falls down the sink.

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It's never there.
Yeah.

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You know, so.
Oh yeah.

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That's really interesting.
I So All right.

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So AP, NS, advanced
practitioners, they don't

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generate as much in terms of as
many RVUS, that certainly

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applies.
So you're telling me like in a

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code situation, if medical
students are doing chest

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compressions, like first of all,
people, are people billing for

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codes?
Yeah.

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I mean, you get a lot of money
for codes.

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You're sort of resuscitating
somebody from the dead, you

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know.
So that's something that we're

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providing value there.
I actually it makes sense,

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right?
And it's technically a

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procedure, but that didn't even
think of that.

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Wow.
OK, so, so that led you down to

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this new world that you're in
right now.

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So tell us a little bit about
this process.

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You you brought up RVU and how
important that is.

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We won't we'll get 'cause I
think that that's maybe a little

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bit more in the billing thing,
unless you think that applies.

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I think listeners of the show
are somewhat familiar with that.

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We brought up the relative value
unit a couple of times and tried

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to explain it.
If you think it's worth it, we

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can get into that.
But talk a little bit about the

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whole physician credentialing
process and what that entails.

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You've had to do it multiple
times.

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And being a locum doc, I'm, I'm
particularly curious how that

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works because I think as a locum
doc, you're, you could be one

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state one week, next month you
could be a different state

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completely.
What's that process like?

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So credentialing under the
umbrella of credentialing is 3

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buckets.
There's licensing, there's

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privileging and health systems,
more telemedicine companies or

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any employer that you might work
for as a doctor, you get

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privileged with that employer.
And then there's the enrollment

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with payers, Medicare and
Medicaid insurance companies so

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that under all those three of
those things are credentialing.

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And in order to get paid, you
have to be credentialed in order

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for those RVUS to actually be
paid out.

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Based on the ICD 10 Coding
handbook that's published by the

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AMA exclusively.
You know, so it's all COD job

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together and it's all
interrelated.

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So our identity as doctors, our
professional brand is

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essentially our credentials
without having them, without

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having received them, without
having being able to prove that

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they're real.
Primary source verification is

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the terminology that's used in
the credential industry.

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Then you can't get paid, you
can't work, you can't move.

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So yeah, it's tightly tethered
to payments and reimbursements

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and revenue cycle management and
all those things too.

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What do you mean you can't move?
Well, if you don't have a

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license, you can't move to a
different state.

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And if you don't get
credentialed for privileging in

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a different hospital system, you
can't move into a different

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system.
And so, you know, as a locums

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physician, if I wanted to take
on a new opportunity, they could

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say you're hired today, but it
would take four to six months

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for me to actually be able to
start working.

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And that's the same, I think, in
most other specialties as well,

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sometimes longer.
I might have heard eleven

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months.
I've had so many people say, Oh

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my God, that promise of
credential would take four

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months, but it took seven
months.

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I decided to just take another
job.

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But this is a significant
barrier for us to be able to

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work, to move freely, to have an
income, to have a say in how we

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work.
And you know, I believe it's a

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significant indirect, you know,
influence on our autonomy

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because when you're credentialed
at a hospital and you signed a

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contract and then they're not
filling their fulfilling their

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obligations of the contract, you
now are kind of forced with just

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staying there and dealing with
it for at least 4 to 6 plus

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months while you look for
another opportunity.

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Or just sometimes the
administrative burden of having

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to credential somewhere else is
just so much.

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You're like, oh, I'll just stay
here.

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And so in my opinion, you know,
credentials are being used as

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leverage for health systems to a
kind of gatekeep the talent

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pool.
And so I believe solving it

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could create workforce mobility
for us.

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That's a really interesting
point.

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I remember my brother, he's in
this ITHR world and him saying

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this, and I think I heard maybe
on the Diary of Aceo podcast, I

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think that person, Daniel
Presley is it.

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He's a big business builder
type, you know, getting startups

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and that kind of stuff.
Remember him talking about the

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fastest way to increase your
salary over time is to switch

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jobs.
You could have, you know, your

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annual 3 percent, 5%, but that's
it's never going to compete with

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the person who switches every
two years, every three years and

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stuff like that.
And you're pointing out a big

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barrier to that.
I think that if you're going to

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get a six month break or a four
month break, to be honest with

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you, maybe this is a little
naive on my part.

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I thought that was a very
location specific thing, you

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know, in terms of
administration, the environment

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that you're working on.
But you're highlighting that

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this is kind of universal in the
States at least.

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So that's disconcerting.
What has it always been that

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way?
Was it better in the golden age

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of medicine?
Do we know?

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Well, I can talk to you a little
bit about the history of how

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this came about.
OK.

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So, you know, physicians used to
all their own private practices,

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and then they used to get
privileged at their local

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hospitals.
And often times they stayed in

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one community for their entire
career.

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But we're in this new era where
people want to not be employed.

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They want to be able to work
part time, They want to be able

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to move around.
So, you know, over the last 30

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years or so, this has really
evolved.

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But back in 1996, the Center for
Medicare and Medicaid put out a

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letter.
It was a one page letter.

231
00:11:20,640 --> 00:11:22,360
And it said, hey, wait a second.
We're not going to be paying

232
00:11:22,360 --> 00:11:24,960
hospitals anymore unless you
verify that these doctors are

233
00:11:24,960 --> 00:11:28,080
safe to practice.
And it was a very vague letter,

234
00:11:28,600 --> 00:11:32,560
but it was around the same time
that HIPAA was created in 1996,

235
00:11:32,560 --> 00:11:34,960
same year.
And hospitals are like, whoa,

236
00:11:34,960 --> 00:11:36,160
whoa, whoa.
What do you mean by that?

237
00:11:37,240 --> 00:11:38,680
You know, we're already checking
their licenses.

238
00:11:38,680 --> 00:11:42,720
What else do you want us to do?
And so they basically developed

239
00:11:42,720 --> 00:11:45,680
a Joint Commission, and they
said, OK, we have a sanctioning

240
00:11:45,680 --> 00:11:48,920
regulatory body that's going to
make sure that you're doing the

241
00:11:48,920 --> 00:11:50,760
right thing.
We're not going to tell you what

242
00:11:50,760 --> 00:11:52,320
to do.
We're not going to create very

243
00:11:52,320 --> 00:11:55,240
clear standards, But we're going
to say that you need to do the

244
00:11:55,240 --> 00:11:57,120
best that you can do.
And this regulatory body is

245
00:11:57,120 --> 00:11:58,480
going to check up on you once in
a while.

246
00:11:59,360 --> 00:12:03,080
And so because hospitals are so
terrified of losing their

247
00:12:03,080 --> 00:12:08,200
accreditation, they kind of
overcompensated and started

248
00:12:08,200 --> 00:12:11,240
checking everything, your
hospital affiliations, your

249
00:12:11,240 --> 00:12:14,840
procedure logs, your background
checks, your, you know,

250
00:12:15,160 --> 00:12:18,000
malpractice insurance made sure
that was covering you in the

251
00:12:18,000 --> 00:12:19,640
right way.
And so every hospital could have

252
00:12:19,640 --> 00:12:22,520
has its own rules.
And the Joint Commission comes

253
00:12:22,520 --> 00:12:25,680
in, as we all know, we've heard
them, well, joint commissions in

254
00:12:25,680 --> 00:12:28,400
the hospital, you know, put away
your sodas and don't drink near

255
00:12:28,400 --> 00:12:29,800
the patient bedside, blah, blah,
blah.

256
00:12:30,200 --> 00:12:33,040
So, you know, they come in and
they just randomly pull files

257
00:12:33,080 --> 00:12:35,080
and they make sure that the
doctors are credentials.

258
00:12:35,080 --> 00:12:36,400
That's one of the things that
they do.

259
00:12:37,200 --> 00:12:42,040
And so, you know, but this was
before the digital era, you

260
00:12:42,040 --> 00:12:46,160
know, before the Internet,
before, you know, the cloud,

261
00:12:46,160 --> 00:12:49,400
before an ability to, like,
rapidly digitally transfer and

262
00:12:49,400 --> 00:12:51,080
authenticate data and
information.

263
00:12:51,520 --> 00:12:54,640
But those vestigial
credentialing guidelines are

264
00:12:54,640 --> 00:12:58,280
still embedded in hospital
systems and in regulatory bodies

265
00:12:58,280 --> 00:13:01,480
like the Joint Commission and
NCQA, which is the one that does

266
00:13:01,480 --> 00:13:03,320
it for payers and insurance
companies.

267
00:13:03,320 --> 00:13:05,440
Yeah.
Thanks for that history.

268
00:13:05,440 --> 00:13:07,600
I had no idea about that.
And Ultimax and I always talk

269
00:13:07,600 --> 00:13:10,800
about how there's still this old
school mentality when it comes

270
00:13:10,800 --> 00:13:13,600
to hospitals and the regulations
and it just takes forever for

271
00:13:13,600 --> 00:13:15,680
things to come through, as you
said in this digital era.

272
00:13:15,680 --> 00:13:19,320
I mean, we're finally seeing AI
come into Epic with some of the

273
00:13:19,320 --> 00:13:22,760
bots that they're releasing, but
for that to kind of take over

274
00:13:22,960 --> 00:13:25,320
and to really help physicians, I
always talk when I think it's

275
00:13:25,320 --> 00:13:27,880
still going to take some time.
So I just wanted to get into

276
00:13:27,880 --> 00:13:29,480
just for some clarification
here.

277
00:13:29,480 --> 00:13:31,240
So and for the audience so that
they know.

278
00:13:31,480 --> 00:13:33,960
So I have my NPI, right?
That's my national provider

279
00:13:33,960 --> 00:13:36,600
identification that stays with
me wherever I go.

280
00:13:37,080 --> 00:13:39,800
Then you have your state
license, which will be different

281
00:13:39,800 --> 00:13:42,680
obviously state to state that
you have to renew every two

282
00:13:42,680 --> 00:13:44,800
years or whatever.
And then you're also talking

283
00:13:44,800 --> 00:13:48,440
about once you have those, when
you get a job and you sign your

284
00:13:48,440 --> 00:13:50,800
contract with the hospital, they
have their own credentialing

285
00:13:50,800 --> 00:13:54,920
process that can take whatever
2345 months up to a year, some,

286
00:13:55,040 --> 00:13:58,320
as you said.
So as we talk about how there's

287
00:13:58,320 --> 00:14:00,960
no real forward thinking in a
way, I guess I mean, this is

288
00:14:00,960 --> 00:14:03,560
where is where you come into
play, where is the root cause in

289
00:14:03,560 --> 00:14:05,200
all this?
Is it really that we just

290
00:14:05,200 --> 00:14:09,040
haven't come up with a solution
or is there somewhere, is there

291
00:14:09,040 --> 00:14:11,760
a stop gap somewhere that if we
just pull hey, a lot of this can

292
00:14:11,880 --> 00:14:16,000
start to flow?
Well, The thing is, is we as

293
00:14:16,000 --> 00:14:17,920
physicians have been super
disempowered.

294
00:14:18,160 --> 00:14:20,600
And even though we sit on
leadership positions at

295
00:14:20,600 --> 00:14:25,360
hospitals, we kind of are like
doing as we're told out of fear

296
00:14:25,360 --> 00:14:29,760
of retaliation, out of fear, you
know, we don't want to rock the

297
00:14:29,760 --> 00:14:30,840
boat.
We don't want to be labeled

298
00:14:30,840 --> 00:14:33,520
disruptive.
And so, you know, these

299
00:14:33,520 --> 00:14:36,080
standards can be changed.
So in every hospital system,

300
00:14:36,080 --> 00:14:38,640
there's bylaws that say, hey,
these are the things that you

301
00:14:38,640 --> 00:14:40,120
need to check.
These are the things that we

302
00:14:40,120 --> 00:14:41,480
accept.
These are the things that are

303
00:14:41,480 --> 00:14:44,000
OK.
And it just takes a vote with

304
00:14:44,000 --> 00:14:46,600
the hospital systems to change
the bylaws.

