Finger on the Pulse | Bret Larsen from eVisit on Delivering Healthcare in the 21st Century

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Alexander Ferguson 0:00
In this episode of UpTech Report, AI interview Bret Larsen, the CEO of eVisit. Historically, the healthcare industry has been slow to catch up to the information technology advancements of the 21st century eVisit is changing that through their telemedicine platform, currently adopted by over 200 major providers, Bret discusses the challenges of merging healthcare and technology, the elusive goal of product market fit the obstacles of running a fast scaling company, and what he would have done differently. Thank you so much for joining us. I’m excited to learn more about each visit and also your story and how you are innovating. First of all, you’re joining us from Phoenix. Correct? Yeah, Phoenix, Arizona. Awesome. And now when what year did your company start,

Bret Larsen 0:46
I left to start eVisit in November of 2014 2014.

Alexander Ferguson 0:51
And the industry that you primarily serve is what

Bret Larsen 0:56
we’re so we’re in the healthcare space, we’re classify ourselves as a virtual care platform. Our target customers are large health systems, anywhere from like mid market clinics, private clinics to large some of the largest health systems in the country.

Alexander Ferguson 1:09
And the pain that you are solving for these, this target market, what is it?

Bret Larsen 1:17
So there’s a lot around patient patient access, and there’s a lot of different pain points that I could call out. But at the end of the day, it really comes down to patient access, you know that the here in the United States, we don’t have a for the most part, we don’t have a quality of care issue. It’s not about whether or not Doctor A, B, or C is providing high quality care, we have probably some of the best health care in the world, it typically comes down to access, you know, as a patient when you can’t get in to see your primary care doctor for 20.3 days, which is the national average. That’s an access problem, you know, and that that results in in subpar outcomes for patients if they can even get to the visit to their physician in the first place. So

Alexander Ferguson 2:01
this concept of telemedicine, it was one the way to describe this isn’t necessarily new, but what you’re looking at is bringing, bringing telemedicine to existing providers on a local on a on a smaller level. Is that correct?

Bret Larsen 2:16
Yeah. So if you look at the models within telemedicine, I think sometimes the term is overly broad, which is why I kind of try to narrow it to virtual care platform. But you have anything from you know, TelaDoc, who’s doing, who has a physician network that they’re using to distribute services on with their own technology, all the way down to a doctor, an individual who might be taking a phone call within his private practice. And so what Eva is doing, as we don’t bring physicians to the table, we’re not a direct to consumer offering. We go to large health systems and health organizations and give them a platform and a mechanism and the infrastructure to deliver their care remotely with their own physicians to their own patients.

Alexander Ferguson 2:59
I’ve tried it out actually, personally on the larger scale, not just some telemedicine, I didn’t know what it was provided by Sure. And it was fine. It worked. But if I could have connected with my local provider, I think that would I would have been much more interested in game to repeat it. I’ve only done it once.

Bret Larsen 3:17
I hear that a lot, actually. But when it when it’s coming from a place of a relationship, you feel a lot more comfortable. There’s more consistency. I mean, it’s it’s it’s the reason we go to franchise restaurants, right? It’s for a consistent experience consistent outcome. It’s and we believe it visit when you pair a patient with a provider, they know that outcomes improve. And that’s

Alexander Ferguson 3:37
why you’re really helping your customer is the the provider or institution. patient access. That was the word you said. Right. So tell me, how many customers do you guys have or institutions you have on your platform right now?

Bret Larsen 3:50
Yeah, today we’re serving a little over 225 health systems and large clinics in all over the country? And what

Alexander Ferguson 3:59
does that then turn into patient wise that there are going through your system?

Bret Larsen 4:03
That’s a great question. The best way to answer that is if you if you measured like size of hospitals in the country by by the number of patients they enrolled, last year even would have been the largest hospital in the country if we were a traditional brick and mortar hospital.

