Deep Dive with Rick Gilfillan

Intro: Welcome to The Daily Bolster. Each day, we welcome transformational executives to share their real world experiences and practical advice about scaling yourself, your team, and your business.

Matt Blumberg: Welcome to The Daily Bolster. I'm Matt Blumberg, co- founder and CEO of Bolster, and I'm here today with Rick Gilfillan. Rick is a doctor. He is a multi- time CEO in the healthcare industry. He is a thought leader in healthcare delivery models and he is also my father- in- law. Rick, good to see you.

Rick Gilfillan: Great to see you, Matt, as always. And congratulations on the series and the great work you're all doing at Bolster.

Matt Blumberg: Well, we're having a lot of fun with it. And I figured it's only fair since I had my dad on in season two that I should have you on in season three, in a family full of CEOs. So for this conversation, as with all the interviews I do on a Friday, it's much more informal and it's sort of about the arc of your career and things that you've learned along the way. And one of the things that's particularly interesting about your career is it started as a small town doctor, a family physician, and most of the people I have on who are CEOs, their career started as a software developer or as a marketing leader or something like that. So you started out after med school as a small town doc, and then if I have it correct in my head, your first move after that was to be Chief Medical Officer at Independence Blue Cross, or an HMO. I'd love to hear about what drove you to move to the business side of medicine as kind of a start, but if there's anything kind of interesting about your time as a doc in Winchendon, Massachusetts, throw that in.

Rick Gilfillan: Yeah, well thanks, Matt. There is one stop along the way actually, but when I went into medicine, it was actually in the early seventies, very early seventies, and there was a lot of talk about healthcare policy even then. Oh my goodness, healthcare was costing 7% of GDP. What are we going to do? And now of course, it's like 19, 20%. And so I actually got interested in health policy before I even went to medical school and I went to medical school so that I could once be of service by being a doc, and two, be credible in the health policy world. So I had always had an intent to move in that direction, but I started out on the ground working as a family doc, and then after I left Winchendon, I actually went to New Jersey where for a time I was a half- time doctor, half- time medical director. And this was kind of like a gradual progression. And the goal for me always has been to be involved in healthcare so that we can deliver, find ways to deliver better care to more people and to everybody actually, better care for everybody, and have the care have better outcomes. That's why I got into it originally, and that's my career path has always been about doing that. So I actually made a conscious decision when I was a medical director, part- time medical director in New Jersey, to go flip over to the business side and go to business school. And so I actually had applied-

Matt Blumberg: You're reading off my script here. That was my next question. I was going to say, if there was ever a poster child for mid- career business school, that's it, right? You're a doctor and you want to get into the business side of things. So it's a career change.

Rick Gilfillan: Right. So I actually was accepted to Wharton when I was still in New Jersey. Meantime, someone recruited me to go to Philadelphia, the chief, actually to be the medical director for a new startup, HMO, and they agreed to pay for me to go to Wharton, but if I delayed a year. So I delayed a year, did that. And they're really a very progressive group. Ultimately, that led to me becoming the chief medical officer at Independence Blue Cross, which I did for five years. And at the end of five years I said to our CEO, okay, it's time. I've got my MBA, I'm a certified business guy, whatever, it's time for me to flip over to the business side. And very kind of fortunately for me, they were starting a new company and they said, okay, go to New Jersey and be the CEO or general manager actually was the title for this new startup we're doing in New Jersey.

Matt Blumberg: And if I remember correctly, at some point around there in your journey, you had a pretty formative conversation with either Porter or Drucker about delivery models. Is that right? Or did you inaudible-

Rick Gilfillan: A little later I talked with Michael Porter about it, yeah. Yeah, yeah. I had read his book and was in awe of him from the MBA world. Right?

Matt Blumberg: Yeah. And had he gone deep in healthcare or you were sort of reading some of his general stuff about models and trying to apply it to healthcare?

