Erynn Petersen: Fixing Healthtech, One Bill at a Time

Hi, I'm Paul Ford, and I'm Rich Ziade. And this is the Aboard podcast, the podcast about how AI is changing the world of software. And goodness, Richard. Remember we talked about healthcare a little bit? We did. We did. We talked about pajama time. Pajama time. And remember how, like, if you go online, you can see the healthcare event we did with the very brilliant doctors and the very brilliant person from the world of AI automated health insurance processing? I think it's only on YouTube. It's not one of our podcast episodes. You're right. It's on YouTube. It's on YouTube. So go check that out. Check out our YouTube channel. Like and subscribe, you know, all that. Do the things. I'm talking to you, but there's someone else here. Erin Peterson, hello and welcome. Hello, everybody. So let's we're going to talk to you in a minute. Let's play our theme song and then let's talk about how AI and healthcare are boring. OK, so Erin, you and I and Rich, we've all worked together in different capacities many times over the years, and we stay in contact. You you're kind of a mentor to me. Just want to get that out there. Thank you so much. I'm surprised every time I hear that. I think the same. That's right. It's very real. And so we've all had many incarnations and you have your most recent incarnation because I'll just I'm going to read people can go check out your LinkedIn, but I'm going to I'm going to give a few like we have Amazon. We have Microsoft. We have the United States Department of Defense, particularly the Air Force and innovation focused. Good times. We had a couple. We had consulting projects that we worked on for like Condé Nast. What are any other big ones I'm missing in there? Time, Inc., AOL. That's right. That's right. Amazon, Microsoft, AOL ordering is a little unusual. So really big platform projects across very large organizations. And now you have a startup in healthcare. In healthcare. And it's called Emi. E-M-M-E dot com. It's a good four letter URL. Love it. Yes, good. And you are the CEO. Yes. Okay. What is Emi? Emi is a service. It's a member service. You sign up for the member service and we lower your healthcare from day one. Okay, so I have healthcare. I don't have healthcare. Like what's the scene? We help you out if you have healthcare and we help you out if you don't have healthcare. If you have healthcare, we make sure you're paying the least amount possible for your insurance and still get your doctor, still get your prescriptions. You don't have to change your healthcare. We make sure you're saving money on every service when you have to go to the doctor, get an MRI, et cetera. And if you get a weird bill or a huge bill, we have a bill negotiation service. And if you don't have insurance, we help you figure out how to get healthcare in the first place and healthcare that you can afford. Healthcare that's not going to bankrupt you. So that's right. So you fixed it. Well, you know, long journey. First steps, first steps. Thank you so much. Department of Defense to healthcare. You fixed American healthcare. That's really cool. That's great. That's good. Give American healthcare a letter grade. Like from F to A, where would you put it? A solid C. So I would give practitioners in the United States a solid B plus to an A. I mean, these are people who show up every day to take care of people. Nurses, doctors, RF. I want you to grade employers in a minute, but let's... Ooh, good one. Let's... We'll hold on to that one. That's the headliner. Insurance. A D. Okay. A D. I think everybody's doing their best. So it's really easy to vilify insurance companies. It is. Sometimes people kill them. That's one approach. It's not just like vilify. I think it's safe to say insurance provokes really passionate feelings in people. You think it's the most hated industry? 100%. Yeah, I think even AI isn't coming in anywhere close. Because people believe AI might go away. They're really afraid insurance will not. A lot of the drama, because it's so tied up in the anxiety and emotions around an event or an illness that has you on the phone for four hours. Obviously, the fees, we don't talk about, we don't talk about as much because it's kind of de facto, the employer is going to cover either all or most of it. If you're at a job, part of your offer is often health insurance. That's kind of the system we have today, which has its own... We can zoom in on that. But I think that a lot of the strong feelings come from those awful moments. I've been in that situation where we had to make insane phone calls in like a very stressful time with a family member who was ill on top of everything else. It felt insane. Talk a little bit about the D. Break down the D, right? The D grade. I think the D grade comes from exactly what you're talking about. You take people at their most stressed. You take people at their most worried. And then you layer over this paperwork concern. It's just a paperwork problem. And we're in 2026 now. We're firmly in the age of AI. We've moved to the cloud. So many things become simplified. There's absolutely no reason that the overhead associated with processing, for example, running your kid into primary care for strep throat, is as complicated and ornery and time-consuming as it is. It's interesting. You know, my kid, I have two kids and both go to Tribeca Pediatrics, which is a network. It's its own storefront pediatric network, I guess you'd say. And if you don't know it, just for like, if you're having a kid in New York City, it's one of the big... And they have this book and the book is literally, like we have it too, and the book is literally like, oh, 102 degree fever? It's fine. Yeah, it's kind of a chill, chill out about everything book. Yeah, it