Entrepreneur Rx_Ryan Grant: Audio automatically transcribed by Sonix

Entrepreneur Rx_Ryan Grant: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

John Shufeldt:
Hello everybody, and welcome to another edition of Entrepreneur Rx, where we help healthcare professionals own their future.

John Shufeldt:
Hey everybody! Welcome back to Entrepreneur Rx. Today, I've got the great pleasure of talking with Dr. Ryan Grant, who is a neurosurgeon, spine surgeon, and entrepreneur. So we're going to hear a lot about Nomad Health, which I know of, obviously, and then Vori Health. Ryan, welcome.

Ryan Grant:
Thank you for having me, sir.

John Shufeldt:
All right, so people are going to want to hear the story. So back up to the early part about college, medical school, and what was your undergrad degree and where did you go?

Ryan Grant:
Sure, going all the way back, I would say just looking at my own career, I was always interested in medicine. There are some extended physicians in the family, but not, none in the immediate family. So I remember even in elementary, medical, middle school, very interested in anatomy and got very interested in surgery working with my hands. My dad was a small business owner, so got very involved in accounting and financial statements, and negotiations, and so I eventually built my first company in the website IT space in my early teens. It still exists, never got big. And then I always wanted to go down to the medical school route because I was always fascinated by medicine. So I ended up going to University of Michigan for undergraduate studies in molecular biology, biopsychology, neuroscience, and then would stay on to do a master's in cell in molecular biology, was doing recordings on mice and rats, of pleasure pathways in the brain, electrophysiological recordings, so very hard basic science for a thesis, was doing grant writing, and then went on to medical school at University of Pennsylvania, and then got very interested in the entrepreneur world again, got involved in some medical device development, would go on to Yale to train in neurosurgery, and they would do complex, minimally invasive spine fellowship as well. I would stay on at Yale for a little bit and then got recruited to Geisinger Medical Center, where I was their only scoliosis neurosurgeon on their main campus, and then had also been recruited to come participate in their Centers of Excellence Spine Surgery program and stayed at Geisinger for several years, and then the pandemic hit.

John Shufeldt:
Wow, is that when you, so, back up, so you were doing, so you started early an entrepreneur, what kind of small business did your father own?

Ryan Grant:
He's a court-appointed expert witness. So medical malpractice, both defense and plaintiff work.

John Shufeldt:
So he was a physician?

Ryan Grant:
Now he's an economist, so computing the damages of how much is it worth? And so got to do a lot of plaintiff and defense, got exposed to that, got exposed to the mail side, got exposed to the insurance industry, so, and then just the small business owner entrepreneurship. So that was definitely a huge influence on the trajectory I would go, and always the status quo is never good enough, you can always challenge it, Ryan.

John Shufeldt:
Well, that was his mantra? That's very cool. So in medical school, you were doing some startups, start-up as well?

Ryan Grant:
Yeah, I got involved in entrepreneur-type work, medical device development, and then wanted to start a business again. And so, made a list of all sorts of things, one, would eventually become Vori, and there were other ones, there was insurance on the mail side that I had been involved in, and actually wrote a long business plan about med mail. Actually started to put a team together and raise money, and I'm like, This is boring for me. I'm like, I don't have the passion to sustain this when the going gets tough, so I shelved it, and so I tabled that because part of, if you're going to try to challenge the status quo, it's going to be tough, and if you don't have the passion to sustain it, then why spend time on it? So tabled that one, still, a great plan that, there were investors who wanted to put money into it, but it wasn't for me, so it still exists in a piece of paper. And then, went down medical device, so I do more medical devices. I didn't really have the patience to go through endless FDA animal trials, it's like ten-year process, sometimes a five-year, or 510K. I don't have that type of personality, I want to move much faster than that. Then just pure medical device development of leading it and then broke down to the things that always made me crazy as I was, went into residency, it's like getting a job is painful. Credentialing seems like it's from 1920, the medical malpractice was so interested in that, so put together a plan of how do you disrupt medical malpractice, credentialing, licensing, and then that would eventually become into the fastest way to get into that market if you're going to break it down, would be, try to disrupt staffing. And so myself and one of the other physicians at Yale came together to put a business plan together, we debated for a while. Which of us is going to leave practice to run this? Because you can't, you're not going to be a startup CEO and do it really well if you're also practicing medicine quite a bit, quite often. You can maybe be the chief medical officer part-time in the beginning. Neither of us were ready to leave practice, so that changed that. ... needed to bring on a founding CEO that would eventually become Nomad Health, which is one of the largest healthcare staffing companies United States now.