Rick Gilfillan: Yeah, it was the general stuff and it was really eye- opening for me. I thought the competitive strategy book was just, it was in medical school, there are a few texts that are just icons of the work and the learning along the way. And I thought that was for me, frankly. And I guess I like paradigm's, frameworks like that. And his was just brilliant. So I was really taken with that, quite honestly.

Matt Blumberg: When you were the GM of AmeriHealth, what was your guiding principle? Now you flipped to the business side, you're in your first role, you're effectively CEO of a reasonably sized organization. What was the North Star for you there?

Rick Gilfillan: Actually, it was a startup. So we actually were starting new and a couple of times along the way I've become aware of the fact that there are, like there's lots of stuff, lots of challenges, lots of questions, decisions, et cetera. But usually there's a couple of core issues that if you get them right, the path is much clearer. And for us, the time was such then that there were two core issues for us to focus in on. One was HMOs were fading, we needed something bigger, and we had to go through the process of creating what we call the PPO, which is a more extensive network, and that's not an easy thing to do. So we had to get that right. And two, I needed to build a sales organization for the first time, and I really lucked out. I got a superstar leader for sales who I had known at IBC, right? I knew she was a great person, but I had no sense of what it took to run a sales organization. And she came in and created a sales organization that allowed us to take that product and some other advantages we have and just run wild with it. And we grew from 10,000 people to about 300, 000 customers.

Matt Blumberg: I mean, a good head of sales is a game changer for an organization, once you have product market fit. And that sort of language that we use in technology all the time, product market fit, it applies to anything. And the PPO as a step in the chain between HMO and I guess ACO, which we can talk about in a little while, is a pretty interesting innovation. So as you were thinking kind of high level about the delivery models, how did you think about that concept of product market fit and what was going to move the needle for customers in a really complicated space where the payer is different from the consumer?

Rick Gilfillan: You know what, it was really simple in a sense. The HMO said, we're going to lock you in as customers, and we had all this horrible language we were using. Gatekeepers and referrals and all this stuff. And then if you juxtapose that to a PPO and say, well, we're going to have more doctors, more hospitals, you can go where you want. You have benefits if you go to someone who's not in the network, it's freedom, et cetera, right? I mean, it was really easy to see, and yet the marketplace was dominated by people who didn't go there, by people who kind of stuck with the old way of doing things. So to me, that's like it was listening to the customer and I mean, all I had to do was go to the movies and see Helen Hunt scream about her blanky blank HMO, and realize there was unrest. So getting the product right. And by the way, we had introduced a similar product in Philadelphia, and I had worked extensively on that. So it was really taking what we learned there and bringing it to the new marketplace. And then, as I say, creating a field force that was largely broker driven. And going up against the incumbents was another interesting story, when you use brokers who are also working for the incumbents.

Matt Blumberg: Yeah, I mean, it's part of the complexity of the healthcare system. There are just so many players and so many layers that you have to navigate. And yeah, I didn't think really about the role of brokers, but yeah, I mean, they're getting paid by everybody to match customer with a plan. What was the approach that you took to getting them to pick up a disruptive product?

Rick Gilfillan: Well, we had, again, our sales leader, Linda, was very persuasive and had a great team and was just incredibly diligent about going out there and listening. And it turns out there are reasons why. They're complicated people too. They have reasons why they don't want all their eggs in one basket with just the blues, for instance. And they like to kind of create a different set of offerings for their customers. So they were open to listening and then it was a question of, can you pay them a little better and can you treat them well and do right by their customers? And so we just kind of really focused on that. We knew we weren't going to dislodge the big boys, but we did find some little niches there that were open to us to gather business. And then we did one funny thing. So there's this minor league baseball team in Trenton, New Jersey, and they got a fence in the outfield. It's kind of a mini version of Fenway or Yankee Stadium, got the fences in the outfield, and they got the little places for you to put up your ads. And I always loved this. We put up, we bought two of the boards there contiguous and put up this big AmeriHealth sign. And the blues were the big incumbent, Blue Cross and Blue Shield, New Jersey. And they go in and they buy the next two next to us. And I thought, man, is that perfect? We just became the equal.