305
00:14:46,960 --> 00:14:49,520
I don't necessarily think that a
lot needs to be changed, but I

306
00:14:49,520 --> 00:14:51,760
do think that we need to start
adopting digital tools.

307
00:14:51,760 --> 00:14:54,760
So you mentioned Epic and how
they're basically building out

308
00:14:54,760 --> 00:14:57,200
some AI scribe technology.
Is that right?

309
00:14:57,520 --> 00:15:00,280
I think I read about that, you
know what we're doing at the

310
00:15:00,320 --> 00:15:03,240
companies, we're building out
agents that actually do the

311
00:15:03,240 --> 00:15:04,840
entire credentialing process for
you.

312
00:15:05,280 --> 00:15:09,760
So we're eliminating all of the
redundant manual entry, all the

313
00:15:09,760 --> 00:15:13,000
redundant authentication and
we're giving you your data

314
00:15:13,360 --> 00:15:18,080
that's already pre verified.
So when it's shared that you

315
00:15:18,080 --> 00:15:20,840
know, credentialing process can
be shortened hopefully to

316
00:15:20,840 --> 00:15:23,280
moments.
That's the goal, so.

317
00:15:23,440 --> 00:15:26,440
I'm going to assume that this is
tried to be done before at least

318
00:15:26,440 --> 00:15:30,840
like a a what IA single system
where you put in all your

319
00:15:30,840 --> 00:15:33,160
information, does the checks for
you, and then it sends it out to

320
00:15:33,160 --> 00:15:34,720
different States and different
hospitals?

321
00:15:35,120 --> 00:15:38,600
Were there any shortcomings from
anything you know from previous

322
00:15:38,600 --> 00:15:41,800
attempts at trying to do this?
It's never been tried before

323
00:15:41,800 --> 00:15:43,560
because LO NS weren't available
until now.

324
00:15:44,560 --> 00:15:46,680
Got you.
So really AI and using that, but

325
00:15:46,680 --> 00:15:49,080
not even like, I don't know,
just trying to think of a system

326
00:15:49,080 --> 00:15:51,480
where I can pay a little bit
extra.

327
00:15:51,640 --> 00:15:53,560
They will do the background
check and everything before we

328
00:15:53,560 --> 00:15:56,760
have a more centralized system
and then just, you know, do

329
00:15:56,760 --> 00:15:58,320
everything.
Right.

330
00:15:58,320 --> 00:16:04,000
I mean, there's huge farms of
hundreds of people overseas in

331
00:16:04,000 --> 00:16:07,240
the Philippines and Pakistan
where they basically work for

332
00:16:07,240 --> 00:16:09,240
these credentialing companies,
and they have humans that are

333
00:16:09,240 --> 00:16:12,120
actually actively doing these
things and actually going to

334
00:16:12,120 --> 00:16:13,560
these websites and testing
things.

335
00:16:13,560 --> 00:16:16,160
However, that's the old way of
doing things, right?

336
00:16:16,160 --> 00:16:20,840
So there's two opportunities now
that can be leveraged.

337
00:16:21,200 --> 00:16:25,360
Not only can we leverage LMS to
allow agents to essentially do

338
00:16:25,360 --> 00:16:29,280
the busy work for you and work
just as you know, as they are

339
00:16:29,280 --> 00:16:32,360
these individual credentialing
specialists overseas, but we

340
00:16:32,360 --> 00:16:38,000
also have AP is which are
essentially access portals to

341
00:16:38,000 --> 00:16:41,680
external data sources, so we can
retrieve this information

342
00:16:41,680 --> 00:16:43,400
instantaneously.
So for example, the state of

343
00:16:43,400 --> 00:16:46,640
California has an API to their
medical licensing database.

344
00:16:46,640 --> 00:16:49,040
So we can connect to that
database, authenticate your

345
00:16:49,040 --> 00:16:51,400
license probably perpetually in
real time.

346
00:16:51,840 --> 00:16:54,720
Other states that don't have an
API, we can let the agents do

347
00:16:54,720 --> 00:16:58,480
that work for you.
Sorry Dave, can you explain API

348
00:16:58,560 --> 00:17:01,920
one more time for the person who
isn't deep into this world?

349
00:17:02,400 --> 00:17:04,720
API, think it stands for
Application Programming

350
00:17:04,720 --> 00:17:10,000
Interface and it basically is if
you have a software system and

351
00:17:10,000 --> 00:17:13,200
it's connected to the Internet,
you can build an API to an

352
00:17:13,200 --> 00:17:16,400
external system like the state
of California medical license

353
00:17:16,400 --> 00:17:19,839
database, the American Board of
Medical Specialities has an API.

354
00:17:20,200 --> 00:17:24,760
The AMA has an API to the
practitioner profile, CAQH has

355
00:17:24,760 --> 00:17:28,000
an API.
So, you know, that's been

356
00:17:28,000 --> 00:17:31,440
developed probably over the last
10 years or so, not everywhere,

357
00:17:31,440 --> 00:17:34,560
but they're slowly, the
ecosystem is slowly evolving and

358
00:17:35,320 --> 00:17:38,360
the guidelines regarding
credentialing the, the deadlines

359
00:17:38,360 --> 00:17:41,440
are tightening.
So it used to be that you have

360
00:17:41,440 --> 00:17:44,960
to check every 90 days or every
120 days to make sure that the

361
00:17:44,960 --> 00:17:47,440
license is active.
They're tightening that window

362
00:17:47,440 --> 00:17:51,720
to every 30 days because of the
risk that, you know, you book a

363
00:17:51,720 --> 00:17:55,200
surgery for two months from now
and today the surgeon's license,

364
00:17:55,200 --> 00:17:57,960
but two months from now, are
they and are they walking to the

365
00:17:57,960 --> 00:18:00,440
OR on license because they
forgot to renew their license?

366
00:18:00,440 --> 00:18:04,120
I mean since I've started this
I've gotten so many phone calls

367
00:18:04,400 --> 00:18:06,960
when I found out my license was
expired, I found out my DA was

368
00:18:07,080 --> 00:18:09,080
was expired and they're only
finding out because they tried

369
00:18:09,080 --> 00:18:10,760
to write a prescription or
something like that.

370
00:18:11,080 --> 00:18:13,800
Right.
So it's a much more proactive

371
00:18:14,040 --> 00:18:16,640
thing.
I come back to the credential

372
00:18:16,640 --> 00:18:19,680
process.
I think you know, so every state

373
00:18:19,680 --> 00:18:22,760
has their own, you know, with
each individual payers, whether

374
00:18:22,760 --> 00:18:25,480
it's the commercial payers, even
with the state Medicaid system.

375
00:18:26,000 --> 00:18:29,080
I can understand how if you go
from, let's just say if I go

376
00:18:29,080 --> 00:18:31,440
from New Jersey to California, I
would have to get re

377
00:18:31,440 --> 00:18:34,560
credentialed.
But Medicare is at the federal

378
00:18:34,680 --> 00:18:39,040
level, right unless.
So maybe I should ask this is if

379
00:18:39,040 --> 00:18:42,440
I go, is that at least with
Medicare, is that process a

380
00:18:42,440 --> 00:18:44,440
little bit faster to get re
credentialed there?

381
00:18:44,440 --> 00:18:46,640
Or Medicare and Medicaid take
the longest.

382
00:18:47,120 --> 00:18:49,600
Oh great.
And they're state specific

383
00:18:49,760 --> 00:18:52,280
sponsors, right?
So even though there's a

384
00:18:52,280 --> 00:18:56,000
federal, you know, umbrella,
each state has its own agency

385
00:18:56,000 --> 00:18:58,480
that actually, you know,
fulfills that.

386
00:18:59,320 --> 00:19:00,440
Interesting.
Yeah.

387
00:19:00,560 --> 00:19:03,400
So the other question is, I have
my understanding is with the

388
00:19:03,400 --> 00:19:06,000
licensing because I am licensed
in multiple States and I know

389
00:19:06,000 --> 00:19:08,360
that there are some states, I
think it's called the IMLC,

390
00:19:08,520 --> 00:19:11,200
right, the Interstate Medical
Licensure Compact or BAT

391
00:19:11,200 --> 00:19:13,320
basically.
There's another one too that's

392
00:19:13,320 --> 00:19:15,600
not coming to mind right now.
Certain states have that.

393
00:19:15,600 --> 00:19:17,880
There's like, I don't know, at
least it's not all fifty of

394
00:19:17,880 --> 00:19:19,600
them.
But the idea is that it's

395
00:19:19,600 --> 00:19:21,680
supposed to make the process
more efficient.

396
00:19:21,680 --> 00:19:24,720
If you get verified with these
people, you pay a ton of fees to

397
00:19:24,720 --> 00:19:27,360
get this IMLC.
Then if you move to a different

398
00:19:27,360 --> 00:19:30,720
state, if I want to get licensed
in Florida, that process will be

399
00:19:30,720 --> 00:19:33,160
a lot faster.
Did we ever have anything of the

400
00:19:33,160 --> 00:19:37,320
sort for credentialing?
So I mean licensing is under the

401
00:19:37,320 --> 00:19:38,600
umbrella of credentials.
Sure.

402
00:19:38,960 --> 00:19:42,680
But with payers, I mean with
like with payers or like type of

403
00:19:42,680 --> 00:19:44,360
credentialing, that bucket of
credentialing rather.

404
00:19:44,880 --> 00:19:50,400
Well, so here's the thing, you
know, on one hand, the payers

405
00:19:50,400 --> 00:19:54,520
and the hospital systems find
this to be a huge pain point and

406
00:19:54,520 --> 00:19:57,520
they find it to be very
inefficient and they themselves

407
00:19:57,520 --> 00:20:00,400
have kind of scattered standards
that are based on this letter

408
00:20:00,400 --> 00:20:04,240
from 1996 that I mentioned.
But on the other hand, it is a

409
00:20:04,240 --> 00:20:08,840
tool for gatekeeping physician
talent and keeping doctors in

410
00:20:08,840 --> 00:20:11,800
their own system.
So they can have you write a non

411
00:20:11,800 --> 00:20:14,400
compete sign a non compete
saying that you won't work

412
00:20:14,400 --> 00:20:15,960
somewhere else, they can have
you.

413
00:20:16,440 --> 00:20:18,840
Language in the contract saying
that you won't refer patients

414
00:20:18,840 --> 00:20:21,880
outside of the hospital and they
also have this credentialing

415
00:20:21,880 --> 00:20:24,960
tool to say, hey, we know it's
going to be hard for them to

416
00:20:24,960 --> 00:20:29,840
leave so but I do want to talk
to you about Interstate medical

417
00:20:29,840 --> 00:20:33,480
licensing reciprocity.
So I'm sure all of us have a

418
00:20:33,480 --> 00:20:37,800
driver's license.
If I drive over the border into

419
00:20:37,800 --> 00:20:40,880
another state, am I doing
something illegal?

420
00:20:41,200 --> 00:20:45,600
No, because driving is the same
in one state versus another.

421
00:20:45,600 --> 00:20:47,680
But it's the same for medicine
too.

422
00:20:47,680 --> 00:20:49,640
Medicine is the same in one
state or another.

423
00:20:49,640 --> 00:20:52,680
So why have we not created
Interstate medical licensing

424
00:20:52,680 --> 00:20:55,600
reciprocity?
Why have we not, as a physician

425
00:20:55,600 --> 00:20:58,680
community pushed for this?
Why hasn't the AMB advocated for

426
00:20:58,680 --> 00:21:00,640
this?
It's because of money.

427
00:21:00,800 --> 00:21:02,160
It's because of money in
control.

