May 1, 2023

Episode 259: Dan Goldsmith, CEO of Tendo

Throughout his career, Dan Goldsmith has focused on how the application of technology can change the world. His work in life sciences, education, and healthcare has allowed Dan to make an impact on a global scale and gain insights from hundreds of organizations. Dan is currently CEO of Tendo, a software company focused on seamlessly connecting patients, clinicians, and caregivers throughout the care cycle. Prior to Tendo, Dan was the CEO of Instructure, supporting the teaching and learning needs of more than 30 million students and teachers using Canvas. Dan also spent 8+ years at Veeva where, as Chief Strategy Officer, he helped the company IPO and become the leading software provider to the life sciences industry. Earlier in his career, Dan held senior executive roles at Accenture, PriceWaterhouseCoopers, and IBM. Dan is an active advisor, investor, board member, and philanthropist. His service spans public, private, and non-profit organizations. Dan graduated from the University of Rochester and currently resides in the Philadelphia area, but he can often be found on the Silicon Slopes of Utah or working with organizations in Silicon Valley.

Julian: Hey everyone. Thankyou so much for joining the Behind Company Lines podcast. Today we have DanGoldsmith, CEO of Tendo. Tendo is a software company focused on seamlesslyconnecting patients, clinicians, and caregivers throughout the care cycle. Danis so exciting to chat with you, not only because of your wealth of experiencebuilding startups, being around startups, but also you know, what you're doingwith Tendo, which is I think, tackling a huge problem in the, at least thehealthcare industry, which is the connection thing.

Finding, patients, the right careproviders. Helping providers, not only acquire new patients, but even retainthem and figuring out the best way to connect those two when you know, it'sbeen fairly fragmented as people move and change and, and, In all differentways. And, life changes and things like that, there's, o oftentimes becomesmore and more barriers to connecting those two when, there are obviousincentives on both sides to offer care, receive care, distribute, and, and allthose things like, but before we get into Tendo, what were you doing before youstarted the company?

Dan: Yeah, sure. So Julian,first off, thanks for having me here. Really excited to spend this time. You'revery high energy. So I'm looking forward to a good, a good engagingconversation here. But I think your question was what did I do before Tendoleading up to that sort of influenced my career? Just, just real quick and Iknow we'll get into more details, I've, I've been super fortunate throughout,last 25 plus years to have amazing opportunities and incredible.

Mentors and, and as an entrepreneur, I,by the way, I don't know when someone's considered a serial entrepreneur. Is itlike two times, three times? I don't know. But anyways, throughout my career,one of the things I've learned is focusing on both difficult and importantproblems was part of my ethos and part of my personal mission.

So I've spent my entire career focus onindustries like life sciences, education, and now healthcare. And if you lookat part of the common thread across each of those industries, Is is not onlyabout innovation and technology, which has been important thing, but more abouthow can we become an impact on people's lives, right.

In, in yeah. The case of patients,students, teachers, clinicians, the people we all have in our world in someway, shape, form or another working tirelessly and effortlessly to try and helpus out. So, so, yep.  

Julian: It's so fascinatingthinking about, where you've been able to kind of spread your impact.

And really another common thread I seeis, is it's heavily influenced by institutions and really large organizations,whether it's students, whether it's, patients in healthcare and what's beeninteresting around navigating, say, an environment that maybe has a lot of blueocean in front of it, but it's kind of has these fairly structured bounds interms of institutions that have been doing it for a while.

Legacy technologies and things likethat. I've been able to kind of, bring in new technology or new solutions, newinnovation into a, a, a kind of a, almost a I guess industries that are reallykind of legacy and, and prescribed and, and have all this infrastructure andthings around it.

Dan: So, so there's a,there's a few things I've learned along the way. First off was learning aboutmyself and, and recognizing even from when I was a, a kid. When someone wouldsay something is really difficult or impossible, I would obsess over thatthing, figured out an answer. So, you have to be a little bit crazy and, andvery persistent to be taking on what you're referring to is large scale complexproblems.

Right. The other thing is when you lookat, at industries like healthcare and education, like sciences, these areregulated industries. These are large industries. They have lots of movingparts and, and to your point, There are many legacy practices andinfrastructure components that mm-hmm in many ways in theory should enableinnovation and growth and change.

But yeah, practicality, they are a, a,an obstacle to growth and change, and especially industries where these are soconnected to, to sort of outcomes on people and critical outcomes. You have tobe very careful. With change as well. Yeah. Now, technology to me, in these industries,I believe needs to be a supporting player, not a star player, right?

There are incredible humans every daythat are working to take care of us in the, in these industries. And I'm afundamental believer in technology should be super powering humans, and that'sthe right goal for, for technology in these industries. However, there aresome, some elements that provide headwinds to change in innovation.