Matt Blumberg: That's when you know that you've struck a nerve.

Rick Gilfillan: Yeah. Anyway, so that was the approach we took with the brokers.

Matt Blumberg: Yeah, I mean, the thing about healthcare is it's so massive that finding a couple of niches builds you a big business and gives you a toehold to bigger things.

Rick Gilfillan: Yeah, absolutely true. I always used to say healthcare is so big that all you have to do is find a few of the crumbs to sweep off the table and you're...

Matt Blumberg: That's right.

Rick Gilfillan: Yeah, you're doing well.

Matt Blumberg: All right, so your next career step is an interesting one. And I was around for this, so I remember at the time thinking like, " Hey, that's a little bit unusual." Although when you look at someone's career in the rearview mirror, it totally makes sense. But you left as CEO and you went to go work at Coventry in more of a functional role or a staff role, kind of leading contracting and procurement. Talk about that move a little bit from CEO to a functional head and why you did that and what you got out of that.

Rick Gilfillan: Yeah. Well, after I left the IBC, because I've been there 11 years and wanted to move on and do different things, and we'd had pretty good, nice success there. I wanted to get into the for- profit world because I'd never been there really. And I wanted to see what was different about it. At the time we thought markets was a solution to everything, and so let's go check out that for- profit world. And the CEO was someone I had worked with at IBC, so he and I had a longstanding relationship. He had just started this new company, Coventry, and he originally hired me to do a couple of specific things around digital and medical costs. But shortly after I got there, I ended up becoming the national contractor, which provided an incredible window into the entire delivery system in the US because we basically had a national network and we contracted with every hospital and almost every doctor in the country. And I had a hundred people who did that contracting. So suddenly I was in a position to actually learn about the dynamics of contracting, specifically contracting between plans and providers. I'd done some of it before, but nothing on this level of this order of magnitude, but also the dynamics of marketplaces and different marketplaces. So that was a great opportunity to really learn a lot about how the systems work in different markets, similarities and differences.

Matt Blumberg: So I am not sure I was aware of the scope of your team. So you had a hundred people working on contracting, and presumably that's everything from agreeing on rates with physicians and health groups to buying tongue depressors. I mean, it's got to be a massive-

Rick Gilfillan: We didn't do any... No. Well, remember this was a contracting for the health plan, so the contracting for hospital services and all that for the services they provided. We contracted with the hospital, but the hospital bought all the things. We didn't own any healthcare providers.

Matt Blumberg: Oh, got it. So it was mostly around contracting with providers.

Rick Gilfillan: It was contracting with providers, and to some extent with other health plans.

Matt Blumberg: Got it. And what was the sort of at that moment in US healthcare, so now we're in the early 2000s, right?

Rick Gilfillan: Right.

Matt Blumberg: Mid first decade of the century. What started to become clear to you about what was working and what was not working about the markets?

Rick Gilfillan: Yeah. Well, the marketplace from the standpoint of what you'd ordinarily expect from a market, I mean, it was clearly a broken system, a broken marketplace because we had was, the reality is, and this was true in every market, just about every market I've ever been in, and it's true of all the markets I saw from there. In any marketplace, there's typically a market leader on the hospital side, and to some extent on the physician group side, although it's much more dispersed and disseminated, but on the hospital side, there clearly are market leaders and they basically dictate price. And then there's everybody else. So there's the must have providers, hospital systems. An insurer has to have them. And then there's everybody else who they don't have much leverage with plants. So the plants give really high rates to the must haves and lower rates to the others, and you end up with a kind of two tiered system. And at one point, a quick story, I went personally around to the five biggest, most expensive systems. We were typically paying them probably 50% more than what we're paying other people. And by the way, much more than the local blues fans were paying. So I went and my favorite story was in Boston. I went to Boston to talk with the people at Massachusetts, Mass General, known then as Partners, now known as MGHB or MGB. And I went and met with their contractor and gave me a nice tuna fish sandwich and said, " Hey, Rick." And I said, " Here's the deal. We are about 3% of your business and we are providing about 50% of your profits because of the exorbitant rates we're paying and we can't do that anymore." And he was very nice. He said, " Rick, I understand that." And he said, " Let me explain to you how things work in Boston." He said, " Here we have what we call hole diggers and hole fillers." He said, " Hole diggers, Blue Cross, Medicare, Medicaid, right? Hole fillers, you." This is at the time of the big dig, so it was particularly-

Matt Blumberg: Poignant.