John Shufeldt:
Are you still involved in Nomad or did you sell it?

Ryan Grant:
No, it's still private. I'm still on the board, but otherwise not involved anymore. That allows me to do the new start-up full-time. I wanted to practice for a little bit, and so after all that training, so I did practice for a few years, so we scratched that itch. I think that helps solidify the thesis for me of what Vori would be, in fact, after working on the front line for several years, like the system is like beyond out of control. So we'll take musculoskeletal, spine, orthopedics, up to 50% of the spine surgeries have been deemed inappropriate or unnecessary. That hasn't gotten better in decades. Unnecessary knee replacements, depending on who you read, hovers around 25%, unnecessary hip replacements hovers around 10 to 15%. And there's been articles in prominent academic journals like The Lancet or Pain, even recently in the last two years that will go across most people with back pain literally, quote, get the wrong care across the planet. Is that acceptable? It's still the top cause of global disability, low back pain. One of the top spends, it's the top spend for most of the self-insured employers on oncology. Looks like it's pulling forward right now, but that's probably because elective surgery was unpaused, so it's top one or two. And as you audit the evidence, it becomes more and more fascinating. And so, there's lots of things the public doesn't know. Average primary care provider is not trained in the sector, and some statistics should be up to 60% misdiagnosis rate. So should the PCP be the backbone for back, neck, hip, or knee? You can argue the pros and cons, but they tend not to be that educated. And now pick on people like me. I'll pick on the spine neurosurgeon and the orthopedic surgeons. I look at my, I went to Yale and Penn and see what like, see what looks great for spine surgery. How much nonoperative conservative spine training that I really get? About none. The surgeons have a huge education gap in the nonoperative arm and most people don't think about it. So the analogy would be, if I sent you to the heart surgeon tomorrow because you have chest pain right now, to most people that's a little bit bizarre. Why wouldn't I go to the cardiologist or, so who's the corollary to the cardiologists in this sector as physical medicine, rehabilitation, also known as physiatry? But people tend to confuse them with psychiatrists, they like to go buy physical medicine, or rehabilitation, or nonoperative sports medicine. Problem is, if you ask the average primary care provider, never heard of physical medicine rehabilitation. And there's just this gap on both sides, so then in the middle of life, physical therapy, which is necessary but insufficient on its own to get people better. So there's a great article in the New England Journal of Medicine Catalyst, and there's a more recent update. If you want to do value-based care really, really, really well, you must practice the integrated care teams and integrated practice units. What does that really mean? That means a specialty physician and the physical therapist and a coached navigator actually working together. Every musculoskeletal institute I've ever worked in, in the real world. The transit physician and a physical therapist talk to each other in the real world, which is usually about zero. They're really food courts. So Starbucks and Sbarro Pizza sitting there in the airport looking at each other, they don't seat customers together. So all these musculoskeletal institutes usually share overhead. So I wanted to disrupt all that, and that's why I do full-time.

John Shufeldt:
Wow, but you said a little bit ago that Vori was something you thought of, was that back in medical school?