Right. An example of that is, is many ofthese industries utilize, use regulations or refer to regulations as an excusefor not innovating right. That fear of risk aversion. Many of these industriesact in what I call a PAC mentality. They're afraid to change unless everyoneelse changes at the same time.

So when you have an environment like that,it's very hard to see these moments of change. And interestingly enough, We'rein a, a really unprecedented period right now for healthcare. There arefinancial pressures like we haven't seen ever before. There's the, what I referto as the covid hangover, where, we're, we're still dealing with covid, buthealthcare will continue to deal with that hanger from Covid for, for years, ifnot decades to come.

And when you hit a moment of in timelike that, it actually is a driver for innovation and change. It causes peopleto move from the status quo. So those are some of the elements and drivers. Ofchange and technology can be a big part of that, but it's not the onlypart.  

Julian: Yeah. And thinkingabout, the ways in which the, when you break into that PAC mentality and, andwhat are the ways that an initial partnership is so valuable, and not onlylearning about your product, but also doing good work and expanding thatpartnership, breaking into industries that have, a high barrier entry beingthat, they kind of know each other.

It's, it, it's almost like a club in asense, and, and it really is difficult to. Not only change one person's mind,but kind of influence the pack there. How important is that initial partnershipand how much, are you kind of working with them to build your product and tothen, adopt into other businesses alike or other institutions to be able toservice your customers?

Dan: Yeah, so the firstfundamental challenge with that is, is there's this misperception that changehappens in these big bang moments when we talk about industry and globalchange. It actually is a spark that ignites the, the fire that drives thatchange over time. And so we get asked a lot. We were like, well, Dan, you andyour team are taking on a really big audacious, challenging goal.

I, I don't think healthcare is gonna beable to change like that. And I always tell it actually, I don't expect all ofhealthcare to change like that. What happens is you work with, one or two orthree or five of the early adopters who share a similar vision. Have a reasonfor change and are committed to that in a meaningful way from leadership, bothinternally and externally.

And as those first five demonstrate the,not only just feasibility, but the benefit of new ways of working and operatingthat will de-risk it and inspire for the next 10, and the next 10 for the next50. And at some point, you've created the momentum that will drive change atindustry scale. So that's the first thing you need to, to, to consider is that.

Like any change, you look at largesystemic change as something like Uber. Uber didn't just happen overnight.These things happen over a protractive period of time. So you need to bepersistent, you need to be patient. You need to stand by sort of the ideals andthe vision of what you're creating.

And you need to also recognize thatchange from from A to B never happens in a straight line either. You're gonnabump around a little bit on the way.  

Julian: Yeah. Yeah. Andthinking about Tendo, what was the initial inspiration behind the company? Youwere coming from different industries and then, moving into healthcare, youshow, kind of walk me through the journey, what really kind of, what was theproblem that you were seeing and, and what kind of, what made you decide totackle it?

Dan: Yeah, so the aboutthree years ago, myself and a whole host of other people, by the way, I'veworked with my sister Jennifer Goldsmith for the better part of the last 25years. And so I've had the pleasure of working with, with family, which is. Canbe both stressful, but, but it's a lot of fun as well.

But what we did is we actually assembledwhat we call a founding team. And the inspiration initially was the recognitionthat consumers of healthcare have a very different experience in healthcarethan consumers in just about any other industry. So when I look at my finances,I can see my entire financial help at a click of a button.

But for the life of me, I can't do thesame thing with my personal health. Right. And arguably my personal health isthe most important thing. So as we started pulling at these threads, we startediden identifying more and more the, the, the deficiencies in the experience wehave as consumers in healthcare and, and seeing the parallels in otherindustries where the, the consumer experiences, the frictionless navigation theway.

We as consumers consume information,services and access and translate information is so easy and has become thenorm. Why can't we apply those same methods and technology and and techniques?Now, what we did from there, Julian, is we went on a listening tour. Generallywe have a philosophy. If your gut says no on something, trust your gut.

If your gut says yes, do your homework.And so, yeah, our gut told us that there was an opportunity and it was time.For fundamental change in the way that people consume healthcare in thiscountry and, and ultimately beyond. But we wanted to do our homework to not tonot just make blanket assumptions.

We wanted to study healthcare. We did itfor about a year in why, why hasn't technology and consumerism taken hold inhealthcare like it has in other industries? So, so we spent the first year ofthe company with that founding team on a listening tour, talking to as manyhealthcare systems, executives, doctors, patients that we could get our hands.