Rick Gilfillan: Resonant, yes. And so I had that conversation in effect, and then he said, " So fine. I understand what you have to do. So walk away." Well, he knew and I knew that I was going to go back to the CEO and the marketing folks and say, " I can't get better rates. They just say, let us walk." And the team says, well, we can't walk because we can't sell a product without them in the system, in the network, so we'll have to give them the rates, end of story. So that story plays out frankly, across the entire US. And it's not clear the market leaders have necessarily provide better care or better service. What they have is a presence in the minds of employer senior leaders who say, " I need them in my network. My family needs them in their network.2 So it's the function of the employer- based system that you create this extraordinary market power for these organizations.

Matt Blumberg: Yeah, I mean, I think it's one of the things as a normal consumer of healthcare, not someone in the system that just is always shocking that different people are charged radically different prices for the same thing, with no expectation that they're all going to pay it.

Rick Gilfillan: Yeah, well, there's that too. Yeah.

Matt Blumberg: So interesting way to learn that lesson.

Rick Gilfillan: Yeah, that's the way the disconnect works, right? Because it's a mix, because we think of healthcare and health as kind of a public good, everyone should have it. It's really hard to push the weight of consumer decision- making back to the patients, say, you'll have to put up with the fact that you can't get good care. And so we don't do that. So we end up with this broken marketplace where some providers end up with remarkable leverage and then we see prices that are insane.

Matt Blumberg: Well, and that's a good segue to the next chapter of your career, which I think in some ways is the most interesting one. If you think about where we've been with medicine, then not- for- profit business side of things, the for- profit business side of things. And then you had what I think of as one of the most interesting roles in healthcare and possibly one of the most interesting roles in the federal government working as, if I have it right, you were the inaugural head of the Center for Innovation and Medicare and Medicaid right after the Affordable Care Act was passed. And my memory of those couple of years was that you were working seven days a week, 18 hours a day, but that you were doing some of the most interesting things that I've ever heard anyone do. So talk a little bit about that experience and sort of your role trying to bring principles of investment and return and entrepreneurship to the biggest checkbook in the world of healthcare.

Rick Gilfillan: Well, it was quite a time. Actually, there was one step along the way. I went from Coventry to Geisinger and I went to Geisinger because the CEO there, Glenn Steele said, " Hey, I want to create some new ways of paying providers that maybe will become a model for the country." So I went there and I spent five years there, and we created some new ways of addressing those issues of payment between health plans and providers. We've created a specific episode based payment where we pay for outcomes rather than services and capitation for primary care docs. And we created an ACO approach. Anyway, so then in the Affordable Care Act, they said, well, let's create this innovation center, which was actually a result of Glenn going to them and suggesting they do that. And try and find different ways to pay providers so we're not paying this kind of exorbitant fee for service rate. And so that was the charge of the Innovation Center, find new ways to pay providers for CMS as a payer to pay providers differently and reward them for delivering better health, better care, lower costs. That was the idea, because the way you pay people has a lot to do with the way they deliver and what they deliver. And so that was the idea, and they gave us$ 10 billion over 10 years to try and develop these new payment entities. So basically the interesting thing was I started, I was actually the second employee of the center, and we had to get going pretty quickly. So we had 90 days to hire a staff of 80 people. And so the first thing we did was go on this all out crash hiring effort and basically sent out announcements to every MPH, Master of Public Health, every MBA program, healthcare program around the country, and started recruiting people. And we went on a seven day a week recruiting effort, and we found a great team. And then we created programs around ACOs, accountable care organizations, new ways of paying primary care, and a bundled payment program where we paid hospitals for 90 days, not for one unit of service, but for all the care someone needed for 90 days. Those were kind of the first things we really went after. And again, this was one of those things where incredible amounts of attention being paid, you got Congress calling you and you got the White House and you got all these people coming to visit. And what was critical there was to keep our eye on the ball and say, we're going to do these three things. They're going to get done. That's what we're going to do. So we kind of focused on getting those out in the first year. And that happened. And then we had an interesting request, and basically the White House was interested in kind of a broad- based approach to innovation of soliciting ideas. So we took a billion dollars and we announced that we were going to do innovation awards to entities for interesting ideas of change in the way care is delivered. And we got 7, 000 letters of interest from that. By the way, our theory was a theory of change was we wanted to create these new models, but we also said we wanted to create a wildfire of innovation and transformation across the industry. And that wildfire was significantly enhanced by this announcement that we're going to give away a billion dollars to people with great ideas.