Alexander Ferguson 4:20
That’s impressive. That’s impressive. So digging into then what that offering looks like when you approach a institution or a local practice, depending on what size you take in what does that those packages or plans look like then that you offer?

Bret Larsen 4:36
Yeah, typically we will what we bring to the table for large hospital systems. We priced them it’s an annual license. It’s recurring subscription based, it’s based off of how many service lines that they’re bringing to the table. So today as a platform eVisit services over 50 different specialties across our 225 Plus customers. So that’s everything from Something as simple as primary care all the way through to something as complex as oncology. And so, based on the use case and the configuration needed on the platform, we will basically price it out for a specific service line or business unit. In that way.

Alexander Ferguson 5:17
Now the technology behind it, let’s dig into that a bit more. Yes, I love tech. So what are the different aspects, your own IP that you put into this that is providing value?

Bret Larsen 5:27
That’s a great question. So the platform is, is is proprietary from the ground up. We we just to kind of walk you through the user flow workflow, you know, as a patient, you know, you most patients will never know they’re actually using eVisit software. It’s white labeled or custom branded, as you know, Florida hospitals, hello, Well, II care, or essentially immediate care, or, you know, on our Health’s actually on house calls, he visit there, there are healthy visit, you know, and so we actually come to the table, patient will enroll, they’ll go through the intake process, which looks and feels very much like the experience you’d have in clinic. So we collect your, your demographic information, we collect your insurance information, we ping the clearing houses to help understand what your what your co pays are, and your reimbursement rates are, how much your deductible you’ve met, you select your pharmacy, you submit a credit card to pay to pay for the visit. And then and then you’re you’re provided the list of providers who you can select from. Usually it’s your own doctor, but there may be other physicians or physician’s assistants or nurse practitioners alongside that, who may be more readily available. So if it’s something a little more urgent, you can you can click a visit on demand or you can schedule a visit out into their calendar. Once you’ve done that, the provider receives a text message notification that they have a patient in the waiting room, they log in, they can review your chart your medical history and information. Again, this is usually your doctor. So they have a lot of information on you already. But additional information to supplement that and they can accept the visit and you’re face to face with your physician. And they’ll go through the same experience that you’d have in clinic face to face. They’ll ask about your symptoms, they’ll they’ll they’ll work to diagnose and then send a prescription to your pharmacy if needed, that you can pick up in about 10 minutes after the visits over

Alexander Ferguson 7:24
brilliant so that that whole patient experience all walking through that would normally happen in person can be done online, giving this whole platform for whether it’s a how small do you go as far as a local clinic or something?

Bret Larsen 7:40
Yeah, we so we find our sweet spot is typically clinics that have more than 15 clinical providers. We used to in the very early days, we sold the visit to single private practice clinicians, and we just found that it was the platform was was a little more robust than what they were able to handle. You know, the support you need internally to get it up and going, we provide an entire team on our end. And we kind of need a team on the other end to help and implement the software

Alexander Ferguson 8:12
team on both sides to get this running. And the nice thing is you have all there, but it’s there’s still a lot involved. As far as then all the different moving pieces, what kind of partnerships have you had to develop? Other I don’t know, API’s or stuff with other types of technology that have now you’ve kind of incorporated into your solution?

Bret Larsen 8:31
Yeah, that’s a great question. So one example of that is, so we prescribe, or we enable our customers to prescribe to over 70,000 pharmacies nationwide. That’s in a partnership with Surescripts. So we leverage the Surescripts network, so that we can access e prescribe into those organizations. You know, we’re we we partner with AWS for our cloud infrastructure, you know, they cover our BAA and make sure that they help us stay HIPAA compliant. In addition to all the things that we do internally around that we have we’ve done some pretty unique work in video, from from like a to a video perspective that integrates best in class video, depending on a lot of things that are that the patient is experiencing. So whether that be you know, low bandwidth, or they’re on their cell phone, or they’re in a rural setting, we can help identify what video technology is going to going to be most conducive to that environment and dynamically pulling that video technology to be able to transact that so we have multiple different vendors in that regard, and act more as a relay system to kind of swap in and pull out what’s going to provide the best experience for the patient.