Julian: Yeah. And thinkingabout on that journey, what were some things that you uncovered and, andparticularly, I think what's, what, what's, really important is like theincentive structure for, especially with the marketplace. Like what are theincentives for both? And it seems as though fundamentally patients wanna getcured.

Providers wanna provide care. So why isthat being, why is there so much friction in that connection process? Where,where does the septic structure break in in regards to how the, maybe theenvironment or the ecosystem is set up? What did you kind of uncover along thatjourney around, topics like that?

Dan: Yeah, no, it's, that'sa, that's a big question. There's a lot of things that we uncovered. I thinkfirst and foremost, let's start with what you highlighted. The, there are verygenuinely good. Intentions and, and fundamental passions for taking care ofpeople that exist within the core stakeholders of healthcare, right?

Patients want to get the best care theycan and have good outcomes. Physicians feel it's part of their mission to takecare of people, and they drive a lot of, of, of satisfaction out of that intheir career. And healthcare systems ultimately feel beholden to the mission oftaking care of people. However, yeah, we live in a world where financials havegreat influence.

We live in a world with regulationshealthcare systems in, in this country, especially many of them being not forprofit, operate in a world where they don't have pricing control. They don'thave margin control. As inflation has gone up over the past six months or so,the material goods for hospitals has gone up, but they still can only chargethe same things for the same procedures.

And interactions. So you, you have aneconomic model that makes it challenging to drive alignment from stakeholders.The other thing that we have within, in, in healthcare is there's been athere's been a focus and emphasis and maybe a, a, a a manipulation, if youwill, or, or a mutation of what the.

The healthcare record and transparency.So a couple decades yeah, ago, the government said, Hey, we need to move toelectronic healthcare records. And so there were a number of, of solutionproviders and technology providers say, Hey, we need to provide systems to beable to, to track and manage an electronic health risk record for patients.

Unfortunately, that morphed intosomething that was more oriented around revenue cycle management and billing.Yeah. Than it was for truly creating transparency, access and interoperabilitywrapped around patients. Yeah. So one of the things that we're working on issaying, how can we put the patients and the clinicians back at the center ofthe equation, recognizing that there are still financial realities of operatinga healthcare system in this environment.

Julian: Yeah. And how do the,how do the kind of, the, the, the change in, I guess, The goals, why is that sonuanced in terms of, I think with super popular, at least with a lot ofsoftware companies and companies within the last five years is focusing on theuser experience. And that pretty much drives revenue, right?

Retention, making your customers happy.It's all this philosophy, but why is it different in healthcare than in inthese other industries? Is it because of the systems in place? Is it because ofall the other kind of factors that they're bombarded with externally as aprovider? Well, what doesn't allow them to, or, or, or even the, the,technology companies building software for these practitioners and, and allthese records, why aren't they building towards the user and why have theincentives gone to a financial model?

I'm sure that's not their, answer. Thatwasn't their, their hypothesis or that wasn't their motivation. Yeah, but whyis that?  

Dan: Yeah. What everyone hears,so, I think this is where healthcare has been a laggard in evolution of theindustry. Other industries have become digitized and virtual and globalized ina way where healthcare is still a very localized industry.

Right? If I need to go and get a knee,at least in today's day and age, if I need to go and get a, a hip replacement,I can't do that online. I can't do that over Zoom, Zoom's good, don't get mewrong. But I don't think they're doing robotic surgeries through my through mymonitor yet. Oh. But you know, so, so, Effectively, healthcare has operatedaround a real, a more monopoli or polis realistic model.

So if I'm a healthcare system thatexists within a, a catchment area of zip codes, I sort of operate historicallybelieving that as people need healthcare, yeah, I'm gonna get some portion ofthat demand. And that's my customer base. So the priority on making the patientexperience better or a more consumer grade hasn't been a priority.

The priority has been more on, how do I,how do I maintain financial stability? How do I, increase and, and, and billin, in the, in an accurate and complete way. And how do I manage effectively myrelationships, with payers in the community to maximize my payer mix? So, yeah,that's what's changed or is changing fundamentally is the healthcare industrywrit large, is experiencing a new era of disintermediation where the financialmodels are not of the past, are not sustainable.

Healthcare systems can't acquire theirway out of this problem. And with more than 50% of healthcare systems this yearexpected to be, less than 1% or less than 0% margins. You have the impetus tochange that's necessary, and there's a renewed focus on how that patientexperience can correlate into more demand, more activity, and a differentfinancial model.

Julian: Yeah. And with thechange in the financial model, what does that mean in terms of like the, theconstruction of a healthcare company and, and business? Say, obviously you havethe provider, you have the doctors, they obviously have the bulk of, of the,the work and the nurses. So there's, there's a lot of individuals, not a movingparts, but in terms of like patient acquisition, what's like the previous like,Now structure in terms of acquiring new patients, and how is changing thefinancial model kind of, is that having any change on the teams that, providersare having at healthcare companies in focusing on acquiring new patients?