Ryan Grant:
I go back to some of my old documents about where this started to come from of some of my writings. I keep a notebook and still write, and would keep something on me. As you went through your rotations, most people for the back pain surgery didn't get better or 50%. There was too many people who didn't seem to get better from surgery. Well, it's not like 1% or 2% or 10%. There's too many people not getting better, and we keep doing this every single day. I was still fascinated by the subject, so I still went in and trained in it. And then as you start to dive deeper, it became clearer, and clearer the education gaps, so the things I wasn't taught. So I went and audited. What's the pain psychology literature? Say Orthopedic surgery, neurosurgery, physical medicine, rehabilitation, acupuncture. Like what is the state of human understanding of this field? Mindfulness, regenerative medicine, stem cells. What is the state of affairs? And put together a big white paper of, Here is the current collective knowledge. Here's randomized controlled trials, here's what we don't know, and here's putting it your best thing about. I didn't learn like 95% of this. So, and, becuase I learned how to operate. I didn't learn how to really take care of the patients that weren't in the operating room operatively that well. I know how to operate safely, pick patients, do it safely, get them better, and then you're done. And so as you watch how the care models are done, the care model, thoroughly convincing the musculoskeletal orthopedic sector is broken. It's the care model that's wrong and no one's really taking the time to overhaul it, and so I shut my practice down during the pandemic to try to work on overhauling it.

John Shufeldt:
Wow, and here you are.

Ryan Grant:
And here we are.

John Shufeldt:
So when did Vori start? Was that during the pandemic? Is that when you incorporated it?

Ryan Grant:
Yeah, we closed our seed round late summer 2020. So we're still only about just over two years old.

John Shufeldt:
Very cool, so give me a sense, and I know because you and I have had some past interactions, so I know about Vori, but give everybody a sense of exactly what Vori is, because it's very compelling.

Ryan Grant:
Yeah, so using all that thing, unnecessary surgery, top cause of global disability, what do we really need to do to practice well? So first was the surgeons in my opinion, and I think the evidence supports it, but the surgeons who might be listening to this might disagree, but here we are, is the surgeons are not the right provider to triage. Like the cart, the heart surgeon shouldn't be triaging chest pain, that makes no sense. And so first you use the right physician, specialist, because the primary care provider is not always educated in it. They might be able to take care of some of it, but when they escalate it, make sure they get to the right specialist, which is physical medicine, rehabilitation. Now the physician specialists drive some value on their own. The physical therapist also drives some value on their own in traditional care, or the PT, so that's what people know, but it's very clear if you want to become value-based care, you have to be a care team. So that physical medicine doctor and that physical therapist and a health coach navigator have to actually see patients and work together, not just be handoffs where they just, it's a bunch of silos, but actually work together, render a diagnosis together, make a plan together, be a team. So we're a virtual first offering that can practice medicine in all 50 states and the District of Columbia. On your first visit, you would see a physical medicine doctor, a physical therapist, health coach, navigator. We do a lot of shared decision-making. So Nancy comes in with ten out of ten back pain. It doesn't matter if it's acute subacute chronic fell back surgery we'll take care of it, we don't exclude, we'll take care of anything. And you do a bio-psychosocial spiritual motivational interview, which is evidence-based, and you find, you need to find from the individual what's most important to them. There's always something more important than pain. What if it's a pain issue? What are they missing in their life? That they used to have, that used to bring them joy, and you find from Nancy, the best thing that goes for joy every week is walking her kid, Tommy, to school. ... her care, but she feels she can't because her back was too much. So her care plan is literally walking with Tommy. We then build an evidence-based back pain care plan around her with the goal to get back to walking with Tommy. We'll do something called a red flag screen in that first visit. Are we sure you don't have cancer? Are we sure you don't have a fracture? Are you going paralyzed? Things that are really scary that we would escalate up, so make sure that we're not going to hurt anybody if it's just pain. Not to minimize, so uncomfortable, someone could be. You don't, you're not supposed to image in the first several months and then take people through that personalized regimen, and then we teach people a lot of things. If you don't teach people where pain comes from, they forever look. The average person doesn't know that you don't need imaging. An average person doesn't know if you're over 30, we're going to find arthritis in every joint. That's just called being human. If you've got one wrinkle and one gray hair, guess what? You've got arthritis. Doesn't mean we needed to do anything about it because people get these imaging reports ... for five cyanoses, severe, sounds terrible. And I might, that person might be running marathons still, it's out of context without knowing more information. And 85% of people will get better through a nonoperative conservative plan like this. The people who don't quite reach their entire goal. We do a lot of shared decision-making because most surgery for back, neck, hip, or knee, or near shoulder, really, if you audit the evidence, belongs in the quality of life operation. And what I mean by that is they belong in the facelift category. Nobody needs a facelift. Facelift surgery is a quality-of-life operation. If your wrinkles bother you enough as you age, you escalate to injections, you can escalate to evidence-based best practice facelift procedures. You don't need to do anything if it's just pain. The person doesn't incur harm if it's just pain. So really understanding from the individual, Are you bad enough to be cut open? What is the risk that this gets you better, and just making sure people really know their options because the medical community tends to talk too much about, Man, you need this. Well, that might be true. Is it an option or does it need? And we find that our surgical referral rate is about 3%. So it's not zero, but it's, then we get people to great surgeons when that makes sense. We're not anti-surgery, anti inappropriate surgery, these are people's loved ones, and we want to make sure that people have their options and exhaust their nonoperative options first.