428
00:21:02,560 --> 00:21:04,960
Like you said, even with the
IMLC, the Interstate medical

429
00:21:04,960 --> 00:21:07,080
licensing called back, you still
have to pay every single

430
00:21:07,280 --> 00:21:09,440
licensing fee.
You still have to do different

431
00:21:09,440 --> 00:21:11,840
CME requirements.
Some of them overlap, some of

432
00:21:11,840 --> 00:21:13,800
them don't in order to maintain
these licenses.

433
00:21:13,800 --> 00:21:16,640
It's all in.
Likely it's a racket, you know,

434
00:21:16,760 --> 00:21:21,040
and it's part of what we as a
company would like to start

435
00:21:21,320 --> 00:21:24,080
advocating around.
But in order to do that, we need

436
00:21:24,080 --> 00:21:27,760
to kind of collectively
organize, and that's definitely

437
00:21:27,760 --> 00:21:30,840
something we care about.
I just want to take the opposing

438
00:21:30,880 --> 00:21:36,960
viewpoint for a second.
Could be that I'm trying to

439
00:21:37,000 --> 00:21:41,480
think of circumstances where
certain state rules require you

440
00:21:41,480 --> 00:21:42,920
to practice medicine a little
different way.

441
00:21:42,920 --> 00:21:44,760
Nothing comes to mind.
Again, I haven't practiced

442
00:21:44,760 --> 00:21:48,160
multiple days so I can't, but
like we do know that the the the

443
00:21:48,160 --> 00:21:49,600
laws of these darts practice in
Florida.

444
00:21:49,600 --> 00:21:53,320
I'm in New Jersey with respect
to inpatient patient care.

445
00:21:53,600 --> 00:21:56,840
Also when you're prescribing
opioid medications, I think in

446
00:21:56,840 --> 00:21:59,720
Florida darts usually you can
only do a three day or some

447
00:21:59,720 --> 00:22:02,280
version of that, right?
In New Jersey it's a three days

448
00:22:02,280 --> 00:22:03,960
right?
In New Jersey is five days.

449
00:22:03,960 --> 00:22:06,240
So there are certain this little
minutiae.

450
00:22:06,240 --> 00:22:09,960
Again, I agree with you largely
I would say 95% of medicine, but

451
00:22:10,360 --> 00:22:13,720
could they make the argument
that this is for patient safety,

452
00:22:14,000 --> 00:22:18,160
provider safety, that you have
to be compliant with their laws,

453
00:22:18,160 --> 00:22:21,080
licensed with their laws, so we
understand that you understand

454
00:22:21,280 --> 00:22:23,960
specifically what the
requirements of this state are.

455
00:22:24,840 --> 00:22:28,000
I mean, I have no nothing
against medical licensing.

456
00:22:28,000 --> 00:22:30,720
I think we should be licensed to
practice because they think that

457
00:22:30,720 --> 00:22:33,040
there's there are safety issues
around it.

458
00:22:33,520 --> 00:22:36,080
I think what I'm trying to say
is the current system is

459
00:22:36,080 --> 00:22:39,880
extremely cumbersome,
unnecessarily administratively

460
00:22:39,880 --> 00:22:43,560
burdensome where you know, if
for example, the state of

461
00:22:43,560 --> 00:22:47,760
Florida wanted to collaborate
with other states in the

462
00:22:47,760 --> 00:22:50,600
Southeast or other states that
have the same ethos around the

463
00:22:50,600 --> 00:22:53,360
practice of medicine and say,
hey, if you have a Georgia

464
00:22:53,360 --> 00:22:55,800
medical license, you can also
practice in Florida, but you

465
00:22:55,800 --> 00:22:58,680
have to take this one other
controlled substance database

466
00:22:58,680 --> 00:23:02,560
CME and pay this additional fee
to add on the Florida license

467
00:23:02,560 --> 00:23:06,920
rather than having completely
separate very, you know,

468
00:23:07,960 --> 00:23:10,280
duplicative efforts is what I'm
feeling.

469
00:23:10,320 --> 00:23:12,600
And I only have three licenses.
I don't know how you how many

470
00:23:12,600 --> 00:23:16,120
you have, but some people that
have used our wallet have 50

471
00:23:16,120 --> 00:23:19,520
licenses and I'm just like, wow.
Like maintenance of that is just

472
00:23:19,520 --> 00:23:21,800
nuts.
So yeah.

473
00:23:22,840 --> 00:23:25,600
OK cool.
So what's the fix?

474
00:23:26,560 --> 00:23:30,960
What do?
We do well, so I believe the fix

475
00:23:30,960 --> 00:23:35,720
is for us to owner data and to
have this pre verified data in

476
00:23:35,720 --> 00:23:38,160
our wallet and allow agents to
do the heavy lifting for us.

477
00:23:38,160 --> 00:23:42,000
So, you know, whenever I have to
renew my licenses, I'm always

478
00:23:42,000 --> 00:23:44,560
like looking at all the Cmes
that I need to do for each

479
00:23:44,560 --> 00:23:47,000
license.
And I'm like, oh, OK, I need to

480
00:23:47,000 --> 00:23:52,000
do at least, you know, 3 hours
or 4 hours of, you know, opiate

481
00:23:52,000 --> 00:23:56,080
prescribing CME and oh, and I
need to do that also in Florida

482
00:23:56,080 --> 00:23:57,400
and I need to do that in
California.

483
00:23:57,400 --> 00:23:59,200
So let me see which one works
for both.

484
00:23:59,200 --> 00:24:00,640
So I don't have to take it
twice.

485
00:24:01,560 --> 00:24:04,800
So but that's like my own
cognitive energy that I have to

486
00:24:04,800 --> 00:24:07,680
do and it's really annoying.
And I'm looking for the cheapest

487
00:24:07,680 --> 00:24:11,280
CME and the one that's easiest
to do and the one that, so if we

488
00:24:11,280 --> 00:24:14,400
have agents that are working on
our behalf that are doing that

489
00:24:14,400 --> 00:24:18,400
work for us and just funneling
it, hey, do these three Cmes,

490
00:24:18,760 --> 00:24:21,640
it'll be good for your Florida
and your Nebraska license.

491
00:24:21,640 --> 00:24:24,520
And then all we have to do is
actually just do the CME,

492
00:24:24,720 --> 00:24:27,960
actually fill out the form,
actually pay the fee and not do

493
00:24:27,960 --> 00:24:30,720
all this extra duplicative
effort stuff.

494
00:24:31,480 --> 00:24:32,760
Just reduce the administrative
burden.

495
00:24:32,880 --> 00:24:35,600
That's it.
And just to clarify for those

496
00:24:35,600 --> 00:24:37,600
who are not potentially
following on, we're talking

497
00:24:37,600 --> 00:24:39,680
about AI agents, correct?
Yes.

498
00:24:40,240 --> 00:24:43,560
Can you explain to those people
who are maybe not as savvy with

499
00:24:43,560 --> 00:24:47,080
all the LLMS that are out there
as what the heck are agents and

500
00:24:47,080 --> 00:24:48,440
how do they specifically even
work?

501
00:24:48,800 --> 00:24:51,880
Yeah.
I mean, so we've heard of LLMS,

502
00:24:51,880 --> 00:24:56,280
large language models.
That's basically like the way I

503
00:24:56,280 --> 00:25:00,240
look at it, it's like the
collective consciousness of the

504
00:25:00,240 --> 00:25:04,160
Internet or whatever data
infrastructure that you put into

505
00:25:04,160 --> 00:25:11,720
these LLMS, and it's able to
learn and behave and act as a

506
00:25:11,720 --> 00:25:14,600
human.
It's able to think because it

507
00:25:14,720 --> 00:25:18,320
takes all this information and
is able to process it and

508
00:25:18,320 --> 00:25:21,360
essentially make decisions for
you on your behalf.

509
00:25:21,840 --> 00:25:27,280
So, you know, for example, with
our product, you can upload your

510
00:25:27,800 --> 00:25:31,440
credentialing documents and we
read the document.

511
00:25:31,520 --> 00:25:33,720
We just truly what kind of
document it is.

512
00:25:33,880 --> 00:25:37,520
We fill out all the information.
But then of course, you as the

513
00:25:37,520 --> 00:25:40,600
human can say, yes, I agree.
And so that way you're not

514
00:25:40,600 --> 00:25:43,880
manually putting it in, but
you're just like having the busy

515
00:25:43,880 --> 00:25:47,720
work done for you.
Now when it comes to applying,

516
00:25:47,920 --> 00:25:50,840
renewing your license, applying
for your license, sharing your

517
00:25:50,840 --> 00:25:53,360
credentials, responding to
credential verification

518
00:25:53,360 --> 00:25:57,200
requests, you know, the agents
can also make recommendations.

519
00:25:57,360 --> 00:26:00,520
Hey, your license is going to
renew in three months.

520
00:26:00,840 --> 00:26:03,720
You have to do these four CM ES.
Would you like me to make some

521
00:26:03,720 --> 00:26:05,600
recommendations on what CM ES to
do?

522
00:26:05,960 --> 00:26:08,760
And we can send you to the ones
that are going to be the least

523
00:26:08,760 --> 00:26:10,240
amount of time, the least amount
of money.

524
00:26:10,240 --> 00:26:13,040
We can collaborate with CME
companies to do that.

525
00:26:13,440 --> 00:26:16,960
And, you know, we can also build
community around this, too,

526
00:26:16,960 --> 00:26:20,480
which I think would be good for
us as practicing doctors who

527
00:26:20,480 --> 00:26:23,520
want to have independence, who
want to build their own referral

528
00:26:23,520 --> 00:26:27,240
networks, who want to, you know,
have some kind of professional

529
00:26:27,240 --> 00:26:30,240
brand that's ours, that's owned
by us and not tethered to

530
00:26:30,240 --> 00:26:33,840
systems.
And so I think that this is a

531
00:26:33,840 --> 00:26:36,640
very exciting future.
And, yeah, I don't know if I

532
00:26:36,640 --> 00:26:38,320
explained agents well enough,
though.

533
00:26:38,520 --> 00:26:41,480
Yeah.
Yeah, I think so, yeah.

534
00:26:41,480 --> 00:26:43,800
I'm like you said, I think it's
gonna be an awesome, awesome

535
00:26:43,800 --> 00:26:46,320
feature where we have agents
really just doing some of that

536
00:26:46,320 --> 00:26:49,160
work for us.
I mean, I think Trashy PT-5 now

537
00:26:49,160 --> 00:26:52,120
has something similar.
I mean, it's not quite to maybe

538
00:26:52,120 --> 00:26:54,920
what Elon's trying to build that
axe, but you know, you can, you

539
00:26:54,920 --> 00:26:56,720
can just say the flights that
you want to go to.

540
00:26:56,720 --> 00:26:59,720
So I have a wedding to go to end
of September and it mapped out

541
00:26:59,720 --> 00:27:01,880
everything.
Here are the best flights, here

542
00:27:01,880 --> 00:27:04,240
are the best rental cars.
You kind of choose what you want

543
00:27:04,240 --> 00:27:05,840
to do.
But at least, like you said, I

544
00:27:05,840 --> 00:27:09,040
don't have to have that comment
of load now to put those extra

545
00:27:09,040 --> 00:27:11,400
efforts and waste my time when I
can be doing something else.

546
00:27:11,680 --> 00:27:13,400
So yeah, definitely.
Right.

547
00:27:13,400 --> 00:27:16,080
And our time is running no SO
100.

548
00:27:17,080 --> 00:27:20,800
Percent, you also mentioned
wallet and you know, when people

549
00:27:20,800 --> 00:27:22,840
think wallet in the digital
sense, they might be being

550
00:27:22,840 --> 00:27:24,520
crypto, right?
But with that comes the

551
00:27:24,520 --> 00:27:26,440
blockchain and all these other
different things.

