Julian: Hey everyone. Thankyou so much for joining the Behind Company Lines podcast. Today we have BrookeLeVasseur, CEO of AristaMD. AristaMD is focused on improving patient outcomesthrough more timely access to specialty care. Brooke, I'm so excited to chat withyou, and as we're talking pre-show, not only about your background and your.

Experience within, healthcare system andhealthcare space, but also thinking about, the ways that new technology isdisrupting this industry that has a lot of old legacy technology or, orinefficient processes or outdated, access. And it's exciting to talk tocompanies like yourself to think about how you're, increasing the access,increasing the effectiveness of companies and honestly patient and outcomes andthe whole care system.

But before we get into all that, whatwere you doing before you joined the company?

Brooke: Well, thank you firstof all for having me. It's great to be here. Of course. So what was I doingbefore? Well, I've been in healthcare forever, basically since getting outtaschool. My interest in healthcare started way back when I was in high school.

I had I was in a car accident when I was16 and had a pretty bad back injury, and it was that, that kind of got meinterested in the whole healthcare. When I got out of school, I went to workfor an investment. And I was able to get on the team that was writing equityreports about like the orthopedics companies that made the devices.

Yeah. And the instruments that actuallyI had in my back at the time. So that's kind of how I got into healthcare andI've been in it ever since. That was in 2001. It's been quite a while. Afterworking at the investment bank, I went on to join a bunch of different startupcompanies, all launching new technologies in the healthcare space.

Everything from diagnostics to digitalhealth tools but all of them with kind of a common mission of getting betteroutcomes for patients in a less invasive, less costly way. I guess that's thecommon thread. Yeah. I joined Arista. Yeah, that's so fascinating. In 2016 andcame on board as chief business Officer and then was promoted to ceo shortlyafter  

Julian: that.

What, what was, what was the, thecatalyst or what was the inspiration? How'd you get involved with AristaMD and,and what was particularly excited about what they're, what, what you're workingon now that, made the move into the ceo position?  

Brooke: Yeah, so I actuallyfirst heard about Arista when they put out a press release.

They announced their series A funding andin that press release I was reading through and just hearing about what theywere doing to help patients get Better access to specialists. And having beenthrough the healthcare system myself, I really, on a personal note, like knewwhat this struggle can look like and thought it was such an amazing solution.

Actually reached out to the CEO just tocongratulate her on what she had built. And she ended up inviting me for acoffee and we really hit it off. And it just so happened they were at the pointof time where they were looking to build out a commercial team and. Bring thismarket and I was able to bring my commercial experience in the space and shebrought me on as Chief Business Officer.

So it was a lot of serendipity.  

Julian: Yeah. It's so awesometo to hear about how founders and or CEOs, how people have kind of not only arebecome supporters and fans of companies, but then end up working, you're,you're not the first founder to have gone through that experience or, or CEOthat to gone through that experience.

And I'm curious, within that transitionperiod, thinking about not only what causes a company to seek out seniormanagement or, or seek out individuals who then become the ceo. But how is thattransition in terms of making it a smooth one for the rest of the team, theculture, and still staying in line with the outcomes that, that you're, Iguess, I guess building the path to, what's that transition like?

What are some best practices for othermaybe founders that are going from that transition and bringing on somebodywith expertise that, that will fulfill a certain outcome that they'relooking.  

Brooke: Yeah. Well, I don't, Idon't even think that it's an issue of transitioning the original founder tonew ceo necessarily.

Startups go through these transitions.In my mind, in my experience, it can be as often as every nine to 12 months,you're going through a total rebirth and moving, as you mature through thevarious stages. Yeah. So I think the one common thing is that there's alwaysgonna be. And a lot of personnel turnover is inevitable.

It's, very likely that the team thatstarts the company is not gonna be the team that grows it to 5 million to 20million and beyond. And so what I think has been important for us is we've gonethrough some of these growth stages, is just to be true to. Baseline DNA of thecompany and the mission.

And so for us, that really has neverwavered. I was lucky to step into a really fully baked idea that came directlyfrom healthcare providers who understood the problem we were trying to solve.The original founder was running a couple hospitals, so she saw the problemright up close and designed the, the product with like firsthand experience ofhow this was gonna move the needle.