is. It's just like, oh, that baby is going to just cook them. Just let them cook. But I think the key feature, one of the key features of Tribeca is they've done a lot of work to very much streamline paperwork. Yeah, they're a case study. They've done an incredible job at that. Oh, you're familiar. Yeah. Yeah, they've done an amazing job. And to not think about that, because you worry about your kid when there's a weird rash or a weird issue or whatever, is a big deal. Like, I can't speak to whether their doctors are more accomplished or more effective than others. I think they're very good, but that's not what they're about. I think what they're about is the experience around getting treatment or going for a visit. It's kind of wild that that's the feature. Yeah, I think we'll come back to the competence myth, actually, when we start to talk about AI. But I think that there's something to be said for primary care being about caring for people. And what you really want when you run into your primary care doctor, when you run into your pediatrician, you just want somebody to tell you it's going to be OK. Yeah. You know, a lot of times when we're talking about insurance, we forget that most people, most of the time, are healthy. They're spending all this money, but most of the time, most people are healthy. And most of the time, only little things go wrong. People just need to be reassured. Yeah. What is this? Because we're talking about in a very broad way about this, like, really messy industry that everybody hates. So give me some stats. You always have stats. Like, how many people are uninsured? Like, what are the numbers to help us understand where things are at with health insurance in America? That's a great question. I think most people right now have insurance through their employers, through the marketplace, through Medicaid, Medicare. Most people right now have some form of insurance. What's really changed since January 1st is the cost of that insurance for most people. So with the subsidies going away, if you're on a private marketplace, if you're paying for your own insurance, you're really feeling the cost of your insurance at this point. If you're paying for it and not your employer. If you're paying for it and not your employer. It's roughly a third of Americans, give or take. So this is lots of people. And it's gone up. Percentage range. Oh, it's gone up for, you know, one of my kids went from $37 to $280. Wow. If you're making $35,000 a year, it's like 4X. Yeah, that's a lot of money. I mean, this is not an unusual leap that people saw after January 1st. OK, so about a third of America just is now going like, whoa, I don't know if I can afford this. Oh, absolutely. OK. Absolutely. Where do you think we're headed? Are people going to start dropping off the rolls again? What's the? Yeah, we're already seeing that. So people are quitting their insurance. People are saying, I can either have insurance or I can eat or I can pay rent. I mean, it's really the numbers have gotten to be this severe. So we're going back to the world of everybody going to the emergency room if something goes really wrong, but otherwise just being sick. We have, but there's one important thing that has changed since that was the case. If you try to go to the doctor now, most doctors, if you try and walk into a hospital, the very first thing they say is, do you have insurance? Right. And To hospital systems. So you you think a huge amount of that, if you could just work through those, you could probably get some margin back into this thing and everybody could have a good time again. A hundred percent. OK, so if you can, because there's a there's one other complication to be aware of. So if you're a hospital and, you know, Paul comes in for his MRI and Paul slaps down the insurance card, goes back and forth between Paul, the insurance company, the hospital, et cetera, et cetera, for about six months before the insurance company says to the hospital, fine, this is what we'll pay you. So hospitals are getting paid six months or so after the service is rendered. Is it six months? It's 90 days to six months. You're lucky if it's 90 days. It's actually generally closer to about 183 days before you're getting paid. So there's also cash flow challenges that small practices are just not designed to handle. Right. So if you can shift to a world where all the medical services that are reasonable to pay out of pocket, we're going to get back to that again in a second, under $2,000 and you get the bill. Make it easy. Just get the bill when you walk in the door, either pay it right then you sign up for a payment plan, the hospital gets paid right then or the doctor gets paid right then or... Lower the barrier to payment too. Exactly. Pause for one sec, so you're talking about what would it cost if you, let's say a doctor came to you and is like, you seem to know a lot. I want to start my own private practice today. How much would you say you need to budget? Like it sounds like at least like a half million or it's pretty serious. I know somebody, Dr. Elizabeth Shields. She's incredible. She just started her own practice. God, that's a good name. Is it a great name? She's also a great doctor. Okay. And this podcast is sponsored by Dr. Elizabeth Shields. You don't even need the Elizabeth, just Dr. Shields. Oh, I want to, whatever she's selling. She's incredible. She's just, she just left the Navy. She just set up her own practice. She's like, hey. Ex Navy, Dr. Shields? Holy cats. All right, all right. Oh, it gets even better. She also sells antivirus software, by the way. So she's like, all right, how do I set up a practice? What's the most cost efficient way? She has kids, you know, etc. So she set up an at home doctor service. You call her like an