Matt Blumberg: And the idea with the billion dollars was that it was grant money, right? It wasn't venture style investment, but it has some of the hallmarks of things in our tech universe around venture studios and accelerators.

Rick Gilfillan: Yeah, it was funny. We tried to do some of that stuff, and the goal was to create new startups that would take the ball and run with it aggressively. That was part of our strategy, was to threaten the incumbents, hospitals and large physician groups, with outsiders who would threaten to take their cheese. And so that was the goal of all this. But we got a lot of incumbents who submitted grants. We ended up getting about 3000 submissions of applications. And out of that, we picked 110 who were funded and with a wild assortment of things that they were doing. Some of them went on to become standalone entities that succeeded and has since been part of roll- ups on the private side. Others were, people probably thought they were a little bit of a folly in terms of the way the money was distributed.

Matt Blumberg: And when you look back on that, do you feel like that model worked?

Rick Gilfillan: I think, here's the way I think about this. If you think about a health system and all the actors in it, 5, 000 hospitals, a million doctors, all the other people, every day they make a decision about what they're going to do. And those decisions are significantly affected by the business reality they're operating in. They've all got great professional ethics. They want to do the right thing for patients, but they also are part of organizations that need to be sustainable. So they react to the incentives they have typically and the way they get paid, and they do the things that make them sustainable. And if you think about each one of those individuals, the decision- making of leaders, et cetera, they're a vector force. They're a vector that ends up driving the system in a direction, and you can measure the outcome of that by how much we spend and also what the quality is. So if you think about it that way, they all sum up into this giant vector force that drives in a particular direction. Right now, I think about this vector force as a gauge. This is like a fee for service world. This is a world where I say, I want to make healthcare, everybody's health better and my community's health better. Typically, providers are like this. The gauge was over here when we started, right? We were trying to drive it over here. The reality is that vector force now is about here. So was it successful when you put all the things together? I would say not optimally. I think we've had movement, but we've been ambivalent about how to do it and what to aim for. And as administrations change, policies change, and every decision at a place like CMS, any meaningful decision at a place like CMS ultimately is a political decision. And that's not a pejorative statement, that's just a statement of reality. And so if someone has a different political context they're operating from, then it changes. So when you think about the long arc of government policy, it's not quick. It's not absolutely predetermined, but it is broad. It has massive impact in ways that I think can be good in the face of a broken marketplace. But time will tell.

Matt Blumberg: Yeah, I mean, look, anytime there's change in anything, there are winners and losers. And when you put that with the backdrop of politics, it means it's harder to get things done because the prospective losers are going to fight it tooth and nail.

Rick Gilfillan: Yes.

Matt Blumberg: All right. So after you left the government and you took a deep breath, after a few years of very, very frenzied work, you went to sort of your final full- time role, which was CEO of Trinity, major, major health system. And the thing I remember most from that is I think we were at dinner one night and I asked you how many people were in the organization and rolled up to you, and you said, "Oh, I don't know. 100,000, 120,000." And so you were obviously operating at a massive scale. So I'd love to hear about what lessons you took from your time in government back into running a health system and also just how you thought about that number of people rolling up to you as the CEO and how you thought about leadership in that context.