John Shufeldt:
And so how do people get connected? How do patients then, connect to a Vori?

Ryan Grant:
A variety of ways. They sometimes find us in the wild, on Google, we get primary care provider referrals, we get first referrals even from surgeons to like, I don't know what to do with this person or can you help me optimize this person who does meet criteria for surgery? We get people through the benefits portal, from a self-insured employer, or through health plans as well. So a variety of different mechanisms.

John Shufeldt:
And then, really interesting, so what has been the biggest surprise for you in this? Because it's your description of it, so it does more than back, it also does basically anything musculoskeletal, it can deal with, correct?

Ryan Grant:
Back, neck, hip, knee, hand, foot, carpal tunnel, tennis elbow, spraying strains, failed back surgery. So what's been most surprising, as I'll take you back pre-pandemic, I was originally, it was the same care model so integrate, a true integrated care team, same people I just described, but we were raising the money to build clinics. And then the, and then do tech wrap-around. But in the pandemic, no one's coming to new real estate, so moved all the money to virtual. What's been surprising is the thesis hasn't changed. So we still park some of our own clinicians inside of some primary care provider offices. We have a growing network of in-person care, so we really believe in true hybrid care. What's been surprising, I think, how much further you can take virtual than I had originally thought, like the utilization of the Medicare arm. I was like, like when I was running the original, the Medicare arm, probably not going to use it very much. This is really going to be, and I was being ..., in my original thesis and Medicare Arm, some of that forced because of the pandemic, the COVID, is significant utilizers of for those who are more tech-savvy than you think. You can do almost the entire exam, it makes you make yourself be more creative so you can look for something called myopathy which is spinal cord compression, having somebody pick up a pen and see what they can do and twirl it around. You can have people stand on their toes, you can look at their gaits. It makes it more interactive, and when you audit some patients, they actually sometimes like the exam better because they had to do versus just a physician or somebody touching them had to do more. We know that virtual doesn't do it for everybody so, and so you maximize as far as you can go. And so I think the biggest surprise besides that, and there's a great article in McKinsey from February of this year, who's the biggest resistance towards the adoption of virtual care in the medical community if.

John Shufeldt:
No, not the patients.

Ryan Grant:
It's the physicians.

John Shufeldt:
Yeah, totally.