Have you seen a change in that atall?  

Dan: I have. There's a few,a few key themes that have come into play. One is this idea of hospital athome. So yeah, if I can serve individuals and patients in a better way at theirhome or in between their home and the hospital. Then I'm gonna bend the costcurve in terms of how I service and drive outcomes, health outcomes.

Secondly is there's a, there's a growingswell of demand around better transparency of information. So patients andcaregivers and, and clinicians for that matter, have more agency in making and,and, and information in making healthcare decisions. Right? I imagine Julianprobably, you and your family make decisions in the way that.

Myself and my family make, if I have ahealthcare issue, then then I'm probably trying to go that to that doctor thatwe've known and loved all of our lives. Those people we know, we trust. There'sa lack of information that's allowing us to make informed decisions asconsumers. Right. So, I don't know if I'm getting an appendectomy, like I don'tknow whether I'm, I need like, the world's best surgeon out there, or whetherpretty much any surgeon who, who yeah, guesses the minimum is probably just asgood as anyone else.

So we need to rewire the supply anddemand curve to, to bend the cost equation in healthcare. And that will open upcapacity and that will change sort of the low balancing across the healthcaresystem as well. And then a third thing is really the digitization of thehealthcare environment. How can we use data and information and digitizing thatexperience?

To, stream, reduce costs, streamlinethat experience, and be much more precise in the, the medicine and therapiesthat we're delivering to drive outcomes for patients in a much more efficientand effective and cost effective way.  

Julian: Well, something thatfascinating that, that, kind of inspired me right now as you were chatting,was.

Kind of coming up with an average for,say, a procedure and, and then measuring, doctors or providers on that average.And seeing, like you mentioned, if you need somebody who's extremely excellentbecause it's a fairly difficult procedure, or if, if an average, surgeon, Idon't wanna say an average surgeon, but somebody who practices it frequentlyand doesn't necessarily specialize, can, complete that procedure.

How do you do that when you know kind ofthe insights to not only. I guess practices and, and which provider you gothrough can have a huge impact on the patient. And almost like for me, I feellike, is it a liability risk? If you offer some insights and incorrectdecisions made, how do you kind of cater to the, the high?

I would say just like the high riskenvironment of offering bad information.

Dan: Well, I think, I thinkit's, it's not about good or bad information. I think it boils down to accurateinformation, right? Mm-hmm. Yeah. Patient should be able to see any provider.What procedures they've done, what the outcomes have been, have they resultedin in mortality, infection, readmission, re surgical rates, what should theybe?

And then I should also be able to lookat certain demographics and other filter criteria to say, Hey, if I need to geta knee replacement, for the physicians in my local area who have operated on,on patients similar to me, and what outcomes have they. Have they had, and thenI need to understand like what is the risk profile of, of different procedures,right.

I think like you and I probably, like ifwe were getting I don't know, an MRI or an x-ray or whatever, we probably don'tthink twice about who's administering that x-ray. Right? Right. But if someoneis, is doing a knee surgery, That we're gonna be a lot more critical about. I,one quick story. I had a real story about 15 or maybe more years ago.

My, my appendix became infected, right?So, by the way, I'm gonna give you some Dan Goldsmith PHI here, so it's allgood. I give permission, but so my impact, my appendix was infected. I had abad stomach ache. I went to the er, the ear was like, Mr. Goldsmith yourappendix is infected. We need to have your appendix out now.

I had no idea what was gonna happen. Icalled my wife. I started freaking out. I'm writing goodbye letters to myfamily. I'm like, oh my gosh, I'm gonna go under the knife. This is gonna behorrible. I don't know how I'm gonna survive. I call up a doctor. I'm not gonnagive the name here. This doctor was like head of the American Cancer Society,one of the top 10 rated doctors in the country.

I said, doctor, please, I'm about to gounder the night. They're telling me, surgeon ABC is gonna do the procedure. Dothey know what they're doing? Am I gonna survive now? I'm pretty sure like, Dr.Superstar said to me at the time, he said Dan, hold on for a minute.

I'm gonna go look into a few things. I'mpretty sure he put the phone down, ate a sandwich, came back and said, you'regonna be just fine. Right? That's all I needed to hear. All I needed to, Hey,Dan, you're gonna be just fine. So, so the moral of the story is if we canempower consumers and others with information Yeah.

We trust consumers to make informeddecision, and those decisions will rewire that supply and demand. So we knowthat the criticality of having the top surgeon for an appendectomy is notnearly as critical for having the right surgeon for me, for a knee procedure ora hip procedure, or a, yeah, a a, a cardiac, a cardiac procedure.