Alexander Ferguson 9:43
Gotcha. And then going forward, you have other plans with obviously, you have all this data you have all this information for these for the providers as well as the patients. You have ideas or thoughts on how you can even more technology could apply or services you could be adding in

Bret Larsen 9:59
you Yeah, we’re looking to the future, we’re really focused on how do we help hospitals deliver across the value chain for patients in a care setting? So you know, what that looks like, kind of categorically is how do we help hospital systems attract new patients? You know, if you look at any given Hospital, a large system in the country, they’re they’re acquiring urgent cares. They typically lose money in urgent care, but they’re continuing to acquire these locations, because it’s, it’s top of that, if you think about it from a marketing perspective, it’s top of the funnel lead gen, to to the hospital where they’re actually profitable on those procedures. So how do we help hospitals attract new patients while keeping costs low? How do we help them engage those patients in their care? You know, in here in the US, I think probably globally, consumers were we are very reactive to medical needs and care, right? Like I don’t go to the doctor until I have a sinus infection or until my appendix is about to explode, or whatever the case might be. How do we help consumers become more active in their care, and switch hospitals from thinking of us as patients to consumers. The third is care delivery, which is what we’re doing today, we’re helping hospitals accelerate the way that they’re delivering care and simplify the way they’re delivering care to their end users. The fourth is how to help them monetize care, more, more straightforward, and more simply, both for patients but also for the systems. I mean, the amount of work and rigor that goes into submitting a medical chart is is mind blowing. And there are reasons for that. But it’s, it’s it doesn’t. It’s not conducive to a great experience on either side of the equation. And then the fifth and final is reengagement, so once someone’s received care, how do we help them stay engaged with their care providers to produce better outcomes more consistently,

Alexander Ferguson 11:52
there’s really automating and helping through that entire process from first time a new patient, acquisition to all the way throughout, that’s a powerful system, I can see I can see the vision. So you started this, this five years ago, started out what kind of hurdles have you had to overcome in the last few years that someone else can learn from, that you’ve had to go through?

Bret Larsen 12:18
Oh, man, all of them. You know, I think I could go through every, every, everything, I think that every founder learns over and over and over again, with every company, I mean, you’re worried about cash flow, you’re worried about product product market fit, you’re worried about, I mean, everything that comes up, it’s it’s a new hurdle. You know, I some of the things that I think if I could go back and coach myself five years ago, is, you know, I think one of the biggest things is, is how you work with people, you know, so just different team members have different motivations. Some people, some people were there for the paycheck, and they and they, you can send them with more money or more options, or, you know, different incentives that actually get them motivated. Other people could care less about that, you know, some people want to be praised, publicly in front of the entire company, other people want you to pull them aside. And it’s really, it’s getting to know your team and learning kind of how, how they how to receive feedback, how they like feedback. And, and understanding how to do that. The other thing is just how you yourself scale, as a founder, as a CEO. Most most people and this is there’s nothing wrong with this, most people can move, you know, one to two stages of an organization as it grows. In order to move more than that, you you really, it really is a constant reinvention of yourself. And when you’re in a high growth scenario, those stages don’t come every five or six years, they come every five or six months, right, like you go from product development, and not having any revenue to moving into revenue. And you go from $1,000 in monthly recurring revenue to, you know, to $8,000 in monthly recurring revenue in the space of 13 months. And there’s some real growth challenges that come along with that and, and the way that you managed and, and applied things, when you had $1,000 in recurring revenue and six employees is very different than what the company needs when you have a million dollars in recurring revenue. And you have 25 employees. And so, you know, the that’s, that’s really for me, if I could go back, it would be get a business coach way earlier. Map out the milestones, you know, make sure you know, you need to be focusing on the big rocks that get your closest milestone and make sure you know what milestones are after that. Yeah, you make