Ryan Grant:
Right, it's the provider. So the, so it's not the patients. McKinsey has a great article for those who want to read about it from February or March. And in the musculoskeletal world, so if you look at physician surgeon, who is the biggest resistance to the adoption of virtual care, and in this realm? In person physical therapy. Is the adoption of technologies by the actual medical community, is one of the biggest barriers, which I find fascinating. And it reminds me of like when banking or shopping went online. Like I remember when banking went, Oh my God, you're going to bank online? They're going to take your money, it's unsecure, they're going to steal your identity, blah, blah, blah, blah. Now nobody talks about bank, it's just banking. And I find this notion that people have to talk about the hybrid care is a little bit, I find it a bit funny, for all, because most of debates across the country right now is, you hear people talk that's virtual versus in person. I'm like, that's the right, in my opinion, the wrong conversation. Virtual is integral to it's just care, and I'm like, anybody listening to that how do you interact with your family or loved ones. You call them on the phone, you text them your smartphone, then you fly and see them or you see them at home at night. It's a mixture of in-person and virtual modalities, all day, care is no different. And so I think I think the people who are pushing that care should only be in person are ..., they always are ostriches with their head in the sand, and I think they'll lose long term. And they're the same resistors you find when banking went online, shopping went online.

John Shufeldt:
Education. In 2010, I did the virtual medicine business and literally, I used your exact same analogy. Look, you trust the banking, we got that far. What's the difference? And, you know, you know, your friends call you and ask for medical advice. And I thought ... with my friends, I can do with anybody, which was at least for me. And B, that was a that was a start of the business. So it's funny, ten years later, 12 years, we're still fighting that battle somewhat.

Ryan Grant:
And no, and it's fascinating. The other thing I would say is I never really thought about it as a physician because anybody who works in a hospital or has a medical license, whether they're a physician, physical therapist, a nurse, almost nobody accesses the system like a normal civilian. So how did everybody in the hospital access the system? They called their buddy down the hall. If they work in a doctor's office, they off the doctor, they walked up. No one's accessing the system, calling the phone tree, doing anything that you're supposed to that everybody else does. And if you have a doctor in your family, they call you.

John Shufeldt:
All the time.

Ryan Grant:
And so what does the average person do, who doesn't have access to that and doesn't work in healthcare? Like what is their, how difficult is it for them to get an appointment? What does that look like? And I remember when I was still inside the academic centers and people working on care design, and we would be in this boardroom, I stopped and none of us in this boardroom have ever accessed the system in the way that we're just trying to design it for us. So it gets me back to like the Jeff Bezos quote. How well do you know your customers? And are you really building for your customers or are you building for what you think your customers want and you really building for yourself and you didn't test it and you end up with a Segway?

John Shufeldt:
I love that. I love that ... on this. Steve Jobs absolutely went head over heels for the Segway, but the product market fit was never there, but it's a very cool thing. What has been, so one of the things you said which is going to concern some folks is that you had to make the decision with Nomad and then you made the decision with Vori, it's like, Look, I can do one or the other, but I'm not going to do a startup founder and CEO. I think a lot of physicians don't have that luxury, and so they're going to have to figure out a way to, and I was one of them, to weave the two together and still practice medicine while they're doing the next big thing. What's your advice for them? Because you've done it the other way. You've done it the all-in way, which takes a lot of balls, frankly.