So all I've tried to do is keep our eyeon the ball and everyone who joins the company knows that we're here because wewanna improve patient access to care. And so when we're looking at who to bringon board, it's not just like skills assessment that we do. It really is sort ofa mission fit. Like are you excited about talking about how we're gonna improveaccess and how wait times for patients are gonna go down?

Cause that's, Something that you'regonna hear every single day of our company. And if that's not something thatgets you out of bed, then you're not a great fit. But if it is, then I thinkthat that ethos can help you grow through these various phases.  

Julian: Yeah, it's incredibleto think about how healthcare has really gone through a, a really rapid transition,especially post covid, even during Covid, of course, and then post covidthinking about, companies and, and, and it's becoming more open to digitalsolutions and creating ways around, giving patients access to care andimproving outcomes.

Why, what, why is that? What would, whata part of the system historically has it been challenging to, or maybe evenmore convoluted, why haven't patients been getting the outcomes at the pace orat the speed, or at the ability that they, that they are now? Is it because oftechnology? What's been a part of the system?

I don't wanna say broken pieces, butwhat's been needing of improving and, and why now? And, and what direction isit going in?  

Brooke: Yeah, I think part ofit is that physicians have been practicing medicine in a certain way fordecades and to expect them to change everything about what they do toaccommodate.

Video or whatever the new Fal tool is.That's really tricky. And so I think that what's been amazing since thepandemic is that we had this forcing function, right? There literally was noway to get here, didn't implement some of these digital solutions. So that hugeunmet need is what pushed providers to get on board so quickly.

And it, it really helped us scale thathuge adoption curve much faster than normal. Mm-hmm. But it's still changed.And so you look at a lot of the data on telehealth usage and it gone back downpost pandemic not to levels prior to Covid, but it's still down from the peak.But what we've seen is that it's sort of proved to everyone out there atclinics and at health systems and either, and even like in health plans, thatwe can all do this.

Like we can move quickly if we have to.Yeah, and what's needed is for everyone to just rally around. What the problemis and, and get together to solve it. But that it's actually possible. And so Isee a lot of yeah. Receptivity now to new programs because they've had suchsuccess. People are really proud to say we stood up virtual in two days andstarted doing 90% of our visits over video.

Right. That was like real positivemomentum for these groups. And now as we're trying to continue to scale ourdigital solution at clinics, I think there's a much greater receptivity ingeneral towards examining the way that we deliver care and questioning, old,old ways.  

Julian: Yeah. Yeah. And howhave patients, in terms of their, their behaviors?

Patient's behaviors changed and inregards to, the increase in telehealth and but there's still the necessity tosay, visit a, a physical therapist in person or some specialist in person tomake sure that they can actually alleviate. The issues that they're, thatthey're seeing. Are we gonna see kind of a hybrid model coming to the futurewhere maybe our, our primary physicians virtual, but anytime we need to go getspecialty care, we're in person, we're accessing, how have the behaviorschanged and are we moving towards a more hybrid technology in person model forhealthcare for the future?

Brooke: Yeah. I think the waythat care's gonna be delivered in the future, and it already is happeningtoday, is, is much more holistically than it was in the. So it's not justvirtual or in person, it's really providers now have a ton of different toolsin their tool. They can text patients, yeah, they can do video visits, they cancollaborate electronically between providers to try and figure out what to dowith the patient.

So there's so many different ways thatwe can be getting patients care and patients are number one, they're consumers.And they expect a great experience. They don't want to be paying more than theyhave to. They don't want to be taking more time out of their busy schedule thanthey have to.

They really expect to have a goodexperience and to be met wherever they are. And so what we're trying to do isredesign care so that we're factoring in patient preference, factoring in cost,factoring in what is the actual issue for the patient, and better matchingthose. To the right provider, of course, but also the right site of care in theright way.

Julian: Yeah. Yeah. It's soamazing to think about how much more intimate a relationship can be between apractitioner and a patient, being that, I feel like in, in the past few fiveyears, it's been a little bit fragmented. You not a lot of people know theirprimary care physician, let alone go to them regularly, and, and it's only whenthere's problems and there's less practice health, are we seeing.