552
00:27:26,560 --> 00:27:29,360
Do you mind digging a little bit
deeper in terms of all the other

553
00:27:29,360 --> 00:27:32,800
things that are part of the
solution that you're creating?

554
00:27:33,680 --> 00:27:38,600
100%, So the company is called H
PEC stands for Humanitarian

555
00:27:38,600 --> 00:27:40,160
Physicians Empowerment
Community.

556
00:27:40,160 --> 00:27:44,360
And our original application was
a decentralized identity

557
00:27:44,360 --> 00:27:47,680
application.
Now decentralized identity is a

558
00:27:47,720 --> 00:27:52,760
protocol that's similar to
crypto protocols, but it's for

559
00:27:52,760 --> 00:27:55,360
data.
So there's public private key

560
00:27:55,360 --> 00:27:57,520
pairs.
And just like you have your

561
00:27:57,520 --> 00:28:00,640
private key and that's your
crypto wallet, you can have your

562
00:28:00,640 --> 00:28:02,600
private key to your
decentralized identity and

563
00:28:02,600 --> 00:28:04,040
that's your credentialed data
wallet.

564
00:28:04,680 --> 00:28:08,040
And so we built out an initial
version of that and it didn't

565
00:28:08,040 --> 00:28:11,320
fully come to fruition, but we
still do have the vision of

566
00:28:11,600 --> 00:28:14,120
having complete and true
ownership over your data.

567
00:28:14,560 --> 00:28:17,800
And we are currently
collaborating with a couple of

568
00:28:17,800 --> 00:28:20,720
other health healthcare
companies in the

569
00:28:20,720 --> 00:28:24,800
decentralization space to
essentially build a Bitcoin

570
00:28:24,800 --> 00:28:29,000
backed payment engine where
physicians can be paid directly

571
00:28:29,000 --> 00:28:31,200
for their services at the time
of service.

572
00:28:31,440 --> 00:28:34,960
We can build payment engines
where you basically name your

573
00:28:34,960 --> 00:28:39,560
price, opt into being in a
network of practitioners or

574
00:28:39,560 --> 00:28:43,040
physicians who offer these
services and patients can easily

575
00:28:43,040 --> 00:28:46,520
find you easily pay you directly
for services.

576
00:28:46,800 --> 00:28:50,320
We can layer in HS as so that
you can have you know pre tax

577
00:28:50,320 --> 00:28:53,920
dollars to use for this.
And we can also collaborate with

578
00:28:53,920 --> 00:28:57,760
large employers who want to
offer this as either complete

579
00:28:57,760 --> 00:29:00,480
alternative to health insurance
or as a supplement to health

580
00:29:00,480 --> 00:29:06,080
insurance, reducing the actual
cost of medical care by 30 to

581
00:29:06,080 --> 00:29:09,120
60% depending on what exactly is
going on.

582
00:29:09,120 --> 00:29:12,040
Because we know that physicians
make about 7% of every

583
00:29:12,040 --> 00:29:15,520
healthcare dollar and about 30%
is wasted on administrative

584
00:29:15,520 --> 00:29:17,440
stuff.
So if the agents are do the

585
00:29:17,560 --> 00:29:21,360
doing the admin, if the payment
engines are essentially self

586
00:29:21,360 --> 00:29:26,160
healing and auto updating based
on feedback, then we can reduce

587
00:29:26,160 --> 00:29:28,480
a lot of waste.
Got it.

588
00:29:28,640 --> 00:29:31,080
Lee, I'm confused.
How would it supplement or

589
00:29:31,080 --> 00:29:33,240
replace the need for health
insurance?

590
00:29:34,280 --> 00:29:37,880
Well, health insurance is kind
of a relatively new concept.

591
00:29:38,120 --> 00:29:42,720
You know, a historically, it was
kind of created in the 50s in

592
00:29:42,720 --> 00:29:44,600
order to entice people to get
back to work.

593
00:29:44,600 --> 00:29:47,520
And it was, you know, created as
like this additional perk that

594
00:29:47,520 --> 00:29:48,960
you get if you come back to
work.

595
00:29:49,320 --> 00:29:52,280
And then in the 90s, they
started, you know, essentially

596
00:29:52,280 --> 00:29:55,800
incentivizing employers through
government programs to offer

597
00:29:55,800 --> 00:29:59,120
this benefit.
And then with the ACA, it got

598
00:29:59,120 --> 00:30:02,000
even more crazy with the
incentivization structure where

599
00:30:02,000 --> 00:30:04,280
they're now penalizing people
that don't purchase this

600
00:30:04,720 --> 00:30:07,360
product.
And so people used to pay

601
00:30:07,360 --> 00:30:11,160
directly for their healthcare.
We know that if you're paying

602
00:30:11,160 --> 00:30:13,560
for healthcare, it's actually
not that expensive if you're

603
00:30:13,560 --> 00:30:15,280
paying directly.
The direct primary care

604
00:30:15,280 --> 00:30:19,840
community has created a system
where patients have immediate

605
00:30:19,840 --> 00:30:21,600
access to their doctor.
They can text with them, they

606
00:30:21,600 --> 00:30:24,200
can see them the next day for
urgent appointments, and they're

607
00:30:24,200 --> 00:30:28,000
paying somewhere between 100 and
150 bucks a month, which is

608
00:30:28,080 --> 00:30:31,480
nothing.
And so, you know, if if we are

609
00:30:31,480 --> 00:30:36,720
able to create direct payment
models and physicians are able

610
00:30:36,720 --> 00:30:40,960
to name their price for the
procedures that they charge and

611
00:30:40,960 --> 00:30:42,960
they know that they're actually
going to get paid.

612
00:30:42,960 --> 00:30:45,840
And they're not going to have to
hire five staff members to do

613
00:30:45,840 --> 00:30:47,720
the revenue cycle management for
them.

614
00:30:48,040 --> 00:30:49,920
And they're not going to wonder
if there's going to be a claw

615
00:30:49,920 --> 00:30:52,240
back because they're paid
immediately directly at the time

616
00:30:52,240 --> 00:30:54,520
of service based on the
infrastructure that we build.

617
00:30:54,920 --> 00:30:57,840
Then the administrative cost
goes down.

618
00:30:58,320 --> 00:31:02,440
So am I saying that, I mean, I
don't have health insurance.

619
00:31:02,640 --> 00:31:06,600
I have a health sharing plan.
So I decided a long time ago

620
00:31:06,600 --> 00:31:08,040
that health insurance was a
scam.

621
00:31:08,400 --> 00:31:10,640
I've been paying for for six or
seven years.

622
00:31:10,640 --> 00:31:12,920
I'd never used it.
I used it once and I still got a

623
00:31:12,920 --> 00:31:16,280
$4800 bill because I hadn't hit
my deductible that year.

624
00:31:16,640 --> 00:31:20,400
And I was like, this is a scam.
So health sharing covers

625
00:31:20,440 --> 00:31:23,000
catastrophic costs and then you
pay out of pocket for every

626
00:31:23,000 --> 00:31:25,320
non-emergency.
It's shown that I also have an

627
00:31:25,320 --> 00:31:28,800
HSA.
So that's a choice I'm making.

628
00:31:28,800 --> 00:31:32,080
It's a risk I'm taking.
I'm a single woman, no kids, not

629
00:31:32,080 --> 00:31:33,760
married.
So it's different for some

630
00:31:33,760 --> 00:31:35,720
people.
But when people look at the cost

631
00:31:35,720 --> 00:31:37,640
of health insurance and the
value that they're getting at, I

632
00:31:37,640 --> 00:31:41,920
mean, like large employers are
paying fourteen, $15,000 per

633
00:31:41,920 --> 00:31:45,680
covered employee that with the
deductibles is making it

634
00:31:45,680 --> 00:31:48,240
unaffordable.
And especially when you notice

635
00:31:48,240 --> 00:31:51,520
that doctors aren't actually
getting paid for the services

636
00:31:51,520 --> 00:31:53,840
that are rendered because
insurance companies are putting

637
00:31:53,840 --> 00:31:57,440
up these prior authorization,
you know, bottlenecks that make

638
00:31:57,440 --> 00:31:59,480
it impossible to actually get
paid for services that are

639
00:31:59,480 --> 00:32:01,960
already rendered.
It's just it's very clear that

640
00:32:01,960 --> 00:32:03,280
it's just broken and not
working.

641
00:32:04,280 --> 00:32:07,800
Does a health sharing plan
satisfy the ECA requirements or

642
00:32:07,800 --> 00:32:10,880
do you still get penalized?
It does not, but this

643
00:32:10,880 --> 00:32:12,320
administration might be changing
that.

644
00:32:12,720 --> 00:32:15,360
How does someone go about if
they're interested, is that

645
00:32:15,440 --> 00:32:17,840
something that you can go on to
healthcare.gov or how does

646
00:32:17,840 --> 00:32:20,680
somebody?
Well, so health sharing is not

647
00:32:20,680 --> 00:32:24,080
insurance.
Health sharing, a significant

648
00:32:24,080 --> 00:32:26,880
number of people put their money
into a pool of funds.

649
00:32:27,120 --> 00:32:29,720
OK.
And then when something happens,

650
00:32:29,880 --> 00:32:34,960
you basically say, Hey, I'm, I'm
a self pay and then your health

651
00:32:34,960 --> 00:32:37,480
sharing and does the cash
negotiation with the health

652
00:32:37,480 --> 00:32:40,280
systems.
And so because the facilities

653
00:32:40,280 --> 00:32:43,480
fees and all these things are
tagged on basically because

654
00:32:43,480 --> 00:32:47,200
insurance has overinflated the
price of healthcare or the cost

655
00:32:47,200 --> 00:32:49,800
of healthcare, health sharing
plans are often able to

656
00:32:49,800 --> 00:32:52,720
negotiate that cash price down.
And then they pay the hospital

657
00:32:52,720 --> 00:32:54,760
directly.
And because the, they'll be

658
00:32:54,760 --> 00:32:57,200
like, Oh, we'll pay you
tomorrow, but we'd like you to

659
00:32:57,200 --> 00:32:59,080
give us a discount.
Hospitals are like, Oh my God,

660
00:32:59,080 --> 00:33:00,560
you're going to pay us tomorrow.
We don't have to go through a

661
00:33:00,560 --> 00:33:04,400
six month, you know, RCM, you
know, back and forth with the

662
00:33:04,480 --> 00:33:08,040
prior authorization process.
Sure, we'll take it, you know

663
00:33:08,040 --> 00:33:11,680
so.
Yeah, I apologize.

664
00:33:12,320 --> 00:33:14,080
Who's managing it though?
Like you said, significant

665
00:33:14,080 --> 00:33:16,000
number of people, I'm talking,
we're probably talking in the

666
00:33:16,000 --> 00:33:18,520
thousands, right, like a very
large number of people.

667
00:33:18,720 --> 00:33:20,440
Yeah, yeah.
Who's managing it though?

668
00:33:20,440 --> 00:33:22,760
Are these, are they still this
the companies that people would

669
00:33:22,760 --> 00:33:24,760
have heard of in terms of a
branch of?

670
00:33:24,800 --> 00:33:27,720
United States, some companies,
so like Liberty Health shares

671
00:33:27,720 --> 00:33:30,080
one of the oldest ones.
A lot of them are called

672
00:33:30,080 --> 00:33:33,440
Christian health sharing
ministries because like people

673
00:33:33,440 --> 00:33:37,280
wanted faith-based organizations
to kind of be able to provide

674
00:33:37,280 --> 00:33:40,560
health, you know, and not
insurance, but you know,

675
00:33:40,560 --> 00:33:43,240
healthcare access for their
members.

676
00:33:43,520 --> 00:33:47,720
There's a, you know, Sedera is
another one and you know, MBVIP

677
00:33:47,720 --> 00:33:50,080
is another one.
Zion Health is another one.