Ryan Grant:
Yeah, it's a great question. Nomad was, I wasn't mentally ready. I still like, I still wanted to practice, didn't want to leave medicine yet. And so that's, so the advice was check your own ego. If you feel like you're going to be 100% practicing and a full-time CEO, sure, you never will get a big company and you'll never move the human race forward. So I find the, a lot of people who I've talked to, I find some of the very interesting is the amount of ego. While I'm the founder, I have to be the CEO and I'm going to practice full-time, right? Well, that's, show me somebody who's really done that at scale, as doing both. Now, there's other ways around it, you can bring on a team to dilute yourself so it's checking your ego again and giving ownership to others, because now it's a team-based, it's about the mission. So I would say it's mission, then team, then self. And so if your cross ranking is the opposite, it will be, you will struggle as an entrepreneur, I don't think you'll be successful. And then I think I did try to do neurosurgery part-time for a little bit, Oh boy. So the cases that gave me the most joy were cancer cases. So spine tumors, scoliosis cases, which is like the huge spine deformities and lots of screws and rods, and I'm moving to a part-time practice, those are much higher, higher-risk cases. I did not find it was fair to the patient. If I'm not doing those cases every week, I should give those cases up. So moving into a part-time practice reduced myself to, for lack of a better word, more bread-and-butter surgery, which is what most of it is, a single-level fusion, a lateral, what's something called an anterior cervical, a bunch of different cases that can be done either one night over today. Those are nice cases, but the ones that gave me the most joy were the ones that I tabled. So then neurosurgery was not as challenging for the thing. All of the cases that gave me the most joy, I just gave up. And then the next thing was something else, looking back, that held me to making decisions was debt. I had to take out all sorts of loans to pay for medical school and college and stuff. And so, I determined, how I'm going to buy after trying to buy a cheaper house. I was still driving a high school car. I was trying to be very frugal. Pay off your debts, live half your salary. Like, your later self will thank you. So don't go live, whatever your salary is, don't leverage yourself to the max because you'll be in debt forever. If you want more freedom of choice, live below your means, pay off your debts and your thinking, so I remember I paid off, so that's what I did. So then I paid off my debts. When the debts were paid off, decision-making became very different. There was not a financial motivator of, I need this salary to pay my medical school debt off. That was no longer part of the decision-making process, and so clarity of thought became much easier and became less scary when there wasn't a big debt bill coming again next month. How are you going to pay that? Pay them off. That means you have to change your lifestyle, make sacrifices, though, to do that.

John Shufeldt:
Yeah, that's so true. I literally have physicians, I have this other business and physicians frequently call me and say, Hey, can you advance me my salary? I'm out of money. And I'm always thinking, you make 350, 500 a year. How are you out of money? And I get the fact that everybody has debt, or most people have debt, but come on, we can do better than that salary and the money.

Ryan Grant:
Absolutely, like 350 is, foreign people listening to us, like the average American is like 50 grand, 60 grand, 70 grand. If you have that earning power as a physician, can you live on 150 for several years and take all the other money and pay your debts off in five years? We can, if you make that, you make that determination, that means you're gonna have a smaller house. That means you're going to have an entry-level car. But when you have all that off, your life, life will be lot, much less stressful.

John Shufeldt:
Yeah, you'll sleep better. So there was, so, you know, I would say what you did I call burn the ship mentality. You know, you put your neurosurgery on hold and you go all in with Vori. With Nomad, it was like, I can't do both and be successful. Okay, I'll be all-in in medicine. In my assessment or my assumption at time was, boy, those people who burn the ships, they have a much better chance of success because, you know, is that a whole difference between the chicken and the pig and a ham and egg breakfast? The chicken's into it, but the ham's, the pig is committed. So I got introduced to this book called Originals by Adam Grant, and he talked about in this book, he says it turns out that people who hedge their bets, who continue their day job, so to speak, end up having a better chance of success because they're less freaked out about this lack of salary. But I think with your perspective of lower, you know, live below your means, that might leverage that a little better or hedge against that a little better. So maybe that's why it was easier for you, because you were living below your means.