Proactive measures going into kind ofhealthcare and behaviors in terms of patient behaviors because of the access totechnology. And are they feeling, are you seeing a, a deeper connection betweena, a practitioner and their patients through technology as well?  

Brooke: Well, part of this, Ithink, has to do with the way that our whole healthcare system is tructure.

We are very underinvested in primarycare. So if you look at the $4.3 trillion that we spend in healthcare, lessthan like 7% of that is on primary care. But primary care providers are trulysupposed to be the quarterbacks of care. So they are supposed to build thatdeep relationship with the patient and help them move throughout the wholehealthcare.

And because they're often the first stopfor the patient, all the decisions that they make around where to refer thepatient or what imaging to do on them, all of those referral and diagnosticdecisions, treatment plans that's where 90% of the cost comes from. So I thinkwhat's starting to happen is that we are putting more of an investment intoprimary care and we're starting to reward.

These primary care groups for takingpreventative measures and getting patients preventative care, building arelationship with them, not just seeing them when issues arise, but really digginginto the populations they're serving. Groups that are doing this well are notjust looking at, cancer screenings and vaccinations, but they're actuallylooking.

Food security. Is my population havinggood access to healthy food? Are they housing insecure? Are these things thatwe can help out with? Yeah. So, I think there's a lot of positive movementhappening on this front, but we're still early and, our system has beendesigned for so long around generating revenue from waiting till people are sickand then treating them with expensive interventions.

So until we continue to move more into asort of value paradigm, Paying to keep people healthy. Mm-hmm. It's, it's gonnacontinue to be, something that we have to work on.  

Julian: Yeah. Yeah. Tell us alittle bit more about AristaMD and the traction that you've seen. Not only,historically what you've seen in terms of the traction of the company, but alsowhat you're excited about this year and the next year.

And as the technology continues to beadopted in healthcare, what's particularly exciting about the horizon infront?  

Brooke: Yeah, so what we dobasically is. Help direct patients, like I said, to the right side of care, theright provider. And oftentimes what we'll do is we will connect a primary careprovider to a specialist to collaborate virtually on a patient care plan.

Yeah. And so what that does is itenables in most cases, the primary care physician to be the one to carry outthe treatment and not require the patient to like take more time off work andgo travel. Wait to go see a specialist and spend more money. This is, yeah,this is something that we're passionate about because right now patients arewaiting way too long to get specialist care.

There's there's just a bunch of factorsat play. Like one of them is we just don't have enough specialists. We areshort, some projections say we're gonna be short, almost a hundred thousandspecialists in the next two years, so we don't have enough. Yeah. And the otherthing is we're getting older, so we have this huge aging patient population andthey need more specialty care.

So if you're referring patients tospecialists who really could have been treated at the primary care provider,you're just making this whole thing worse because you're increasing the longwait times. Which it's unbelievable. When we review wait time data, there aresome markets where you could literally wait a.

To get a new patient visit with aspecialist, that's totally unacceptable. So, so the reception for what we do ishuge, just because everyone has experienced this, even personally, physicianshave experienced not being able to get their own care. So that's been reallygood for us. And, post pandemic, like I said, a lot more receptivity to digitaltools and to rethinking how we get patients care and where we get patientscare.

Julian: Yeah, so, so thinking,it's fascinating thinking about, from the physician's point of view that I, Idon't think a lot of consumers maybe consider, their experience and, may maybewe're all, we all kind of think, I don't wanna say selfishly, but obviously wehave our own interest and okay, I can't get the care I need in a certain amountof time.

But from the physician's standpoint, itmust be frustrating to. Not be able to see patients in an efficient way,provide them the type of care, get the outcomes, or even be in an ambiguousstate where, Hey, I saw this person two weeks ago. I wonder if they're feelingbetter or if their ailment is, is, has improved if, if their circumstance hasimproved.

Describe some of the challenges that arecoming from the physician's point of view and how the technology is able tokind of alleviate a lot of those, whether it's concerns or inefficiencies oreven just lack of intimacy in, in, in terms of the structure in, in maintaininga relationship. Speak on that, if you will.