678
00:33:51,720 --> 00:33:53,680
So this is not something
somebody would just trip over.

679
00:33:53,680 --> 00:33:55,440
You have to actively be looking
for this.

680
00:33:56,120 --> 00:33:57,480
You have to actively look for
it.

681
00:33:57,480 --> 00:34:01,000
I mean, I have some friends who
are in the financial services

682
00:34:01,000 --> 00:34:03,640
industry and they often
recommend this to their high net

683
00:34:03,640 --> 00:34:08,480
worth clients because it's
overall smarter and better to

684
00:34:08,480 --> 00:34:10,320
not waste money on health
insurance.

685
00:34:10,320 --> 00:34:13,280
And you can have more choice.
And you know, you don't have to

686
00:34:13,280 --> 00:34:16,880
be only going to this facility
or that facility and you know,

687
00:34:16,880 --> 00:34:18,880
only doing networking.
Go wherever you want.

688
00:34:19,880 --> 00:34:23,600
Sweet, I want to come back to
employing agents to do some of

689
00:34:23,600 --> 00:34:26,239
the scut work if you will.
Right.

690
00:34:26,639 --> 00:34:31,760
Today I was reading a newsletter
where open AI can flag any parts

691
00:34:31,800 --> 00:34:34,920
of your conversation that they
determine might be harmful

692
00:34:34,920 --> 00:34:38,760
either to yourself or to
somebody else, and give it to

693
00:34:38,760 --> 00:34:40,199
the police.
It could end up in a police

694
00:34:40,199 --> 00:34:42,440
report.
Sam Altman's talked about this

695
00:34:42,440 --> 00:34:44,199
for the last couple of weeks.
I've heard him on different

696
00:34:44,199 --> 00:34:45,440
podcasts.
I've heard him in the news talk

697
00:34:45,440 --> 00:34:49,440
about, hey, people are sharing
their deepest, darkest secrets

698
00:34:49,440 --> 00:34:52,800
with these large, you know,
these LMS with Claude and, and

699
00:34:52,800 --> 00:34:54,440
they're so good.
People are often times

700
00:34:54,440 --> 00:34:56,560
outsourcing the need for a
therapist.

701
00:34:56,560 --> 00:34:59,400
And all this stuff can be
subpoenaed.

702
00:34:59,400 --> 00:35:01,120
All this stuff can be used
against you.

703
00:35:01,800 --> 00:35:04,880
We're even finding out instances
where the stuff is actually

704
00:35:04,880 --> 00:35:08,640
getting leaked.
And I think not a lot of people

705
00:35:08,640 --> 00:35:11,680
are bullish on AI, right?
I hear a lot of really smart

706
00:35:11,680 --> 00:35:15,280
people who've left the industry
and they're not talking about

707
00:35:15,280 --> 00:35:16,800
some of the concerns that they
have.

708
00:35:17,240 --> 00:35:18,920
And I actually share some of
those concerns.

709
00:35:19,080 --> 00:35:24,160
It hasn't it hasn't stopped me.
I I use it like 24/7, but you

710
00:35:24,160 --> 00:35:25,840
know, it begs the question is
like, what are some of the

711
00:35:25,840 --> 00:35:27,400
security concerns with those
agents?

712
00:35:27,400 --> 00:35:30,400
Because you started with that,
you get to own your own data.

713
00:35:30,960 --> 00:35:36,600
But one, I would think that, you
know, these agents, ChatGPT or

714
00:35:37,000 --> 00:35:40,080
Claude or Gemini or they're,
they still, I wouldn't even

715
00:35:40,080 --> 00:35:42,880
necessarily say hallucinate, but
they're still largely inaccurate

716
00:35:42,880 --> 00:35:44,440
on a lot of really important
things.

717
00:35:44,880 --> 00:35:47,040
And I use it as a thought
partner for a lot of healthcare

718
00:35:47,040 --> 00:35:50,200
related decision making.
And I find that it, you know, in

719
00:35:50,200 --> 00:35:52,920
the domains where I am an
expert, it's not very good.

720
00:35:53,240 --> 00:35:57,920
And so, you know, if you kind of
just just outsource this and we

721
00:35:57,920 --> 00:36:00,920
all know that like when you have
a document that's has 200

722
00:36:00,920 --> 00:36:02,600
questions and you're like, does
this look good to you?

723
00:36:02,600 --> 00:36:04,560
Technically, people just sign
off, right?

724
00:36:04,720 --> 00:36:07,040
Those terms and conditions, you
just yeah, yeah, yeah, I agree.

725
00:36:07,680 --> 00:36:10,920
Does that give you some concern?
And if not, are there any

726
00:36:10,920 --> 00:36:13,520
concerns that you have with this
type of model employing it for

727
00:36:13,520 --> 00:36:18,760
security reasons?
So Open AI and Claude and Grok,

728
00:36:18,880 --> 00:36:25,120
they're all private companies
that have the, these models that

729
00:36:25,120 --> 00:36:28,600
are taking our information and
learning on it, training it and

730
00:36:28,600 --> 00:36:30,600
all that kind of stuff.
And I don't, I don't know the

731
00:36:30,600 --> 00:36:33,800
specifics.
So, you know, I'm not an expert

732
00:36:33,800 --> 00:36:37,160
in these different companies.
What we're doing differently is

733
00:36:37,160 --> 00:36:41,240
we're creating domain specific
large language models that are

734
00:36:41,240 --> 00:36:45,680
owned by the company.
So as long as you trust Evercred

735
00:36:45,680 --> 00:36:48,560
as a company, then you don't
have to worry about that.

736
00:36:48,960 --> 00:36:52,920
And I also want to point out
that like right now our data is

737
00:36:52,920 --> 00:36:55,480
being sold.
It's being sold all over the

738
00:36:55,480 --> 00:36:58,680
place.
You know, when we get a job, we

739
00:36:58,680 --> 00:37:02,520
sign an agreement saying here's
my password, so my CAQH, here's

740
00:37:02,520 --> 00:37:06,840
my password, so my FSMB, you
know, we just give these people

741
00:37:06,840 --> 00:37:11,760
who are then handing them to
some $4.00 an hour VA and you

742
00:37:11,760 --> 00:37:14,920
know, Pakistan who does God
knows what with our data.

743
00:37:15,440 --> 00:37:19,920
On top of that insecurity, they
also know how well we're

744
00:37:19,920 --> 00:37:22,480
credentialing data and they're
selling it and they're sharing

745
00:37:22,480 --> 00:37:25,400
it.
So we have 0 protection right

746
00:37:25,400 --> 00:37:27,600
now.
And so if we have a domain

747
00:37:27,600 --> 00:37:31,280
specific LLM that's owned and
controlled by the company that

748
00:37:31,280 --> 00:37:36,080
isn't using any external large
language models, then that risk

749
00:37:36,080 --> 00:37:39,280
is reduced.
And we have people on our

750
00:37:39,280 --> 00:37:42,920
technical team who had a lot of
experience with set to

751
00:37:42,920 --> 00:37:46,680
compliance and HIPAA and
privacy, people who were at the

752
00:37:46,680 --> 00:37:49,400
head of privacy at Knocking Eye,
which is one of the first AI

753
00:37:49,400 --> 00:37:53,080
healthcare companies.
So I really feel strongly that

754
00:37:53,080 --> 00:37:56,760
we will not have a problem with
that, but you just have to trust

755
00:37:56,760 --> 00:37:58,800
this is a company.
But you know, we're, we're

756
00:37:58,840 --> 00:38:00,960
building this, we're a physician
owned company.

757
00:38:01,240 --> 00:38:04,640
We are a physician, you know,
developed with doctors in mind

758
00:38:05,040 --> 00:38:07,120
to specifically solve this
problem.

759
00:38:07,160 --> 00:38:09,920
So it is a concern though
something to think about.

760
00:38:11,000 --> 00:38:13,360
I'm assuming blockchain adds
another layer of security

761
00:38:13,360 --> 00:38:15,200
though, right?
I mean, that's one of the things

762
00:38:15,200 --> 00:38:17,880
that it counts on.
And if you don't mind, can you

763
00:38:17,880 --> 00:38:20,160
explain blockchain?
I did take a master class on it,

764
00:38:20,160 --> 00:38:23,160
but I probably forgot about 80%
of everything I learned.

765
00:38:23,160 --> 00:38:25,800
But you know, just in general
terms what blockchain actually

766
00:38:25,800 --> 00:38:28,280
means and why it's used.
So, yeah.

767
00:38:28,280 --> 00:38:31,440
And so I'll do a little history
lesson again.

768
00:38:31,440 --> 00:38:36,600
So like, back in the day, you
know, back in feudal Europe, you

769
00:38:36,600 --> 00:38:40,360
know, we had the merchants
bringing their goods across the

770
00:38:40,360 --> 00:38:42,680
different countries and selling
their, you know, their

771
00:38:42,680 --> 00:38:45,360
merchandise.
And when there are people buying

772
00:38:45,360 --> 00:38:47,800
and selling goods, they kept the
Ledger.

773
00:38:48,720 --> 00:38:51,160
And they said, OK, how many
barrels of grain did you have?

774
00:38:51,160 --> 00:38:53,640
How many, you know, rolls of
silk did you have?

775
00:38:53,640 --> 00:38:58,000
And they realized that it was
hard to discern who was actually

776
00:38:58,000 --> 00:39:01,080
buying and selling unless they
had a duplicate Ledger that they

777
00:39:01,080 --> 00:39:05,440
could look at it and say, hey,
this person sold this and it

778
00:39:05,440 --> 00:39:08,480
matches this other Ledger.
And so duplicated ledgers have

779
00:39:08,480 --> 00:39:10,760
been used throughout history for
commerce.

780
00:39:11,600 --> 00:39:15,400
And so a blockchain is is it's a
digital duplicated Ledger.

781
00:39:16,320 --> 00:39:20,560
So when something happens on a
blockchain, it is

782
00:39:20,560 --> 00:39:25,080
instantaneously copied on
thousands of different ledgers.

783
00:39:25,800 --> 00:39:30,840
And so essentially those ledgers
are also constantly checked and

784
00:39:30,840 --> 00:39:35,240
updated.
So we hear, you know, so

785
00:39:35,240 --> 00:39:39,000
basically if I make a
transaction with you, we put the

786
00:39:39,000 --> 00:39:41,920
block in the blockchain, it's
instantaneously duplicated.

787
00:39:42,240 --> 00:39:45,640
And then across the world we
have these liners.

788
00:39:45,720 --> 00:39:49,560
At least this is for the Bitcoin
blockchain who are checking

789
00:39:49,560 --> 00:39:52,080
these ledgers and making sure
they're all the same.

790
00:39:52,600 --> 00:39:57,920
So they basically only accept
additions to this duplicative

791
00:39:57,920 --> 00:40:02,680
Ledger when more than 50% of
people have agreed that it's

792
00:40:02,680 --> 00:40:04,640
it's a transaction that actually
happened.

793
00:40:05,200 --> 00:40:08,920
And so the other important piece
is that this is immutable.

794
00:40:09,280 --> 00:40:12,200
So once a block is placed in the
blockchain and once it's

795
00:40:12,200 --> 00:40:14,600
duplicated, you can't erase or
go back.

796
00:40:15,680 --> 00:40:20,880
And so it basically creates a
permanent perpetual business log

797
00:40:20,880 --> 00:40:23,880
business record of the
transactions that actually

798
00:40:23,880 --> 00:40:27,320
happened.
And so it creates a system of

799
00:40:27,320 --> 00:40:31,680
trust that's developed in code
that doesn't require humans to

800
00:40:31,680 --> 00:40:34,160
decide.
You go to Chase Bank, you go to

801
00:40:34,720 --> 00:40:37,800
you go to any bank.
And essentially they have their

802
00:40:37,800 --> 00:40:40,320
centralized database, their
centralized servers.