Alexander Ferguson 14:48
a great point that as the CEO or founder, if you’re planning on scaling, you’re going to have to reinvent yourself for each of these new stages and plan for it. Great point that and realizing you need to plan for, as you said, it’s different when you’re smaller has less employees less revenue than when you’re already scaling. You also mentioned product market fit, did it take a little while to find product market fit? And when did that happen? You know,

Bret Larsen 15:14
that’s, that’s really interesting, I think at eVisit, what we recognize we grew really, really fast, very early on. So I would say we found some semblance of product market fit pretty quickly. If you look at traditional startups or companies, they typically spend the first two years trying to figure out the right product and the right market and the right customer and everything in between. We we got some really early like, really, really meaningful, early traction. And then right around 24 months into into the, into our growth trajectory, we started to see some some data points and some themes that made us realize that maybe we weren’t maybe we weren’t targeting the exactly the right customer. You know, I mentioned the early days, we sold anyone who had a credit card and $99 a month. You know, and as we started to analyze the data, we realized that those customers didn’t use the product, the same way that our larger customers who were spending, you know, $25,000 a month we’re using it, and they want adopting it as quickly. And they were five times more likely to not renew their contracts when the contract came up for renewal. And so it’s hard. I think everyone’s looking for that magic bullet where like, you just find product market fit. The reality is, the market changes so rapidly, you know, things are happening so quickly, that you’re constantly trying to find product market fit. You’re constantly like if you’re growing, you’ll constantly be faced with that challenge of okay, what is Product Market Fit look like tomorrow or the day after? Because it’s not gonna be the same as it was today because the product, the markets changing and the product change.

Alexander Ferguson 16:55
I appreciate that point that you’re constantly trying to find product market fit. Have you ever heard the concept of crossing the chasm from early adopter to then early majority? Do you feel that you have crossed said chasm and now gotten to the early majority?

Bret Larsen 17:09
No, no, I don’t think I don’t think the market has crossed the chasm yet. You know, it’s, it’s telemedicine has been around for decades, you know, 30 plus years. I mean, talking to one clinician about a medical chart qualifies as telemedicine. I think the recent the recent shift in telemedicine, the recent kind of what we’re finding ourselves set is is a truly a virtual care platform and enterprise wide solution that can sit across every service line of care, that allows you to have one digital front door to the entire system as a patient that allows you as a system to provide the patient, one entry point and then to be able to triage that patient to the most appropriate point of care as quickly as they possibly can to provide the best outcomes and service. And with insurance like like these large tech enabled service plays. As patients, we have more options now. And local healthcare infrastructure needs to compete with that. And I think I think many of the of the more forward thinking ones are starting to come around to that thought, and then they’re the ones that need to adopt to get to that early majority.

Alexander Ferguson 18:22
Looking forward, then, five years from now, where do you see you guys?

Bret Larsen 18:29
Five years from now, we’re the market leader in remote care delivery. You know, we’re already we already have some massive wins. Earlier this year, we were recognized by Forrester as one of the top 13 solutions in virtual care alongside some of the largest providers of virtual care in the country much, much better funded a lot more time in market. You know, I say this a lot, but even had the advantage of we’re not so early that we’re the word we’re spending massive amounts of capital to educate the market. And we’re not so late that we’re spending massive amounts of dollars trying to replace an incumbent solution we have. I see you hear a lot of founders say this, but a lot has a lot to do with it. I’d like to say it’s because everyone else is just remarkably brilliant. Reality is we’ve gotten really lucky. And we have we do have really smart people though. But go ahead.

Alexander Ferguson 19:20
And so it’s good to recognize that it’s it’s the luck and knowing that that’s where you want to go, you’re already poised in the right place the right time with the right team. What hurdles Do you see that you’re going to need to overcome though, in order to truly be the marketplace leader?