Julian: Yeah. And, andthinking about, obviously transparency is hugely popular and, and a lot ofcompanies are even throwing transparency into their pricing, to their businessfactors in terms of their values, but healthcare is different because of theinformation. So clinical and, and just somebody's personal kind of wellbeingand life and things like that.

How do you think about transparency in,in offering that between providers, between, with patients and providers, andwhat are the, some of the things you have to consider? That normal companiesdon't when thinking about, distributing and having transparent privateinformation.  

Dan: So look, I mean, thisis not a new topic.

I think companies need to not be afraidof navigating privacy and security. There's well ingrained me mechanisms andmethods to be managing privacy and security of data and information, right? Andthat that's not to say every once in a while we see in the news a server fallsoff a truck or some, someone gets an information, but, In healthcare, there's acouple things that need to happen.

First, there needs to be much more of aninteroperability information H Highway, so the people relevant to the carejourney of an individual can have access to that information in a much easierway to make informed decisions and recommendations. Secondly is we need totrust patients to be part of that equation.

So it's less about data security andprivacy, it's more about, what I refer to as sovereign identity management. Howdo I as a patient become the traffic controller of what my, where myinformation is, understanding what my information health history is and how itis shared, right? So we need to put that control and agency back in the handsof the patient and their loved ones and they can be have, have more control.

Over, you know how that information isconnected, but that doesn't exist today. It's a great opportunity for a companyto tackle on. There's some good companies out there trying to do it tender, nottrying to do that piece of it, but you know, we hope that they're. Someone helptackle that problem across the industry.

Julian: Yeah, yeah. Tell us alittle bit more about Tendo in terms of, what's been exciting about thetraction you've seen up to this far, how many users are on the platform, howmany providers, what are some, really cool and inspiring and stor stories thathave really kind of motivated you continue, but also what's the next phase ofgrowth look like for you?

Dan: That's great. So, sowe started in earnest about two years ago after our listening tour. And we'rereally excited about where we are now. Some unique things in the way we startedthe company. We're still very early stage. And we, there's some unique thingsin the way that we built the company. First and foremost, we, we wanted tobuild an amazing team, a team that's a combination of what we call SiliconValley DNA and healthcare expertise.

So some of the best and the best fromthe technology industry combined with the best and the best of the healthcareindustry that really have a vision towards, towards change. Secondly, we wantedto put capital fuel into the company in a way that allows us to pursue anambitious vision over a long period of time.

Without having to take shortcuts, makemistakes, take side avenues, and really maintain a focus on that long-termvision. So, we partnered with a couple VCs general Catalysts and Luxe inparticular, and we put about 70 million on the balance sheet early on in thecompany. We also have what we call this sort of strategic customer orfoundational customer model.

So what a lot of technology companies doin the early stages is they will. Build a small product and try and get a lotof customers and to get revenue flowing. So what we've done is we, we've verydeliberately chosen a handful of healthcare systems to work with exclusively inthe early days of us building products and the platform.

So our first product is focused on, onenabling patients to navigate the care journey. End to end, we go well past thedigital front door. So whether a patient is seeking, scheduling, engaging, orfollowing up in care. We're able to help that patient navigate healthcareacross, across providers. Secondly is we're building out capabilities forpatients to navigate complex care journeys.

So it's not good enough just to have,like filling out forms and scheduling appointments. How do we help a cancerpatient navigate care, an orthopedic patient, a heart patient? And then thethird thing, Julian, probably one of the most imp important and, and. Integralparts of our mission is we recognize that data and information is an importantpiece of solving this problem.

So we've built a whole data andanalytics enterprise to build what we call Tendo insights. And those insightsare driving things like empirical care journeys and helping the guide. What isthe personal care journey that makes sense for Dan and having that surfaceitself to both the patient and the clinician.

So we're working with about six or sevenorganizations. Right now, very closely. We don't talk about their names. We'llbe doing some announcements soon. We have some, made some announcements in thepast. But we have customers live on our platform. We have our data enterpriseup and running.

And over the next, 12 to 24 months,we'll continue to work with those, those early customers and bring on a fewother early customers. And then, yeah, they're much more broader into theindustry, but we wanted to work with strong focus to, to prove, yeah. The, the,a new model before we went too broad.

Yeah, yeah.  

Julian: Thinking about whetherit's external intro, what are some of the biggest risks that Tendo facestoday?  

Dan: So in terms of thebiggest risks, we, we, we live in environment right now in healthcare wherethere's lots of pressures. There's economic pressure. Yeah. There's never beena time that I can think of where.