Ryan Grant:
No, yeah, I would say that my decision-making, when you have a huge debt load of hundreds of thousands of dollars, like I financed my own education through debt, like what most people do, and then, no one's to pay it off except yourself. But I didn't want it over my head, and so I just was, live below the means to get it done. And I like Adams's quote, I'm also biased related in terms of being original and thinking different and similar to that type of philosophy would be, so much in Colin's work but books like Good to Great of having an unrelenting faith, unrelent-less faith that you can figure out what to do, but also at the same time looking the brutal facts in the mirror of what reality is, of like, things are going to take longer. It's going to take more capital than you think. You're going to think, you're going to, I don't know anybody who in a startup who doesn't have some type of imposter syndrome at some point like, am I crazy? Yep, yep, yes, and am I the right person to do this? I gave up all this life and took a 80% pay cut and my family thinks I'm nuts. I'm like, You are nuts, but Steve Jobs quotes, it's the crazy ones. We're crazy enough to make the leap, who try to pull it off.

John Shufeldt:
Yeah, the same thing, change the world. Well, as we wrap up. What, because, like I said before, there's going to be a lot of physicians who are like, okay, this is badass, I want to head down this path. What advice would you have for physicians to, who listen to this and want to start, and they're like, hey, I want to be Ryan Grant, I want to start down this path?

Ryan Grant:
Talk to people that you want to be like. So like if you wanted to be a surgeon, you would go talk to surgeons. If you wanted to be an astronaut, you could go start talking to astronauts like, so I would say the worst advice that you can get if you really want to be entrepreneurial is inside of a hospital. That's like the status quo. That's where the status quo will live. And they're not bad people, but that's like trying to overhaul the DMV, like good luck. And so, I always say the worst advice to get, if you really want to be innovative, is likely inside of a health system. So it's likely it's not likely your colleagues, but maybe. So you have to listen to your own drum. So your chair, if you're in a formal academic system, is going to think you're nuts most likely, and are going to and most likely, most academic systems, not all, will poo-poo you. So you're going to get a lot of criticism, but sometimes you know that you're on the right track. And be willing to not let the critics kill your dream or your idea get past that. It's growing a little bit of a thicker skin like all these people are going to tell me I'm an idiot, you're going to hear that and you're stupid, and go do it and go figure it out. Because the only person in control of your own destiny is you.

John Shufeldt:
Amen. Well, Ryan, working people learn more about you, learn more about Vori Health?

Ryan Grant:
Vori I think go to our website, www.VoriHealth.com, V O R I. You can Google it too. It's easy to find me on LinkedIn. Email is there, so don't be a stranger, always happy to connect when it's time.

John Shufeldt:
Excellent, well, I'll have everything in the show notes. And if physicians, and as you were talking, I'm thinking of people I know that I'm going to refer to you and I have somebody right out of the gate with failed back. What's the easiest way to refer patients to Vori Health if you're a physician? Just online?

Ryan Grant:
Yeah, they can go to the website. There's one 800 number there. People can refer directly to us through an EMR, so there's a variety of different ways. We accept most insurances and if we don't, there's also pretty reasonable cash rates.

John Shufeldt:
Great, and you said you've already raised your series A. Great, good, what's the next phase? Series B, obviously, but when are you going to do it?

Ryan Grant:
They are looking at, just looking at the macroeconomy and it's like what's going on, and inflation and stuff, probably not raised until '24, but we'll just sort of watch, what the, what's happening in the industry. Like I would say, as you look at valuations across the board, there's, lots of things have reset and there's been lots of corrections. And just what is, the thing this is that new world is here to stay. What happens with CMS in terms of telemedicine regulations? All states recognize telehealth now, so the practice of medicine has been protected, but that's not all the insurers. So like the Blue Crosses of the world have lifted their regulations that you can credential providers or cross state lines on a virtual side. Other health plans that move back to like 1920, horse and buggy. We only credential in-person people here and are ignoring telehealth. So I think the health plans who are following where the technology is moving will beat out the health plans who are going back to ...

John Shufeldt:
Yeah, so true. Well, thanks, this has been amazing. I really appreciate the time and the insight. You have very, very sage wisdom, so thank you.

Ryan Grant:
Thanks for having me.

John Shufeldt:
Pleasure.

John Shufeldt:
Thanks for listening to another great edition of Entrepreneur Rx. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. Thanks for listening.

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