Bret Larsen 19:37
It’s continuing to innovate. There’s a lot of really bright well funded companies in the market, the market from the from an outsider’s perspective looks really crowded. The reality is once you get in and you start to look at nuances, there are very few solutions that are providing total solutions like total solutions across across the value chain of healthcare for these large health systems, and that’s what really needs to happen. We need to consolidate the patient experience and make it more consistent. Because with consistency comes repeatable outcomes. But you know, it’s all it’s all the same hurdles, we’ll continue to have to try to find product market fit, you know, making sure that we are helping our customers succeed by educating them on best practices and implementation, onboarding, you know, it’s, it’s, it’s going through the motions of how do you how do you help the customer learn how to use your product, I think that’s been one of the learnings for me is, as you’re going to market, you’re trying to sell the customers, we’re selling to multi billion dollar organizations with very intelligent executive teams and strategic teams. And, and I’m the expert, when I step into a room with those with those individuals, it’s intimidating. But I’m I know more about virtual care and the implementation of virtual care than most anyone else in that room. And coming to the table as a trusted partner, and instead of you tell me what you want to do,

Alexander Ferguson 21:01
that’s a fantastic point to bring that as you enter and continue to grow, realizing even though you go into big company, you need to recognize that you are the expert, and you can bring that confidence with you. for it. So for you, what are the points he said, You need to innovate constantly innovate. So how are you innovating? And where do you go for news and thoughts for new ideas? How are you innovating?

Bret Larsen 21:20
I go to my team. And to be honest, I I think I’m as a CEO, I think your role is to enable innovation, your if the innovation itself always rests on you, then that’s a very small sample size. Right. And, and your ability to actually get anywhere is is limited dramatically. I think one of the challenges of growing quickly is constantly surrounding yourself with with the right team members. And at visit, we’re fortunate to have a super strong social mission alongside a very strong financial mission. So it attracts amazing talent we’ve got we’ve got an incredible team. But I think the places I go for innovation, our team members, specifically the frontline team members who are seeing, seeing the challenges that customers face and under and helping those customers solve those challenges. You know, I think a lot of times innovation comes out of iteration, you know, you you it’s not always a huge firework of an idea that this is going to change everything. It’s small changes rapidly, till you start to see those outcomes

Alexander Ferguson 22:24
for you personally, in growing in your own leadership ability and growing the company. Are there any books that you’re reading right now? Audio books, podcasts that you can share?

Bret Larsen 22:34
Yeah, I think I think my go to podcast right now is masters of scale by Reed Hoffman, I find that a lot of things that most tech companies are doing, or most industries are putting into practice are things that are sometimes overlooked in healthcare, because of how guarded healthcare is and how, you know, most of the companies when we started out their go to market strategy were trade shows. You know, we took the approach from a demand perspective about content generation thought leadership and creating a demand gen system. And I was told a lot of times, no, that’s not how healthcare buys. And we scaled really nicely doing that a lot of companies are doing that now. You know, so I tend to go masters of scale is great, because you’re learning from Google story and LinkedIn story. And you know, Airbnb, you’re seeing how those companies scale, there’s always application back to a different niche or industry about how to apply those tools.

Alexander Ferguson 23:32
I need to read that book. I’ve been hearing it several times. And it’s a great point to look at into other industries and see how you can apply that to your own because most likely your own industry is not looking at that one example, I’m gonna sign up. Cool. Thank you again, for joining. Is there any other thoughts or that you’d like to share with with those who are listening, whether they’re entrepreneurs or folks who are trying to build their own product or just tech technology enthusiast intrigued and how it’s being applied in other industries?

Bret Larsen 23:57
No, I think I mean, I think the most important thing is, is one of the things I’ve learned over and over is, is identify your your MVP, your minimum viable product early and just get it out there. You know, it’s, it’s a lot of us spend so much time you know, trying to, to craft the perfect solution when in reality, you can validate a lot with just a webpage and the right messaging, and a few few $100 You know, and save yourself a lot of pain and ache on the on the back end of building something that no one actually wants.

Alexander Ferguson 24:29
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