Healthcare systems were required to shownear term economic r o i to support anything they're investing in. Sohistorically, when you look at the patient experience in healthcare healthcare systemshave done the best job they can, despite the fact that technology has beenfragmented and disconnected, right?

Healthcare systems haven't had a role ora consolidated view in the organization around a, a patient experience, andthat needs to change. And then third, healthcare systems haven't typicallycorrelated improvements in the patient experience with economic outcomes androi. So what we need to do is we need to draw connections to the fact that ifyou improve the patient experience, you'll reduce no-shows.

Patients will be better prepared whenthey show up for employments. You can reduce readmissions, you can identifypatients with high acuity that have a higher need for intervention, and all ofthose things are great for patients. But they also drive economic outcomes forhealthcare systems. So that's probably the biggest challenge we face right now,is just the, the pressures in the marketplace influencing the things that weneed to bring forward in our roadmap and our emphasis to make sure that we cannot only achieve the vision we've set out to, to achieve, but address the nearterm and acute needs within the healthcare systems today.

Julian: Yeah, I was gonna saylong-term wise, what's the long-term vision of the, so everything goes well.What's long-term vision of Tendo?  

Dan: Yeah, I mean, first,when I talk about Tendo, what we're trying to do is build an enduring companythat's having a really positive impact on people's lives and being a greatplace to work.

So that's the first thing we thinkabout. The way we measure success is are we creating better experience forpatients and is it driving better quality outcomes and, and clinical outcomes?So we'll continue to measure ourselves with that. But over time, When we lookover the long term, our goal would be that there is now a pervasive and moreubiquitous access point and navigation landscape for patients in healthcare.

Patients can navigate a marketplace ofhealthcare and environment healthcare, where they have control over their owninformation. They can make informed decisions and the the journey of gettingfrom, from sort of caused outcome and beneficial outcomes. Is much shorter andmore confident and less anxiety ridden than it's ever been before.

Julian: Yeah. Yeah, yeah. Ilove that. I, I like this next section I called my founder f faq. So I'm goingto hit you with some rapid fire questions. Let's do it and then we'll see whatwe're gonna get. I always like to open it up with this question. What'sparticularly hard about your job day-to-day?

Dan: What's particularlyhard?

Oh, there's supposed to be rapid fire.Hard about, my job is I don't get to interact with. With employees andcustomers nearly as much as I would like to. I would spend a hundred percent ofmy time doing that all day long, and there's just sort of necessary things thatneed to be done that, that prevent me from spending focus time in that way.

Julian: Yeah. What, what wassomething that you spend too much time on that you would like to spend less andthen little time on that you would like to spend more?  

Dan: The financial stuff,there's, there's a lot of budgeting and reporting and compliance things and,and it, it, it's, it's all necessary.

It's all important. My job is a ceo. Iactually, I don't, I don't want this to be more simplified, but my job CEO inmany ways is about, setting direction and removing obstacles. Right. Yeah. IfI'm doing my job well, then, then we've assembled an amazing team. My sisterand I as leaders of the company, our job is to assemble an amazing team, setthe vision, and then then remove obstacles to be able to get those thingsthings done.

So that's where we spend the majority ofour time.  

Julian: Yeah. Well, thinkingabout working with family, I, I, I, I'm the. The oldest of five. So I'm, onceeverybody else grows up, I'm sure that there'll be some relationship in termsof businesses, but for those you know, who do kind of navigate familiar or evenclose friendship relationships and founding relationships, how do you segment,business from, personal relationship, but also how do you.

Communicate and set, set expectationson, what the each person's good at and also where your responsibilities lie forthe benefit of the company. Being that the company's kinda the most, prioritykind of, I think focus of, of both of you. How do you kind of set those, thoseboundaries?

Dan: Yeah. Look, I thinkfirst of all, you need to understand that you can't have any ego or insecurity.There's no agenda. And by the way, that's, that's for anyone who wants to beclose on a, on a. A leadership team and, and, and teams in general. But when itcomes to family, there's no one you wanna let down.

Like, you'll work harder and be morededicated. The last thing you wanna do is let down a family member. And soyeah, that dynamic can work really well. What, what, what Jen, my sister Jenand I do is we are very open about each other's strengths and weaknesses. Weknow the areas we, and are very clear in our communication around where wedivide and conquer.

We also are each other's primaryadvisors. So we consult each other and recognize without, any ego or insecurityareas where we can ask for help. And knowing that in many areas when we combineforces and collaborate, it's gonna come up with better solutions. And then,when it comes to the dinner table, we don't talk about work.

That's a very important thing. I thinkwe drive our drive, all of our families crazy to talk about. Work a lot. Sojust knowing how to put work down. Enjoy family and having that personal timeis important.  