Brooke: Yeah. Well, I mean,you're exactly right. It's extremely frustrating to physicians. In fact, thewhole origin story of this company is that the idea for ArsitaMD came fromcomplaints out of a local health system in San Diego where they had over a yearlong wait list to get into the orthopedic clinic. And one of the orthopedicsurgeons was complaining, saying, this is totally unacceptable.

We literally can't get patients in andunder a year to any of us in the clinic and. The reason for this is that halfmy waiting room is filled with primary care patients. So if you could solvethat, my patients would get in right away. And so that is literally how theidea for the company came about. But no, they're frustrated that patients arewaiting and when patients wait, their issues don't just go away, they getworse.

So the patients end up and going intothe hospital and going into the ER to be treated, which is terrible and very.Yeah. So we've found that when you can give providers the tools to get patientsin more quickly, to ensure that they're being matched to the right provider whoactually specializes in the very specific thing that the patient needs, thatthey're close to the patient's home and they take their insurance.

So it's. Actual that that visit will befulfilled by the patient instead of them looking at their schedule and saying,oh my God, the near spec specialist is 50 minutes away and I have to get publictransportation and take time off work and all of that. If we can try and solvesome of those issues virtually that's a huge patient pleaser and it's a hugerelief for physicians who are just totally overburdened right now.

Julian: Yeah, it's, it'samazing to think about what the technology allows physicians to do, allowspatients to do in terms of efficient access to the care they need, and not bottleneckingby being in the wrong place and, and, and being in at the wrong care center inparticular. But thinking about the company, whether it's externally orinternally, what are some of the biggest challenges that AristaMD faces today?

Brooke: The biggest challengethat we face is just general burnout and overwhelm on the provider side. Thepandemic still, I guess, still going. It's, it's rough, right? Providers reallywere hit hard across the country, as we all know. And so even when you arebringing to a provider a solution that's gonna help them, that's a tool thatwill probably in the long term alleviate stress and be great for.

It's still change. And so that is ahurdle for us. It's change management every time we go into a clinic. And a lotof these providers have been sort of burned on technology, the whole move intoelectronic health records with not the most seamless change of a lot of bumpyparts of that road. I think that's really it.

It's, it's that providers understand thevalue that we bring. Being ready to invest, invest in some change management.Is, is the initial hurdle that we're having to overcome.  

Julian: Yeah. And ifeverything goes well, what's the long term vision for AristaMD?  

Brooke: Well, right now we're.Saving health plans and we're saving clinics, millions of dollars.

Every time they implement our solution,they're able to treat 70% of the patients that they were referring out, theycan now retain at primary care and treat them immediately. So that's just giantcost savings, and we're gonna continue to scale this solution so that everyprimary care provider out there in the country will have.

To our network of virtual specialistswho can consult with them and in most cases, support them in treating patientsright away. Right? So it's number one, just scale number two, the whole processof transitioning a patient through the healthcare system is really complicated.There's a lot of stuff you have to do.

It starts with finding the rightprovider. This is something we already solved for. So making sure that theproviders in network, that they're near the patient, that they're a highquality provider then you need to be able to actually place that order and.Talk about old school. Most providers are still on fax, fax today, thousand 23or on the phone.

So we replace that with something moreseamless. It's totally electronic, and get rid of the phone and fax and you cantrace all of your referrals and see which patients have been scheduled. Yeah.And then there's a whole other realm of hurdles involving care transition. Sothere's often prior authorizations that have to happen.

There's. The ability for patients to beenrolled in other programs that might be a part of their benefit that theydon't even know about. And when primary care providers can get access to all ofthis data in a really easy way to take action, then we're gonna see betterpatient outcomes cuz we're getting them the care that actually is available tothem.

But might be too difficult for them to accessright now. Yeah. So that's kind of where we're headed, but our North Star isalways going to be improving access and doing it in a cost effective way.  

Julian: I'd love to hear that.And, and it's so exciting to hear, what the technology will do and, and kind ofhow it will compound and have an effect and, and really alleviated, like yousaid, a lot of the stress that providers are having.

