On the Health Record - Interview with Ryan Howard, Founder & CEO of 100Plus

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We recently sat down with Ryan Howard, CEO of 100Plus, a remote patient monitoring company that helps doctors manage patients with chronic conditions. You can listen to the full episode on our DrChrono podcast here.

Tell us a little bit about yourself and how you got started in this business.

Before I started Practice Fusion, I had previously been a product manager for a company that was bringing AI tools to market by effectively streamlining the Walmart supply chain. During that time, a good friend of mine got leukemia, and I ran the team-in-training marathon. While doing that, I recognized that when I die, my legacy would be that I added a fraction of a penny to the Walmart share price in the upside scenario, and that was the genesis that pushed me into healthcare. A lot of my skill set at the time mapped over to healthcare when I started working for a healthcare company, Brown & Toland in San Francisco, where I solved the problem of data exchange between practices. This is all around 2002 and 2003 when I also recognized that the average individual sees 18 different doctors in their lifetime, and that there are a quarter-million deaths simply from the unavailability of medical information and that other chart data should clearly flow from practice to practice.

You’ve been coached by some pretty famous executive coaches like Bill Campbell and Tony Robbins who are both highly regarded, among other coaches. What are those sessions like?

Bill Campbell passed away a few years back. He had a lot of interesting wins and losses. He founded a company called Go years ago that was incredibly well-funded with hundreds of millions of dollars, and it failed. He then went on to be the CEO of Intuit, and I believe he brought them from $60 million to $6 billion in revenue, so he had seen a massive amount of successes and failures. I tend to think we’re more defined by our failures over time than our successes and our learnings from them, and he had gone through that. Bill was an expert on venture capital fundraising and bringing a company public. He focused a lot on predictability-if a company was ready to go to the market and make a public offering, and if it wasn’t time to go.

Cora helped us navigate a lot of volatile personalities that we have on the boards. We had a lot of venture capitalists that were quite challenging, and it was just remarkable to see a five-foot-two Filipina woman take on these seasoned male venture capitalists and put them in their places, and she’s remarkable in her own right.

Tony’s a little bit different. He’s an investor in 100Plus. He is a lot like how he is on his podcasts and his other coaching efforts. When he’s with you, he focuses on changing your psychology through techniques like NLP (neuro-linguistic programming).

Two other notable coaches are Christina Harbridge, CEO of Allegory, and Melissa Derby, a renowned coach to Fortune 500 CEOs. Christina coaches a lot of the Ted Talk speakers, and she’s brilliant on her own. Melissa takes on a different approach and is incredibly interesting and has been a massive asset to me.

I encourage everyone to put a team around them much like this - people who you have known and seen conquer these different challenges. It takes that type of team to ensure that a true CEO is running at the top of their game, especially when you’re running a really large company that has a lot of value.

There’s a lot of people that have a regular nine-to-five and aren’t executives starting their own companies. Why should they maybe take on an entrepreneurial mindset?

I think that a lot of entrepreneurs feel like it’s never come easy, so I do think that the risk is real. I sold my house and by the time my last company got funded, I had a house in foreclosure, and I was four years behind on my taxes, and I needed two root canals. I don’t recommend that path, but I think that the inspiration can be a beautiful thing. I don’t think you need to go to these deep, deep extremes. Your impact can be a side job, or it can be helping on a smaller scale. It doesn’t necessarily have to be this binary outcome, quit your job, but I think it’s waking up and being inspired and making an impact on your own- it doesn’t have to be altruistic per se. I know a lot of people that are passionate about mapping the bike routes in San Francisco, for example. The barriers to entry are so low. It’s inspiring, and you don’t need to quit everything you’re doing to enrich your livelihood. You can do a side hustle that expresses your spirit of creation, which I think is cool.

How were you able to turn your idea into a business?