Julian: Yeah, yeah. I alwaysShifting back to Nin Tendo and the platform, what are some of the, obviouslyyou're working on these insights as you're driving ROI for, providers outthere.

What are some of the surprising insightsthat you maybe didn't hypothesize or didn't expect, or maybe these companiesweren't really. Had the expectations that, something was gonna be eitherpositive or negative, the impacting their business. What are some surprising insightsyou've seen kind of throughout this journey?

Dan: Yeah, so one of theareas where we do a lot of work with insights is around how quality is measuredin healthcare, right? And we look at quality rankings and, and ratings withinhealthcare. There's lots of systems like US News and Leapfrog and, and CMSrankings. And others out there. And so part of our insights tool really decodesthose things and understands that at a, at a deeper level than many others,some of the surprising things is how disconnected those quality rankings andoutcomes can be.

Yeah. From what information is importantin making decisions. So for example, one of the quality rankings aroundorthopedics, you can look up online, what's the top orthopedic. Department in,in, in the Philadelphia area, let's say. Mm-hmm. What many consumers don't knowis those rankings, in, in one of these particular systems is based exclusivelyon wrist and spine procedures that have nothing to do with hip or kneeprocedures.

So if I'm looking for an orthopedicrequirement, cause I need a knee replacement and I'm looking at these rankings,they actually have no correlation. So it's those types of things that arealways surprising. To me, I think the other thing is when we look at insightsin this, in this industry is the, the nature of data and information and thealgorithms that are used to determine quality outcomes, financials, and otherscan be very complex and convoluted.

And when you start decoding them, theydon't necessarily depict the reality that you would expect. Like the hip andknee procedures for example. Yeah. That goes into health equity is a big.Challenge right now. How do we look at and measure and understand equity andaccess within the healthcare environment?

There are no good metrics right now thathelp us understand true health equity within this country. And what do theenvironments look like in different cities and different environments? How dohealthcare systems best support equity? Yeah, we can see that in thedisparities and outcomes.

That happened within this country butthe data is still relatively opaque to help lead us to the answers to how wesolve these problems.  

Julian: Yeah, obviouslybecause it's popularized now with chatt p t, we've gotta talk about, ai,artificial intelligence, ml, machine learning and things like that.

I'm just adding all the buzzwords, sothe transcripts to pick up on seo. But anyways what, how, how has, this type oftechnology kind of impacted your, your company now and what's been excitingabout new developments in, these, whether it's machine learning models or toolsthat, have some kind of AI component.

What's particularly excited aboutintegrating new advancements in it that you think would be benefiting your, yourcompany? If, if there's anything,  

Dan: there's a lot, machinelearning has become moving into the fabric of most tech companies right now,most industries in one way or another. Machine learning can be very simple, itcan be very complex.

But the, the premise of machine learningand AI really is about iterative pattern recognition and looking at largescale. Yeah. Information to help inform decisions, drive precision, and createautomation. Right. So, so, AI and ML sit at the center of industries likerobotic process automation, sit at the center of, of new paradigms of, ofmarketing and growth marketing and understanding data at large scale.

They sit at the center of, of customersupport and inter automated interactions in ai, bots and in healthcare.There's, we're starting to experiment about. What AI can do. There arecompanies we're doing some work with a company called AI Doc right now. They'reusing AI to interpret medical images and they can text things on medical imagesthat can be really important in terms of the, the, the, the care of patients inidentifying things.

So AI is another tool I view in the, inthe toolbox that can help superpower humans get us to the right answers faster,and automate tasks that have higher precision and higher efficiency. So we'rebuilding that into some of the Tendo tools. We use machine learning within ourinsights to simplify work get it more precise answers, and, find patterns thatmaybe we wouldn't see with the human eye.

Julian: Yeah, discover to seethe impact in, in the little ways it could really drive ROI and your internalbusiness and, and really drive those insights for, for customers. And, it onlybecomes better and better as you use it. But yeah, it's exciting to, to seewhat those advancements will have in terms of their impact.

I always like to ask this questionbecause I love how founders extract knowledge out of anything that they ingest.So whether it was early in your career or now, what books or people haveimpacted and influenced you the most?  

Dan: Yeah. InnovatorsDilemma is, is one of my go-to. Books. I think that's, that's something thatevery, every individual, every business person should read.

Just my, my inherent nature is to alwaysquestion and sort of break things so we can build and do and figure out newways of doing things. That's effectively the innovator's dilemma. If you lookat the s and p 500 right now, versus 60 years ago, I think there's now lessthan 5%. Of brands on the ASM P 500 that, that 60 years ago.