old fashioned doctor and she shows up at your house. She gives you care. You pay the $300 for the appointment. You both go away happy. She's a phenomenal doctor. So where is this? She's in Rhode Island. Okay. That's great. She must cover a whole state. That's pretty cool. On a bicycle. Does she have an office? Does she have an office? No, she has a car. Okay, that's huge. It's huge. Because you don't have to fit an office and have all that. So she's mobile and moving around. She's mobile. She's moving around. She's seeing people in the house, which is great. You know, you don't want to take your sick kids. No, you used to be. You know, but it's awkward because then you have to clean because the doctor is coming over. Like, you actually have the same thought. That's what you're going to say afterwards. Pretty awkward. Your wife would be very happy to hear you say that. Yeah, exactly. All right, keep going. So she can really bring down the cost of overhead. But you know, it takes a different kind of mindset as a physician to say, you know what? I'm going to put my hand up to the system. I'm going to open my own practice. I'm going to figure out how to right-size opening this practice, take the risk, and get it up the door. There's nothing stopping. There's no, like, regulatory reasons you can't just go to someone's house and treat them. There's nothing stopping anyone from doing it. Doctors can doctor anywhere. Doctors can doctor anywhere. It's DoorDash for doctors. DoorDoc. DoorDoc. DoorDoc is what we need. So you're kind of giving the insurer, the insurers are a little off the hook here because there's something endemic in the way the system works that has less to do with, everyone thinks insurance companies are hoarding money, right? Which maybe they are. Maybe that's another issue, right? I mean, they're hoarding a little. Let's be, come on now. Yeah. But the picture you've painted here is one where the bureaucracy is so, it's so, like, getting crushed by its own weight that the costs have gone up, not for treatment, not because medicine is hard to produce. It's because of paperwork and process. I hear something different, though. What I hear is the insurers are holding on to things for 183 days and aren't able to financialize everything that they've got. So they're basically giant. Separate issue. These are giant banks, and it's really in their best interest to add as much friction into the system so they can hold on to that money for as long as they want to. And so they just, essentially, it's like. And the doctors are the one. Holding the bag. Holding the bag. They're the ones that are in the bind. What can technology do? I mean, I don't even know if we need to get, we can talk about AI. We should talk about AI because it's an AI podcast. But put aside AI. I got to imagine a lot of this has to do with just ripping roots out of the soil and changing how we work. Yes. And every great technology change is an opportunity to re-examine large, gnarly problems and see if this is an opportunity to finally disrupt what's going on and really fix it. So we've all seen very large industries that are failing under the weight of their bad technology choices or technology choices that made sense 20 years down the road but are now an encumbrance, right? They're outdated. So you have all this cruft, all this process that piles up around it, blah, blah, blah. I mean, try to access your checking account right now. Great example. Great example. And if you think about technology, the last big technology change that drove a lot of efficiency across major industries was the shift to the cloud. Not just because people moved their data to the cloud from their own servers, but because when they did that, CTOs used that as an opportunity to shift to services-oriented architecture and people using Git and Slack to communicate instead of email, right? Let's actually be explicit about the process, which is you fired the old CTO and then hired a new one who would re-platform and bring you into this whole new world, right? It was a big transition everywhere. Now, some CTOs did make the jump, but that's what I'm saying. Yeah, you went from a CIO to a CTO in those cases. Yeah, and it was understood, like the CEO made this decision because they're like, we gotta get there. This is what the investors want. This is where we have to go. Yes. Okay, so that's, you think we're at another inflection point like that? I do, and there was a corresponding change that happened, if you guys remember, the role of the CFO suddenly shifted because you went from, for example, running a giant media company and not knowing how much it costs to produce anything to suddenly your CFO can see a report that shows you in Jira tickets what your CapEx versus OpEx is of building things, maintaining them, et cetera. So there was this rationalization and cost that came into a lot of industries. People may not know this, right? Like if you're in a publicly traded tech company, like your GitHub commits become part of the thing that gets analyzed by your price waterhouse. Such a great example. Yeah. And if you, if your career started after the cloud, you don't even realize that happened before. So this entire transformation. God, we used to have fun in this country. You know, nobody was paying attention to anything. Just hack some Perl. Anyways, go ahead. Is it worth noting? I mean, before we get to this, we're just like a distressed... No, no. We're about to talk about the next. This is a transformational opportunity today. Yeah. I agree with that. And that's where I'm going. Like with healthcare, that whole shift to the cloud skipped healthcare because everybody was on Epic, right? Epic was working fine. I mean, if anything... Nobody would bother. Like you had this segregated data because