803
00:40:40,640 --> 00:40:45,600
And you know, a friend of mine,
her brother was involved in a

804
00:40:45,600 --> 00:40:49,040
business transaction.
And it was with somebody who

805
00:40:49,040 --> 00:40:53,080
then was later investigated by
the feds and they had a family

806
00:40:53,240 --> 00:40:55,080
bank account, for instance,
childhood.

807
00:40:55,560 --> 00:40:59,560
And so her assets were all
frozen because she had to kill

808
00:40:59,560 --> 00:41:01,920
with her brother, who then had
this business thing happened

809
00:41:01,920 --> 00:41:04,960
with this guy.
And she was in this, you know,

810
00:41:04,960 --> 00:41:07,920
they froze her assets.
So there's still centralization

811
00:41:07,920 --> 00:41:12,120
and control when there's one
point of failure with, you know,

812
00:41:12,120 --> 00:41:15,520
Bitcoin, with blockchain, with
cryptocurrency that is actually

813
00:41:15,640 --> 00:41:18,320
fully distributed and fully
decentralized.

814
00:41:18,720 --> 00:41:23,640
That is that risk is approaches
0 unless there's a 51% attack.

815
00:41:24,120 --> 00:41:27,360
Now, the risk that comes along
with that is then you are fully

816
00:41:27,360 --> 00:41:30,520
in control of your private keys
and you are fully at risk if you

817
00:41:30,520 --> 00:41:33,800
lose those keys, which a lot of
people have lost their Bitcoin

818
00:41:33,840 --> 00:41:35,880
way.
Does that make sense?

819
00:41:36,600 --> 00:41:38,400
Yeah, no, absolutely.
I love that this perfect.

820
00:41:38,400 --> 00:41:40,400
I love the history lessons as
well as things to make some very

821
00:41:40,400 --> 00:41:42,760
relatable easy to understand.
So thank you for that.

822
00:41:43,360 --> 00:41:46,400
So you talked about how these
solutions definitely work on an

823
00:41:46,400 --> 00:41:49,480
individual level, right?
As a physician myself, Ultimash,

824
00:41:49,560 --> 00:41:52,200
we can buy into this.
It's makes it easier for us to

825
00:41:52,200 --> 00:41:55,440
get our Cmes, have everything in
one place, the payments, all of

826
00:41:55,440 --> 00:41:57,760
it.
What is the broader impact of,

827
00:41:57,760 --> 00:42:00,360
of what you're thinking about?
How does it now affect hospital

828
00:42:00,360 --> 00:42:03,120
systems cross state?
You know how?

829
00:42:03,120 --> 00:42:06,520
Where do we take it from here?
I mean, I feel like patients are

830
00:42:06,520 --> 00:42:11,720
frustrated, they are diagnosed
with colon cancer and all of a

831
00:42:11,720 --> 00:42:13,520
sudden they need to find a
colorectal surgeon, an

832
00:42:13,520 --> 00:42:17,280
oncologist, and they're OK.
I can look at this roster on my,

833
00:42:17,440 --> 00:42:20,320
you know, insurance list of in
network providers.

834
00:42:20,320 --> 00:42:23,360
I can look at Google reviews.
But are they really the right

835
00:42:23,360 --> 00:42:27,800
person for me, especially now
with advancements and genetics,

836
00:42:27,800 --> 00:42:30,440
proteomics, genomics, where
you're getting more granular

837
00:42:30,680 --> 00:42:33,440
understanding of, you know, the
actual, you know, genomics of

838
00:42:33,440 --> 00:42:35,040
your tumors and things like
that.

839
00:42:35,040 --> 00:42:38,040
And, you know, wanting to really
go to the right person for you,

840
00:42:38,040 --> 00:42:41,160
wanting to have that precision
level care, you know, and that's

841
00:42:41,160 --> 00:42:44,000
on the, the medical and the
scientific side.

842
00:42:44,200 --> 00:42:45,800
There's also the social
component of it.

843
00:42:46,040 --> 00:42:48,960
People want doctors that they
can relate to, that they that

844
00:42:48,960 --> 00:42:52,320
share their value systems,
especially in, you know, the

845
00:42:52,320 --> 00:42:54,480
functional medicine space, the
longevity space.

846
00:42:54,920 --> 00:42:57,120
You know, people kind of want to
do things a little bit outside

847
00:42:57,120 --> 00:42:59,520
the box.
And they want to find, you know,

848
00:42:59,760 --> 00:43:02,160
physicians who are in alignment
with their value systems, who

849
00:43:02,160 --> 00:43:06,720
are willing to supplement their
tea if their tea is low normal,

850
00:43:07,000 --> 00:43:10,320
but they're having symptoms of
hypothyroidism, for example.

851
00:43:10,600 --> 00:43:13,400
And, you know, we as physicians
have always historically been

852
00:43:13,400 --> 00:43:17,640
able to make these calls, but
under the insurance model, under

853
00:43:17,640 --> 00:43:20,600
the employment model, we've been
kind of prevented from having

854
00:43:20,600 --> 00:43:24,040
that kind of autonomy.
So if we can create an inter

855
00:43:24,040 --> 00:43:27,400
physician referral network of
doctors who are able to practice

856
00:43:27,400 --> 00:43:30,960
on their terms, we're able to
serve patients where patients

857
00:43:30,960 --> 00:43:33,040
are able to find the right
doctor for them easily and

858
00:43:33,040 --> 00:43:35,680
quickly because their
credentials are easily

859
00:43:35,680 --> 00:43:37,280
accessible.
And physicians are able to

860
00:43:37,320 --> 00:43:39,840
advertise and work in
collaboration with other

861
00:43:39,840 --> 00:43:42,480
practitioners who are in
alignment with their value

862
00:43:42,480 --> 00:43:44,840
systems and with their, you
know, their competency and their

863
00:43:44,840 --> 00:43:48,160
skill sets, then we can kind of
usurp the whole healthcare

864
00:43:48,160 --> 00:43:50,120
system.
And I know that sounds kind of

865
00:43:50,120 --> 00:43:54,480
grandiose, but I think that both
patients and physicians are

866
00:43:54,480 --> 00:43:56,640
frustrated to the point that
we're ready for something like

867
00:43:56,680 --> 00:43:58,000
this.
So it's really exciting.

868
00:43:59,040 --> 00:44:02,240
I can see the excitement in your
face with every answer that you

869
00:44:02,240 --> 00:44:05,440
give us.
And I'm wondering, Leo, why is

870
00:44:05,440 --> 00:44:08,520
this so important to you?
Is it all because of that one

871
00:44:08,520 --> 00:44:11,800
incident, or have you?
Is this something that's been

872
00:44:11,800 --> 00:44:14,560
brewing in the back of your mind
for a long time?

873
00:44:15,640 --> 00:44:20,120
So a couple of things, you know,
I, like every physician out

874
00:44:20,120 --> 00:44:25,080
there, had spent my entire youth
with my nose in a book learning

875
00:44:25,080 --> 00:44:27,200
how to prevent death and
permanent disability,

876
00:44:27,480 --> 00:44:30,560
understanding on a molecular
level, you know, the organic,

877
00:44:30,800 --> 00:44:33,640
you know, chemistry interactions
that you know, lead to the Krebs

878
00:44:33,640 --> 00:44:37,120
cycle, all this stuff.
And I did all of this work.

879
00:44:37,120 --> 00:44:41,400
I worked these 15 hour days
throughout my entire 20s and 30s

880
00:44:41,920 --> 00:44:45,120
with the expectation that when I
exited, I would actually be able

881
00:44:45,120 --> 00:44:48,320
to serve people and do the right
thing for them.

882
00:44:48,880 --> 00:44:52,880
What I was basically thrust into
a system where I was forced to

883
00:44:52,880 --> 00:44:55,240
practice unethical medicine or
not have a job.

884
00:44:55,720 --> 00:44:58,400
And I think a lot of physicians
are feeling this way.

885
00:44:58,400 --> 00:45:00,160
And that's why there's a mass
exodus.

886
00:45:00,960 --> 00:45:02,760
That's why there's a high
suicide rate.

887
00:45:03,200 --> 00:45:08,280
And so it's really about knowing
what we deserve as physicians

888
00:45:08,280 --> 00:45:11,360
and what our patients deserve.
Our patients deserve to have

889
00:45:11,360 --> 00:45:12,880
people that are advocating for
them.

890
00:45:12,880 --> 00:45:15,640
We are to be of service for
them, not this system.

891
00:45:16,280 --> 00:45:18,360
And you know, I've had my own
experiences like, you know, my

892
00:45:18,360 --> 00:45:23,440
mother suffered from leukemia
and I was very lucky because not

893
00:45:23,440 --> 00:45:27,760
only am IA physician, but I also
know so many people that I was

894
00:45:27,760 --> 00:45:29,840
able to find the right person
for her.

895
00:45:30,200 --> 00:45:33,640
And then I also was able to kind
of make some recommendations and

896
00:45:33,640 --> 00:45:36,080
influence her care.
So, you know, my mom's a tiny

897
00:45:36,080 --> 00:45:37,320
woman.
She's 4 foot age.

898
00:45:37,320 --> 00:45:41,240
She was 100 lbs and she had gone
through a couple of the

899
00:45:41,240 --> 00:45:44,080
different regiments for
chemotherapy and she was having

900
00:45:44,080 --> 00:45:46,880
severe reactions to all of them.
And I said, wait a second, what

901
00:45:46,880 --> 00:45:49,200
if we lower the dose?
They lower the dose.

902
00:45:49,200 --> 00:45:53,160
She was fine.
So that recommendation was only

903
00:45:53,160 --> 00:45:56,680
made because I was a doctor and
because, you know, the physician

904
00:45:56,680 --> 00:45:59,040
that was working with us felt
OK.

905
00:45:59,040 --> 00:46:02,760
Well, I'm able to do this
because the patient asked for

906
00:46:02,760 --> 00:46:04,440
it.
It's not part of the protocol,

907
00:46:04,440 --> 00:46:07,320
but I can document that we had a
discussion about the risks and

908
00:46:07,320 --> 00:46:10,000
the benefits and I can give this
a try because they're requesting

909
00:46:10,000 --> 00:46:13,360
it.
So I want that for everybody.

910
00:46:13,480 --> 00:46:15,920
I want, I want to have that when
I'm 80 years old.

911
00:46:16,360 --> 00:46:19,040
I want to know that if I get
rolled into an emergency

912
00:46:19,040 --> 00:46:22,560
department with a stroke, that
somebody that is, as you know,

913
00:46:22,720 --> 00:46:26,200
that cares as much about as I
cared about my patients is going

914
00:46:26,200 --> 00:46:27,640
to be available to take care of
me.

915
00:46:28,040 --> 00:46:31,800
And right now with this assembly
line medicine problem, it's not

916
00:46:31,800 --> 00:46:33,640
going to be that case.
So we have to fix it.

917
00:46:34,080 --> 00:46:36,400
Yeah.
And not even, I think you kind

918
00:46:36,400 --> 00:46:40,840
of highlighted this, I'd even go
as far as to say that that

919
00:46:40,840 --> 00:46:44,560
doctor probably, you know, gave
you that respect, that

920
00:46:44,560 --> 00:46:46,280
professional courtesy.
Oh, look, she's also a

921
00:46:46,280 --> 00:46:48,920
physician, so I'm more likely to
listen to her, right?

922
00:46:48,920 --> 00:46:51,520
Whereas if it was another
patient who had looked that up

923
00:46:51,520 --> 00:46:54,880
on chatty PT or Googled it, even
if it had the same amount of

924
00:46:55,080 --> 00:46:57,800
accuracy behind that or, you
know, as reasonable of a

925
00:46:57,800 --> 00:46:59,840
suggestion, they might dismiss
that person because they don't

926
00:46:59,840 --> 00:47:01,320
have that background training
and stuff.