We started Practice Fusion in 2007. As I mentioned, I worked at a company called Brown & Toland previously, and it was a really large medical group, and I think that the best ideas come out of problem sets. Beginner’s mind is great sometimes, but understanding why things are the way they are is generally pretty critical. I saw that Brown & Toland in particular had a few thousand doctors on a management team. Every one of them used a different system to manage their practice, and at the time, 15-20 years ago, I couldn’t think of a single practice that had digitized records. Soon after I worked for a company called Grand Central, and the founder of that business was the largest outside investor in Salesforce. His name was Halsy Minor, and he really was taking what Salesforce had done and just made it generic for other apps and developers to build in the cloud.

Unfortunately, the Grand Central didn’t work out, but we knew that by putting the service in the cloud, we could move to a SaaS-based model like Salesforce, and it solved the price issue and the delivery issue. The third component of healthcare was these doctors needed to be connected to CVS and Walgreens for prescriptions and LabCorp and Quest for lab results for their patients. Because I had an integration background, I knew that each one of these connections was incredibly challenging to implement and required a lot of time to coordinate with the respective lab or pharmacy, so I knew that it required a platform approach that everyone could leverage with that connection. As we got going, we started seeing some traction, and we started selling the product for a couple hundred bucks a month. We struggled to get the doctors to pull their wallets from their pockets, so we went to a free model, but it was like $50 a month for support.

Then one day, I was on the phone with a doctor who didn’t want to pay $50 a month. He offered me $25 a month instead of $50. I work well when I’m boxed in and I’m a little bit frustrated because I’ll start throwing spaghetti at the wall. So the next day we tried free software and free support. We thought we could come up with a model to subsidize the rest of the delivery of the service and support.

We had a webinar where we had 23 doctors or so on, and 19 of them signed up for the service and from that, we knew that this cost barrier was just dramatically higher with a doctor than it was for you and I, as consumers. So Practice Fusion was the first-ever enterprise product in history to deliver a free model to market.

Why was 2020 an important year for remote patient monitoring, and what should we expect to see in this space moving forward in say, 5 years?

As of January 2019, when the codes were approved, no one knew what competitors or what vendors would come to market. 2020 has seen several vendors including 100Plus come to market with viable solutions that scale up aggressively.

In our current state without RPM, the average senior citizen may have three or more chronic conditions that they go to the doctor for a little over once a year. They should be going once a month if not once a week. If their blood pressure and blood glucose becomes uncontrolled and exacerbated, which it does all the time, they go to the ER for primary care and have a three-day visit to the hospital which would cost about $45,000 each visit. Overall, Medicare will spend $750 billion this year managing patients. 90% of that is on these episodic care events that I just mentioned.

RPM is trying to solve the problem of the high-cost visits, and replace them for quick low-cost visits where the doctor looks at the patient, coaches them to adjust their meds, and moves on. That’s what the programs are for in addition to the increased quality of life for the patients.

IoT (Internet of Things), in my opinion, has improved from it. Three or four years ago, putting a cell chip in any device wasn’t viable. It would have added one hundred or two hundred dollars to the device. Now you can have a blood pressure cuff with a cellular chip for $70, which makes the program pragmatic, from an economics perspective. Now you can sell plans to offer IoT devices where they’re a dollar or two a month instead of a standard plan that you pay for on Verizon, which might be $40 or $50.

I think that there’s a fair amount of innovation coming out right now. It’s about taking existing devices and plugging in a cell chip, which is great, and it’s super helpful and powerful. I think over the next two to three years, you’re going to see stuff come out like continuous, non-invasive glucose monitoring. Instead of putting a plugin on your arm, I think that you’ll have a wristband that can detect heart circulation, perfusion, glucose, pressure, and can even detect mood. So I think we’re a few years off from a unified hardware platform that will gather biometrics that will identify risks early and curb the need to go to the hospital for primary care.

Listen to the full episode on the DrChrono podcast here. Or subscribe to learn about all of the latest industry trends in the EHR, telemedicine and healthcare technology space.