Overall, kind of disrupt this accessand, and, and, and really this process issue behind healthcare and, and, andgetting the care you need. I always like this next section, I call it myfounder faq. So I'm gonna ask you some rapid fire questions and we'll see wherewe get. So first question is just to break into it, what's particularly hardabout your job?

Brooke: What's hard about myjob? Probably having enough patience. Healthcare is so slow. Yeah. That's mybig struggle every day is just being patient. Cuz we move really, really fastinternally and it's the whole external market Yeah. That I can't control thatis constantly frustrating. So I guess like exercising patience Yeah.

Is one of my big things.  

Julian: Yeah. Yeah. I lovethat. I love that. What, what's a particular challenge in, in working withcommercial, kind of working, working in the commercial space? What are somechallenges that we may not be aware of working with healthcare, but what aresome benefits, saying, working within the commercial space, outside of workingwith large hospitals or large organization?

What, what's some challenges and whatare some benefits in, in addressing the commercial market?  

Brooke: Challenges are, Iguess, Every organization is incredibly different. So there are of course, orcommon themes, but when you go to work with a health system, when you go todeploy with a group of clinics, they all have nuances around the populationthat they're serving around some of their local challenges.

And so you have to. Be willing to do thework and to dig in and to really understand some of those nuances. That's whatultimately makes our deployment successful. We don't try and just like plug andplay the same thing in every single market. Again, a lot of commonalities, butyou have to be willing to do that work and when you do, you can really forgesome deep partner.

So we've put in the work. Yeah. Some ofthese relationships take more time than you'd like because they have to becustom, but they pay off. And just to like throw out a couple examples. We arepartnered with Stanford Healthcare who's been a phenomenal partner of ours, butthat took a lot of upfront work because when you work with Stanford, you haveto customize it and make sure it's completely designed for your market and soon.

But now that we're out there, it's justbeen such a phenomenal reception to what we're doing together. So it's, it'sdefinitely worth it, worth it, but it takes upfront.  

Julian: Yeah. Yeah. What'ssomething that you spend too much time on and what's something that you wouldlike to spend more time on as a, as a ceo,

Brooke: why do I spend toomuch time on.

I don't feel like there's a lot of workthat I do that isn't value add, like, which is amazing. But we, so our whole,just to back up, like our whole philosophy when we go to market is trying toget providers to like operate at the top of their license. We talk about thisall the time. How can we provide the tools so primary care can.

Expand their scope of care. How can wemake specialists only handle the most acute complex cases? So that wholephilosophy, like we actually take internally, And we are constantly asking theteam to look at like, where do you spend your time and what of it can beautomated? What of it can be passed down to someone who is better matched to dothis?

So that we're all kind of optimizing thelimited amount of time that we have. So I don't know. I think, I think Iwouldn't, there's nothing I really complain about that I feel like I'm doingtoo much of. It's every day is different. So there's no one thing that I'malways. But that's part of the job.

I guess. It's really dynamic, constantlychanging.  

Julian: Yeah. Yeah. Yeah. I'malways interested with healthcare because you have so many stakeholders, somany players. You have providers, I'm sure you have insurances. There's a lotof HIPAA compliance. There's so much you have to involve when thinking aboutbuilding in the space.

But one particular thing that isinteresting to me is the pricing model. And so how have you defined a way tooffer this level of service and care and, and, and technology. And has thepricing model always been the same, or is it a subscription model? Is it kindof a, a full year access? What, what's the pricing model and has it alwayschanged?

And what's particularly I guess invitingabout the way you've structured it now?  

Brooke: Yeah, so we've had tochange over time because the market's changing. Our history in this country. Ahuge fee for service chassis that runs all of healthcare, meaning providers getrevenue when they provide services, when your paid, yeah.

What they are doing. And there's a lotof issues with that. Creates a lot of misaligned incentives. However, that isthe reality of how today the majority of providers are. So when we firststarted the company, we realized that it wasn't necessarily the provider groupswho were gonna be incented to adopt this because the health plan was the onewho was paying for all of these specialty fees that we could help reduce.

So we went early on to insurers acrossthe country. To get their support to reimburse for what we do. And again, theydo it not only because it's improving access, but because we are carving outthat specialty cost line item for them significantly. Now over time, wow. Wehave been moving more into what's called value-based care, which I'm a hugechampion of, and that is paying providers for value and outcomes, not just fortheir services.