927
00:47:01,320 --> 00:47:03,640
And often talk about this.
I think Darsha and I have talked

928
00:47:03,640 --> 00:47:07,720
about this offline, how much of
A privilege it is to be in

929
00:47:07,720 --> 00:47:11,280
healthcare and then to be that
resource for the for those that

930
00:47:11,280 --> 00:47:12,800
you love.
You know, with the aging parents

931
00:47:12,800 --> 00:47:15,600
and you talked about, right,
being able to advocate for them,

932
00:47:15,680 --> 00:47:19,520
being able to connect the docs,
being able to interpret why

933
00:47:19,520 --> 00:47:23,600
certain things are the way they
are and always keeping that

934
00:47:23,600 --> 00:47:26,000
forefront when you are serving
patients.

935
00:47:26,000 --> 00:47:28,760
And when you're sitting in this
role and you know, you're taking

936
00:47:28,760 --> 00:47:31,320
care of a 75 year old who's
three months out of a stroke,

937
00:47:31,320 --> 00:47:33,080
maybe a little less, maybe a
month out of stroke and the

938
00:47:33,080 --> 00:47:35,320
inpatient rehab unit.
And you're like, man, that that

939
00:47:35,320 --> 00:47:37,200
could be my mom, that could be
my dad.

940
00:47:37,200 --> 00:47:40,600
So I should potentially give
them the same type of energy

941
00:47:41,240 --> 00:47:44,440
that I would ask for if I was
sitting at bedside with them and

942
00:47:44,440 --> 00:47:46,560
advocating for them.
So I love that.

943
00:47:47,000 --> 00:47:49,040
I love your mission.
I do have an important question

944
00:47:49,040 --> 00:47:51,600
for you.
You, you mentioned earlier, you

945
00:47:51,600 --> 00:47:55,920
know, when you're contrasting
Evercred and or excuse me, H PEC

946
00:47:56,000 --> 00:47:59,040
and you know some of the other
big companies, private

947
00:47:59,040 --> 00:48:01,680
organizations out there who are
employing LLMS and really trying

948
00:48:01,680 --> 00:48:05,160
to maximize their utility.
You said it, you use an

949
00:48:05,160 --> 00:48:06,480
important word.
You said trust.

950
00:48:07,040 --> 00:48:10,240
We have to trust you.
And I'm sure somebody out there

951
00:48:10,400 --> 00:48:13,640
who's listening and said, well,
why should we trust you and why

952
00:48:13,640 --> 00:48:15,000
is this something that's worth
investing in?

953
00:48:15,760 --> 00:48:18,720
Well, I'm a physician.
I took the Hippocratic Oath.

954
00:48:19,160 --> 00:48:23,440
I could be making 3400 KA year
as an emergency doctor, just

955
00:48:23,560 --> 00:48:26,600
stacking cash and retiring as
early as possible to get out of

956
00:48:26,600 --> 00:48:29,320
his system and you know, wish
the rest of the world luck.

957
00:48:29,320 --> 00:48:33,480
But I've chosen to essentially
dedicate more time than I have

958
00:48:33,680 --> 00:48:36,160
dedicated during medical school
and residency to build a

959
00:48:36,160 --> 00:48:38,680
solution for us and to solve
this problem for us.

960
00:48:38,680 --> 00:48:43,400
And, you know, it's important
for me because I think that we

961
00:48:43,400 --> 00:48:45,560
need this.
And, you know, you mentioned

962
00:48:45,560 --> 00:48:48,320
that if a patient comes in with
Ohio Chacha TV said this or

963
00:48:48,320 --> 00:48:53,200
that, you know, there's this,
there's this lie that's being

964
00:48:53,200 --> 00:48:57,160
told that doctors don't care.
I think it's more that we don't

965
00:48:57,160 --> 00:49:01,360
have time where we have this
cognitive overload where it's,

966
00:49:01,440 --> 00:49:06,440
yeah, if I had an extra 30
minutes to review what you found

967
00:49:06,440 --> 00:49:09,880
and read about it, and if I was
going to be paid for that time,

968
00:49:10,240 --> 00:49:12,320
then yes, I could have this
conversation with you and

969
00:49:12,320 --> 00:49:14,640
understand the risks and the
benefits and have that, you

970
00:49:14,640 --> 00:49:17,560
know, consent conversation and
make a decision with you, which

971
00:49:17,560 --> 00:49:19,720
is what doctors used to do in
the 50s.

972
00:49:20,120 --> 00:49:24,320
But patients have this
perception that we're stupid,

973
00:49:24,320 --> 00:49:27,520
that we don't care, that we
don't know anything, but it's

974
00:49:27,520 --> 00:49:30,360
really that we are being
controlled by the employment and

975
00:49:30,360 --> 00:49:33,160
insurance model.
And even if we do want to give

976
00:49:33,160 --> 00:49:35,960
that extra time and we want to
give that extra attention, we

977
00:49:35,960 --> 00:49:39,200
often have no say.
And we're also practicing

978
00:49:39,200 --> 00:49:41,080
defensive medicine under that
model.

979
00:49:41,080 --> 00:49:45,440
So, you know, I want to untether
the physician community from the

980
00:49:45,440 --> 00:49:48,120
medical industrial complex.
I want us to have autonomy and

981
00:49:48,120 --> 00:49:53,200
agency to practice and to serve
our patients directly without

982
00:49:53,440 --> 00:49:57,560
influence, without, you know,
inappropriate influence from all

983
00:49:57,560 --> 00:50:00,280
these external sources.
Yeah.

984
00:50:00,400 --> 00:50:03,000
How?
If somebody wants to help you

985
00:50:03,000 --> 00:50:04,520
get there faster, how do we do
that?

986
00:50:04,560 --> 00:50:08,600
How do we make it successful?
We'll also join the app.

987
00:50:08,600 --> 00:50:11,640
It's free to use.
You can go to our website,

988
00:50:11,640 --> 00:50:15,000
evercred.com, click Join us.
You can download the

989
00:50:15,000 --> 00:50:18,000
application.
If you have a small practice and

990
00:50:18,000 --> 00:50:21,360
you need a credentialing
solution, we are rolling out

991
00:50:21,360 --> 00:50:23,360
sharing and we're basically
building out a full

992
00:50:23,360 --> 00:50:25,560
credentialing system where we're
building out the agents.

993
00:50:26,000 --> 00:50:28,920
October should be the deadline
for the first sharing version

994
00:50:28,920 --> 00:50:31,480
and then we're going to be
continuing to iterate on that.

995
00:50:31,480 --> 00:50:35,600
We've already signed, you know,
a large practice group and we

996
00:50:35,600 --> 00:50:39,640
have a couple of others in the
pipeline and, you know, we are

997
00:50:39,640 --> 00:50:41,320
going to be opening up an
investment round.

998
00:50:41,320 --> 00:50:43,960
So if you are interested in
investing, you know, reach out

999
00:50:43,960 --> 00:50:45,600
to us.
There's a contact us button on

1000
00:50:45,600 --> 00:50:48,560
the website as well.
Follow us over social media.

1001
00:50:48,880 --> 00:50:52,240
We're on all platforms.
Evecrad Leah Houston, MD, you

1002
00:50:52,240 --> 00:50:55,200
can follow me as well.
And we want to hear your

1003
00:50:55,200 --> 00:50:56,960
feedback.
This is a new idea.

1004
00:50:57,640 --> 00:51:01,240
This is a new solution.
You know we believe it is the

1005
00:51:01,240 --> 00:51:06,240
key to essentially fixing this
you know healthcare system mask

1006
00:51:06,240 --> 00:51:10,280
that we're in and but I'm also
not close to other ideas it's.

1007
00:51:11,480 --> 00:51:12,440
Awesome.
I'm on it.

1008
00:51:12,640 --> 00:51:14,920
I'm on the mobile app right now
on the website.

1009
00:51:14,920 --> 00:51:17,720
So yeah, this looks great.
Well, yeah, I'm very curious.

1010
00:51:17,720 --> 00:51:20,920
How did you get into this tech
world?

1011
00:51:21,080 --> 00:51:23,120
You know obviously of your
story, but how did you learn all

1012
00:51:23,120 --> 00:51:24,240
of it?
Because one of the things as a

1013
00:51:24,240 --> 00:51:27,040
mentor, I mentee a lot of pre
Med students, I talk about

1014
00:51:27,200 --> 00:51:30,680
building rage and being diverse
and having different skill sets.

1015
00:51:31,000 --> 00:51:34,160
And often times, you know, in
our fields, everyone is so

1016
00:51:34,160 --> 00:51:36,360
siloed, right?
Our sports medicine P&R, like

1017
00:51:36,720 --> 00:51:39,360
even though Altbash and I are
P&R, we'll still do completely

1018
00:51:39,360 --> 00:51:41,920
different things in our
respective settings.

1019
00:51:42,200 --> 00:51:49,760
So how did you get into tech?
So I entered as an attending and

1020
00:51:49,760 --> 00:51:53,760
I was immediately disillusioned.
I was like, this is crazy.

1021
00:51:54,240 --> 00:51:56,360
I'm being forced to see more
patients that are safe.

1022
00:51:56,400 --> 00:51:58,080
I don't have the resources I
need.

1023
00:51:58,320 --> 00:52:00,200
It's an understaffed emergency
department.

1024
00:52:00,560 --> 00:52:03,240
I need to figure out how to
stack cash and retire early.

1025
00:52:03,680 --> 00:52:06,320
And so I started learning about
stocks.

1026
00:52:07,200 --> 00:52:14,880
And in 2012, I was investing in
Tesla and Facebook and Bitcoin

1027
00:52:15,320 --> 00:52:17,240
and I just was learning about
this stuff.

1028
00:52:17,360 --> 00:52:21,600
And then I moved to Silicon
Valley in 2014 where I got to

1029
00:52:21,600 --> 00:52:24,320
meet a lot of these tech
entrepreneurs and like really

1030
00:52:24,320 --> 00:52:26,440
dig into it.
And they started asking me

1031
00:52:26,440 --> 00:52:28,920
advice and feedback on their
health tech platform.

1032
00:52:28,920 --> 00:52:33,880
So for example, this Theranos
deck came across my desk in

1033
00:52:33,880 --> 00:52:35,760
2014.
They're like, what do you think

1034
00:52:35,760 --> 00:52:38,240
about this?
So like, it's like a scam to me.

1035
00:52:38,600 --> 00:52:44,880
And so I kind of just from being
in Silicon Valley, was kind of

1036
00:52:44,880 --> 00:52:47,840
exposed to the tech world.
And then after the identity

1037
00:52:47,840 --> 00:52:51,080
theft issue, I realized that
this was a solution.

1038
00:52:51,080 --> 00:52:54,400
So it was more like solving a
problem that led me and just

1039
00:52:54,400 --> 00:52:56,480
being curious and wanting to
learn about it.

1040
00:52:57,280 --> 00:52:58,920
Yeah.
Yeah, awesome.

1041
00:52:59,120 --> 00:53:01,120
Love that.
Ultimash, any questions?

1042
00:53:01,120 --> 00:53:03,200
Alia, is there anything that we
haven't touched on that you

1043
00:53:03,200 --> 00:53:06,640
think would be important to?
No, I mean, I think I just want

1044
00:53:06,640 --> 00:53:10,600
to make it clear that yes, this
is a credentialing solution.

1045
00:53:10,600 --> 00:53:12,840
Yes, credentialing is a huge
administrative burden.