Rick Gilfillan: Yeah, so my goal at Trinity, it was a great organization. It just merged two entities together, and it was in the process, and that was the first step was to complete the merger and all that went with that. But the overall strategy was actually to kind of be part of that transformation, and it was to change the mindset of the organization from being strictly a kind of service- based, fee for service- based organization, focused on one patient at a time, to thinking about delivering care for large populations. And so there was the basic underlying issue of creating the merger, running the finances. We had about 130,000 people when I left. About, we were at 99 hospitals in 24 states, but that was broken up into 18 regions. And so my focus was really on working with 18 leadership teams and our own leadership team and trying to create consistency in strategy, et cetera. Underlying this all by the way, is a very interesting business problem, which is all those hospitals had different infrastructure. We tried to create a standard platform, and that process continues actually today, same electronic medical records, same backend operations and all that stuff. So we had to do all that. And scale doesn't necessarily create efficiencies. It's not a given.

Matt Blumberg: In fact, probably some cases it goes the other way.

Rick Gilfillan: It goes the other way. Absolutely. Without careful attention and curating what you end up is a more expensive, and the whole notion of transaction costs is very real. I mean, I didn't grasp that before, but it's very real and you have to work really hard to get the efficiency from scale. So we were working on all those, and my example was we're going to be, pardon the analogy now, but we're going to be southwest. We're going to fly one thing. We have a standard platform. We're going to be efficient. So we tried to do that, but then we also said, and by the way, the way we're measuring success is not this way, it's that way. And that was really hard for people to get across. And so it's making major strategic change in 18 different markets and all the nuances of that. So I worked with the leaders and tried to hire CEOs, and we replaced about probably 50% of the CEOs were replaced during my time, and we tried to get people who were focused that way. But I had a leadership team, by the way, that was about 15 people. So per our other conversation, I think it was important to have a broad- based leadership team so that you improve the opportunities for things to diffuse. But we also had another leadership team, which was 18 CEOs running their systems. And the trick was they had to have enough authority to make the decisions they needed to make, and yet I was trying to convince them of making dramatic change. The way we did that was to create what we call the Trinity Health Management System, which was kind of a Toyota management system approach, which we used within the corporate office. And then we started spreading and requiring each organization to adopt that. Visual management boards, et cetera, with a common set of metrics, the definition of success, et cetera. So when I left, that was about a third of the way spread through the system, and I think they've continued to do that, but that was at that level of scale. I believe you can't just take the granted how people run things. I believe we needed to put in place a standard, well- structured and data- driven management system, and that's what we did.

Matt Blumberg: Yeah, I mean, it's funny, you talk to CEOs of startups who are 50 person teams, 100 person teams, and they talk about they want to run a team of teams approach as opposed to a top down command and control organization. You literally had a team of teams, and with CEOs reporting in. So it has to be that the only way to keep any consistency in the organization is to get people to buy into a way of working.

Rick Gilfillan: A way of leading and managing, yeah.

Matt Blumberg: Yeah. How did you think about leadership development and consistency? Did you focus on training or you're talking about managing CEOs at that point? You're not talking about managing early state, early career, mid- career leaders?

Rick Gilfillan: Right. Well, one thing I come away with is it's really hard to change people who've been in the same mindset for a long time. It's really hard. And frankly, I'd almost prefer to get a really talented individual and elevate them much more rapidly than you would expect and support them than to try and take an entrenched leader and change their entire mindset. It's really hard to do it. It's a rare individual who will change. So we had three levels of a managerial training corresponding to CO, C- suite and director level, basically VP director level, and we put that in place and used some outside folks to do training in those spaces. In the lower two spaces, so the non CEO spaces. The CEO spaces was like we were directly, we would get together on a quarterly basis for three day sessions and we would talk about critical issues, and it was somewhat of a common decision- making team. And by the way, we brought a couple of CEOs into our leadership team to kind of make sure that we were getting that perspective. But it's very hard. Change is hard. Nobody likes it. Nobody wants to do it. And pushing it through an organization, it's a difficult thing to do. Looking back on it, I probably should have done more to really kind of push harder on the street probably than I did. I probably erred a little bit on the side of giving folks too much local authority and not holding the feet of the fire on the transformation stuff.