In that paradigm, the providersthemselves actually have skin in the game and they're incented Yeah. To drive costdown while also maintaining really good outcomes. And so because more providergroups are entering into these site types of. We have shifted our pricing a bitto give these groups subscription based access, where it can be all you caneat, referral management, any consults, and they will pay for that directly.

So we still maintain kind of twodifferent models depending on the market.

Julian: Awesome. It'sincredible to think about and, and a lot of companies kind of struggle withthis. I'd love to ask that question because it really helps kind of frame notonly identifying your customer needs and, and giving them the, the tools thatthey need, but also how to make sure that the value is received from their end,vice versa.

That you're, it is this kind of cohesiverelationship and not something that's, hyper scalable and. Now, don't wanna saypredatory, but one that's not in line with, with the incentives of both thecompany and, your, your customer, your target market. I always love to ask thisquestion because I love the way CEOs, people who are building companies extractknowledge from things that they ingest.

So whether it's early in your career ornow, what books are people have influenced you and impacted you the most?  

Brooke: let's see, people, Imean, I could list famous people, but the reality is that I'm probably mostimpacted just by my family and my close friends. I have like an incrediblegroup of girlfriends that I've had now for 30 years.

And they do everything under the sun, likeeverything from an avocado, rancher. Of documentary filmmaking friend. Nobodydoes anything like what I do, so I've just learned so much from them and beenable to just observe like how people are innovating and how people are solvingproblems in industries.

Completely different to mine. And I'vegotten a lot out of that exposure, honestly, just through my friendships. Seeon the books side, I've read a lot too. I was an English major, so I love toread and I kind of read the gamut of things. I, I think that for me, you knowwhat, one of my favorite books is a book I read last week, honestly.

It was a memoir called What BraveryLooks Like, and this book was just this incredible raw story about like, Brutaland also beautiful, like basically being human is. And it's those sorts ofstories that I think I learned the most from. Especially for me working inhealthcare. We're often meeting people at some of the most vulnerable anddifficult times of their lives.

So I think, yeah, developing reallystrong compassion and empathy is just super important. So books that remind meof that I really appreci. Cuz at the end of the day, like what we're trying todo at our company is just to help kind of improve this human experience andkeep everybody healthy.  

Julian: Yeah, it's incrediblethat I love asking that question because you, you don't always get the businessbooks.

You get other things, anecdotal storiesand, and really it, it's awesome to see how you connect those stories and, andthings that you learn to, even your business and, and what you do and, and howso intimate. And so I love that knowledge sharing bit. But last little bit, Iknow we're coming to the end of the show here and, and I always want to give achance to make sure that we covered everything.

Is there any question that I didn't askyou that I should have or that you would have wanted to answer? Anything thatwe didn't cover that you would've liked us?

Brooke: Maybe just to give areminder to anyone listening that be really proactive with your providers ifyou're getting healthcare, and if they're gonna send you to a specialist, askthem if they can do an e-consult and just consult a specialist first.

Be demanding about where they'rereferring you, because if you're not, you could be getting more costly care andyou could be sitting on a wait list. So, just ask the question of yourprovider.  

Julian: Amazing. Brooke, it'sbeen such a pleasure learning from your background, your experience, and alsowhat Arista's doing and, and also what essentially changing this wholeecosystem and access of, of technology to really change a lot of the behaviorsand give people the access to care that they really, are, are, are seeking outand, and making an efficient process.

And what I've learned most in particularis, is the change from the physician side and the provider. To be able to givethat care through technology. So it's amazing. It's been such a pleasurechatting with you. And last little bit is where can we find you? Where can wefind Arista, md give us your plugs.

What are your LinkedIns, your websites,your Twitters? Where can we be a supporter of you and supporter of thecompany?  

Brooke: Yeah, go followAristaMD on Twitter, on LinkedIn. Go to AristaMD.com. I'm likewise all overthose platforms. So, appreciate you asking that question.  

Julian: Thank you so much,Brooke, for being on the show.

I hope you enjoyed yourself today.  

Brooke: Thanks for having me.This was fun.  

Julian: Of course.

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