1046
00:53:12,840 --> 00:53:16,960
Yes, it's a $5 billion problem.
Yes, we want to reduce all this

1047
00:53:16,960 --> 00:53:19,120
nonsense that we have to do.
But this is really a movement to

1048
00:53:19,120 --> 00:53:22,160
save medicine.
It's a movement to allow doctors

1049
00:53:22,160 --> 00:53:26,320
to work and move freely, allow
us to collaborate and to have

1050
00:53:26,320 --> 00:53:30,120
autonomy again on top of it, so.
I love it.

1051
00:53:30,560 --> 00:53:34,120
I just.
Are you doing any more locums

1052
00:53:34,320 --> 00:53:35,520
work?
Are you still practicing

1053
00:53:35,600 --> 00:53:39,040
medicine at all?
I am practicing, I have a small

1054
00:53:39,040 --> 00:53:43,040
piddle of private patients that
I see but it's more like people

1055
00:53:43,040 --> 00:53:48,200
that couldn't find care and they
wanted my help so it's not for.

1056
00:53:48,400 --> 00:53:51,160
For like a from a primary like a
direct practice.

1057
00:53:51,160 --> 00:53:54,680
It's more direct primary care,
but it's, it's, it's longevity

1058
00:53:54,680 --> 00:53:58,120
and urgent care that I'm doing
Also, you know, knowing who I

1059
00:53:58,120 --> 00:53:59,600
know.
I mean, I have a network of over

1060
00:53:59,600 --> 00:54:02,480
60,000 physicians.
You know, I've learned a lot

1061
00:54:02,480 --> 00:54:04,960
about the stem cell space of a
background in molecular biology

1062
00:54:04,960 --> 00:54:07,480
and biochemistry.
I know a lot about the peptide

1063
00:54:07,480 --> 00:54:08,800
space.
It's just been something I've

1064
00:54:08,800 --> 00:54:10,640
been following.
I almost started my own private

1065
00:54:10,640 --> 00:54:14,000
practice in 2017 to kind of get
out of the rat race.

1066
00:54:14,120 --> 00:54:17,080
And I started learning about it
and following it then.

1067
00:54:17,440 --> 00:54:20,760
So yeah, I stay in touch.
For.

1068
00:54:21,280 --> 00:54:24,520
We we've talked about DPC and
direct specialty care, which is

1069
00:54:24,520 --> 00:54:27,120
kind of where, where Darsh and I
live I suppose or or Sue and

1070
00:54:27,120 --> 00:54:30,480
hopefully they, those folks
don't need to be credentialed

1071
00:54:30,480 --> 00:54:33,640
with payers, right.
But licensing of course can

1072
00:54:33,640 --> 00:54:34,960
matter.
I mean how could they benefit

1073
00:54:35,600 --> 00:54:37,280
aside from the resources and
network?

1074
00:54:37,800 --> 00:54:41,440
Could they utilize the resources
with respect to the app and the

1075
00:54:41,440 --> 00:54:44,280
services?
Yeah, so direct primary care

1076
00:54:44,280 --> 00:54:46,840
docs can join.
Joining the app is free, the

1077
00:54:46,840 --> 00:54:50,960
basic version is free, and you
know, they can get their one

1078
00:54:50,960 --> 00:54:54,440
license tracked all for free.
The benefit that they can have

1079
00:54:54,440 --> 00:54:58,000
is the network.
So one thing that I keep saying

1080
00:54:58,000 --> 00:55:01,720
in every single private DPC
group is where do I send my

1081
00:55:01,720 --> 00:55:03,480
patient for this?
Where do I send my patient for

1082
00:55:03,480 --> 00:55:05,800
that?
How do I know that I'm sending

1083
00:55:05,800 --> 00:55:09,360
my patient to somebody who isn't
going to essentially like, you

1084
00:55:09,360 --> 00:55:13,080
know, advise them to go to this
hospital system and to do these

1085
00:55:13,080 --> 00:55:14,920
wrong things?
So it's really about the

1086
00:55:14,920 --> 00:55:17,880
referral network piece that I
think would be beneficial to DPC

1087
00:55:17,880 --> 00:55:20,520
to have a lot of respect for the
DPC community.

1088
00:55:20,720 --> 00:55:23,720
There's a couple of the original
DPC docs who actually invested

1089
00:55:23,720 --> 00:55:27,720
in this because they acknowledge
the DPC is not scalable unless

1090
00:55:27,720 --> 00:55:30,760
you have infrastructure for this
referral network piece.

1091
00:55:30,760 --> 00:55:33,160
And so it's really more the
community piece that I think can

1092
00:55:33,160 --> 00:55:35,760
help DPC docs.
But yeah.

1093
00:55:36,840 --> 00:55:39,480
Can I ask Leah, where do you
realistically think with this

1094
00:55:39,480 --> 00:55:42,040
new administration within the
next 10 years, where's

1095
00:55:42,040 --> 00:55:43,520
healthcare going to be?
What's going to look like in the

1096
00:55:43,520 --> 00:55:47,600
next 5-10 years?
Well, I think that there's a lot

1097
00:55:48,000 --> 00:55:51,960
of movement in the what people
call functional medicine, but I

1098
00:55:51,960 --> 00:55:55,680
really call the longevity space.
People are going to have more of

1099
00:55:55,680 --> 00:55:58,520
their own data.
You know, their people are

1100
00:55:58,520 --> 00:56:01,280
getting whoops and aura rings
and they're having a better

1101
00:56:01,280 --> 00:56:04,560
understanding of like their own,
you know, sleep cycles and

1102
00:56:04,560 --> 00:56:08,600
things like that.
The ability to sequence genomes

1103
00:56:08,640 --> 00:56:11,080
has become more and more
accessible.

1104
00:56:11,440 --> 00:56:15,280
So having a better understanding
of, you know, your genetic

1105
00:56:15,280 --> 00:56:18,120
markers, your proteomics, your
genomics.

1106
00:56:18,480 --> 00:56:22,640
And I think that, I mean, people
can buy peptides online without

1107
00:56:22,640 --> 00:56:25,400
a doctor's prescription.
So I think there's going to be

1108
00:56:25,400 --> 00:56:29,000
more and more people that are
like usurping the physician

1109
00:56:29,000 --> 00:56:32,800
community to do stuff.
I'll make ourselves available to

1110
00:56:32,800 --> 00:56:36,200
help guide them.
Now, I also see a lot of

1111
00:56:36,280 --> 00:56:40,040
potential to psychedelic space.
There's a lot of research and

1112
00:56:40,040 --> 00:56:44,240
psilocybin and ibogaine and how
it can help improve symptoms of

1113
00:56:44,240 --> 00:56:47,360
depression.
And so I think that essentially

1114
00:56:47,360 --> 00:56:50,400
people are going rogue and
they're doing what they know is

1115
00:56:50,400 --> 00:56:54,080
best for them.
And that could, you know, lead

1116
00:56:54,080 --> 00:56:56,840
to some people going down a
rabbit hole and, and harming

1117
00:56:56,840 --> 00:56:59,560
themselves.
But if we as physicians step up,

1118
00:56:59,560 --> 00:57:03,360
acknowledge this, lean into it,
learn as much as we can about

1119
00:57:03,360 --> 00:57:07,320
this space and offer ourselves
in whatever frame, framework and

1120
00:57:07,320 --> 00:57:11,760
capacity we feel comfortable to
serve this patient population,

1121
00:57:12,000 --> 00:57:14,040
then we can really, you know,
make a big difference in

1122
00:57:14,040 --> 00:57:15,080
people's lives.
Well.

1123
00:57:15,680 --> 00:57:19,280
With that, I mean, I can't think
of a perfect guest to to bring

1124
00:57:19,280 --> 00:57:20,920
on to our show.
Honestly, everything you've

1125
00:57:20,920 --> 00:57:24,000
touched on the solutions, this
is really what medicine

1126
00:57:24,000 --> 00:57:25,720
redefines about.
It's about bringing these real

1127
00:57:25,720 --> 00:57:28,520
time solutions, talking about
the problem, the root cause and

1128
00:57:28,560 --> 00:57:30,720
bringing everyone together,
which is what you're doing.

1129
00:57:31,000 --> 00:57:34,240
So with that, our last question
that we ask everyone, and feel

1130
00:57:34,240 --> 00:57:37,240
free to be as brief for as long
as you want, is how do we put

1131
00:57:37,240 --> 00:57:40,960
the health back in healthcare?
I think it's untethering the

1132
00:57:40,960 --> 00:57:44,600
physician community from the
medical industrial complex,

1133
00:57:44,600 --> 00:57:47,440
which is why I'm doing this.
I think, you know, we are

1134
00:57:47,560 --> 00:57:51,480
extremely knowledgeable.
We know, I mean, we understand

1135
00:57:51,480 --> 00:57:55,520
the root cause of what's going
on in healthcare, but we are,

1136
00:57:55,840 --> 00:57:58,320
you know, forced into these
models where we're practicing

1137
00:57:58,320 --> 00:58:00,920
assembly line medicine, where
we're practicing defensive

1138
00:58:00,920 --> 00:58:03,360
medicine, where our employers
and the insurance companies are

1139
00:58:03,360 --> 00:58:06,480
influencing how we practice.
We need to untether ourselves

1140
00:58:06,480 --> 00:58:08,120
from that.
We need to stop being afraid.

1141
00:58:08,600 --> 00:58:11,360
And as soon as we do that, then
patients will better be served.

1142
00:58:12,280 --> 00:58:13,200
Love it.
I love it.

1143
00:58:13,200 --> 00:58:15,120
Yeah, you've been great.
Thank you.

1144
00:58:15,720 --> 00:58:18,560
It's been such a pleasure, I'm
really looking forward to seeing

1145
00:58:18,560 --> 00:58:20,920
how this turns out.
Thanks, Lee.

1146
00:58:21,040 --> 00:58:23,400
Thanks for listening to another
episode of Medicine Redefined.

1147
00:58:23,920 --> 00:58:26,080
If you enjoyed this episode,
please be sure to check out some

1148
00:58:26,080 --> 00:58:27,800
of the additional resources in
the show notes.

1149
00:58:28,480 --> 00:58:31,480
Please also check out our social
media platforms where you can

1150
00:58:31,480 --> 00:58:34,960
find more content like this.
You can follow us on Instagram,

1151
00:58:35,240 --> 00:58:37,680
Twitter, and TikTok at Med
Redefined.

1152
00:58:38,400 --> 00:58:40,360
We also want to thank our team
for the production of this

1153
00:58:40,360 --> 00:58:42,240
podcast.
Aretha Yapuri on social media,

1154
00:58:42,600 --> 00:58:45,040
Zenab Lugmani on research, and
Saira Khan for newsletter.

1155
00:58:45,480 --> 00:58:48,280
Oh, and if you want to get
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1156
00:58:48,280 --> 00:58:51,120
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00:58:51,120 --> 00:58:53,880
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1158
00:58:54,160 --> 00:58:56,720
please be sure to subscribe,
review and share with anyone who

1159
00:58:56,720 --> 00:58:58,320
you think will gain value from
this as well.

1160
00:58:59,240 --> 00:59:02,280
Now time for the ever so
important disclaimer.

1161
00:59:03,080 --> 00:59:05,920
This podcast is intended for
general public use and it's for

1162
00:59:05,920 --> 00:59:08,680
educational purposes only.
It does not cost you the

1163
00:59:08,680 --> 00:59:10,480
practice of medicine.
No should be construed as a

1164
00:59:10,480 --> 00:59:12,560
medical advice.
No physician patient

1165
00:59:12,560 --> 00:59:14,600
relationship is formed and
anything discussed in this

1166
00:59:14,600 --> 00:59:16,720
podcast does not represent the
views of our.

1167
00:59:16,720 --> 00:59:19,080
Employers.
We recommend that you seek the

1168
00:59:19,080 --> 00:59:21,640
guidance of your personal
position regarding any specific

1169
00:59:21,640 --> 00:59:22,640
health related issues.