Matt Blumberg: Yeah, some elements of transformation have to be top down authoritative, but it's interesting, a couple of your key lessons there certainly match things that I've learned over the years, our management team at Return Path. By the end, most of the people came in, not at the top, came in at the director VP level and grew up in our system a little bit more. So I certainly understand that. All right, my last two questions for you, if you put it all together, I want to bring this back to technology because a lot of the people that listen to this and watch this are more in the tech space. Where has technology hurt healthcare and where has technology helped healthcare? And I'm not talking about bioscience, life science technology.

Rick Gilfillan: Right. First of all, I think kind of overall it's important to realize that technology gets deployed to the strongest business purposes, basically is what happens. And so if your business purposes are around how do I collect more revenue, how do I get more money from a premium standpoint, then the technology gets directed there. And ironically, some of the biggest uses of technology in healthcare have been around the business side because there's not a strong pull on the quality side, unfortunately. So I say that because to say that the overarching policy issue of changing the way people think about what they're doing is critical to the direction that technology and entrepreneurs take. And so I remain committed to policy as a critical component. Places it has helped. People talk about electronic health records. I had the great opportunity to spend a fair amount of time with Judy Faulkner from Epic, and I would urge any of your folks to think hard about, Judy is the ultimate startup person. She started in her basement writing the code for Epic, by far the dominant electronic health record these days. And she has built it up step by step and is still the CEO. She's a remarkable person and it's a remarkable story, and I think that they have set the stage for great opportunities in terms of AI and machine learning, et cetera. The data's there, it's still very dirty. So the data in is not what it should be and that needs work. But that's an incredible story. I think Judy's story on electronic health record is a great opportunity. A lot of this other stuff that we've seen, unfortunately today, the single largest use of AI in healthcare is actually around managing money. And we have to get it to the place, and I think people now are talking about getting it to the place of where we actually use it to make care better. And I think that's really the exciting frontier. It starts, but it's interesting to see that the domination of... And by the way, I'm leaving aside all the great medical technology, which has made an incredible impact on people's health and is great stuff. And drugs as well. But in terms of the pure technology in the space, I think I hope we will see the emergence of more clinically oriented technology that really can make a difference in the way we deliver care as opposed to the way we generate revenue.

Matt Blumberg: Yeah, I mean, some of the technology that I've heard about that's focused on maximizing billing codes for example, doesn't seem like it's really helping anyone, but it does get back to your point about technology goes to best and highest business use and P and L.

Rick Gilfillan: Yeah, it is. Yeah. So hopefully I've seen great examples of the way... Actually, the other thing that's really interesting is the way we tell our stories. I mean, everybody drapes their story in these elaborate thoughts of making care better, and then you dig down deep and you say, oh my goodness, they're really over here. So I think the other thing that's interesting to watch, quite honestly, is the storytelling and the degree to which the storytelling reflects the reality of what we're doing with technology. And it's really important to probe hard underneath the storytelling. This kind of goes back to the notion of being close to the business, and I don't mean people delude themselves, but if people from the outset are trying to look at what's really happening, they need to dig deep to find out what's really going on and what uses we're really making of technology.

Matt Blumberg: That's probably the subject of a whole other episode. So let's wrap it there. Rick, thank you for joining me today. Rick Gilfillan, I think safe to say expert in our nation's health system, and appreciate your taking time to tell your story and share a bunch of lessons along the way.

Rick Gilfillan: Thanks, Matt. I really enjoyed it.