So there's a reason why they've notsurvived over the last six decades. And the primary reason is the, theinnovator's dilemma. They've been afraid to disrupt their own innovation. Sothat's something I'll always keep in mind. Another important book for me is Dan,he's Power of Moments, right? There's a great story about the Magic CastleHotel, I think it is in, in Los Angeles being one of the top rated hotels.

And really the, the premise of it isabout how do you create these. Delightful unique moments and the power of thosemoments in creating affinity and, and loyalty and trust to, to to brands, toorganizations and other things. They're the unobvious things. The, the thisthis hotel has a Popsicle hotline where you can, call poolside and you'll havea an individual in a tuxedo come forward and give you popsicles, right?

So, so to me, I love the unobviousthings. So another book of Vine. That I like to, to, to cite as well.  

Julian: I love, yeah, theunobvious things is really cool because it like the experiential componentthat, that really ties an experience to a brand, which, the Popsicle thing ishilarious, but I, I could see it's like, an obvious takeaway.

You come away with that product and inan obvious moment you could tie, with an experience from a different user. So Ilove, I love that. That's, that's super cool. And then innovators dilemma.That's, that's fascinating cuz I, I, yeah. I guess, I guess disrupting your owninnovation. In a lot of ways is where a lot of companies maybe kind of, stop progressingforward.

Yeah. Own companies are extremely goodat it. And other companies, kind of miss on

Dan: that. And I think,this is especially relevant to the healthcare environment right now wherechanging innovation is necessary. However, so many companies, what they'll dois they'll say, Hey, this is the main thing we do and we've done for years andyears.

If we're gonna try something new, it'sgonna be done in like little bursts on the side. Rather than, thaninstitutionalize innovation the way we do things all the time and rewardinnovation. Right. Yeah. That's why organizations like Amazon and Apple havereally succeeded and thrived over time. Yeah.

They've been willing to question thestatus quo and, and, and build confidence and persistence in their pursuit of,of, of new ways of doing  

Julian: things. Yeah, I knowwe're coming up to the close, the episode here, so I wanna make sure that wedidn't leave anything on the table. Is there any question I didn't ask you oranything that we didn't talk about that you wanted to kind of touch on Rightbefore we leave here?

Anything left on the table? Dan?  

Dan: We we're at aninteresting time, as we talk about entrepreneurship and starting companieswe're at an interesting time. I'm sure a lot of your, your listeners arethinking about, oh my gosh, what do I do in this environment right now? Theeconomy has gone through all these fluctuations.

How do I raise money? How do I connectwith these Ds? How do I think about starting companies? We, we've seen thesemassive fluctuations. What, what I always like to share with you, say go backto the fundamentals, right? Yeah. There's, there's such a thing as good moneyand bad money, um mm-hmm.

Focus on those fundamentals in gooddiscipline. And, and this is a, not a sprint, it's, it's a marathon when you'restarting a company. And again, put that ego and insecurity at the side. Youneed to give yourself time to trust your gut and then do your homework. Youneed to go out there and learn and iterate and course correct.

And so I think that's, that's no moreimportant than it is now for entrepreneurs. And when you're starting companies,I think the hardest thing for companies and entrepreneurs and founders to do isto recognize when their original idea wasn't necessarily the right idea. And sothe most successful entrepreneurs.

That I, I've seen are ones that, thatrecognize when they need to course correct and absent perfect information, arewilling to make decisions. So yeah, I talk a lot about that with people, butthat's one of the things we haven't touched on.

Julian: I love that. I lovethat, Dan, it's been such a pleasure. Not only learning about your background,your experience, but also what Tendo is doing and how you're impacting yourcustomers.

Last little bit is for our audience.Where can we support you? Where can we find you? Where could we be a fan? Giveus your plugs. What are your LinkedIns, your Twitters? Where can we be not onlysupport of you, but also Tendo?  

Dan: So, yeah. Thank youJulian. Really appreciate it. Look, we're a community for change in healthcare,so we look at the health tech industry and the broader healthcare industrycoming together.

Expect greater than what we've had inhealthcare. Question why things are the way they are. Yeah. And, work incollaboration as a community to help create change within this industry. Don'tbe selfish because it's not gonna be one company that is the star company, thatthat changes healthcare and changes the dynamic for patients, clinicians, andcaregivers.

So go to or on a missionto connect patients, clinicians, and caregivers in a frictionless. And seamlessway and evolve and change that experience, but we can't do it alone.  

Julian: Amazing. Dan, it'sbeen such a pleasure. Not only learning about your experience, your background,but also what Tendo is providing.

And I hope you enjoyed yourself today.And thank you so much for being on Behind. Company Lines.  

Dan: Yep, Julian, this wassuper fun. Thanks for having me.

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