like it didn't, nothing changed about the architecture. So there's nothing challenged about the economics of it. It's really confusing because we did this event, right? You were there. I was moderating and the doctors just love tech. They're like, let's go. Ready. So, but then the industry is like, you can never do anything because of HIPAA. We actually can't even use computers. We just have to go back to index cards. Nothing can ever change ever. But we've seen this before, right? Literally the three of us have seen this happen. We have sat in rooms with CTOs who have said, no, thou must use Teams. You will never use Slack. And what happened? Everybody adopted Slack anyway. Then Microsoft made Teams free. And now everybody complains about Teams every time. What was the thing before Teams? It was worse. It was worse. That's the one that... At Microsoft? Yes. They've acquired it. Anyhow, we'll get back to it. Oh, the social Yammer. Yammer. Thank you. Yammer. See, CTOs were trying to make people use Yammer. Yeah, it was. And then Slack came Like to do this, like how does that work? No, they're giving us their statement of benefits. We're taking their statement of benefits and we're shopping for the best possible plan. We've had one person so far who is on the best possible plan out of, you know, 40 something. And they were just relieved to know they're on the best plan. Right. So they're on the best plan. So once you're on the best plan, then when you need services, you come back to us and we say, okay, here's the best value for you for an MRI or the best value for you for an X-ray for your thumb or your annual shots. And then if you do have any weird or surprise bills, we have a bill negotiation service. We use AI on the bills up to 400. And after that, we have a partner, Wheelhouse Health, and we send you over to them. Okay. So I subscribe to you like as a service ongoing or I pay you once or how does that work? Pay us once. It's a $25 a year membership. And if you don't save at least $100, we refund your $25 back to you. That's a no brainer. That's pretty solid. Okay. And now on the practitioner side. On the practitioner side, if you're interested in working with us, Dr. Elizabeth Shields, for example, works with us. She's back. So when we have somebody in her area, we say, hey, by the way, for your medical care, here's an option for you. You can call Dr. Shields. It's a predictable price. She'll come to your house. The care is amazing. Clean your kitchen, though. She's very nonjudgmental. She's incredibly kind. I'm sure she'll look away. She'll look away. She's got children. Just that chill Navy doctor. They are very, very nonjudgmental. You really have to have an appointment with us. She's incredible. But we have partnerships. We're starting to set up partnerships. We're like, hey, here's where it goes. And then over the long term, when we're able to show physicians and we're able to show hospitals and medical services that look, you get paid faster at better negotiated rates with us than you're getting with insurance companies and with no paperwork. You're sort of an intermediary. Yeah, we're like a Costco for medicine at that point. Yeah. Nice. All right. So big, huge, sprawling problem. The fact that you're pecking away at it is. I'm guessing as you look ahead for me, the roadmap is beyond just this. Right. And trying to make a bigger impact in this challenge. Yeah. Our goal is to save people millions of dollars, one person at a time. First, we save it on insurance. Then we save it on medical care. Yeah, we give practitioners a really good negotiated rate. We can move forward. Okay, let me end this on a really positive note. How can this get worse? Oh, Lord. This gets worse if we decide that an AI primary care doctor is good enough for poor people. Oh, if Dr. Claude is like, sounds like you broke your leg. Well, no, it can get even worse, more dark than that. Right. Is if you're paying a low premium or you're an augmented. Send you off to a chatbot. Yeah, send you off to a chatbot. Like, hey, you know what? You're not really a person doctor person. You're a chatbot doctor person. That's going to happen. You know they want that so bad. So bad. They are thinking that's what AI is for, aren't they? Yeah, yeah, yeah. And this goes back to that conversation that we're having before about. When I say they, I mean the shadowy forces that run the world. Like, I mean, it's just. No, I think like people. The ones building camps in Arizona, like summer camps for people with bad paperwork. I think people really, when they look at this stuff, they always see technology as this hammer to just hit the thing that they know the best. And so they're just like, oh, well, doctors. Right. And so we'll replace the doctor. Whereas if you talk to doctors, they're like, let me see five times as many patients. Just don't make me fill out 50 forms every time I talk to someone. Empowering the people. I think there's actually another key too. Remember at the beginning when we were talking about competence. And I said, we're going to get back to competence when we get back to talking about AI. There's this myth amongst technologists and also, frankly, among a lot of medical people. That there is one answer for any person that comes in the office. Any person. And so the race is to get to the right answer for a person. This is House, right? It's House. But when people interact with the medical system, they want to feel cared for. You know, I've been in a room with somebody who was in rough shape. Six highly competent physicians with six completely different opinions as to what should happen next. And the voice that mattered most was that person's primary care doctor because they knew them. Right. They know the picture. They know the picture. So it's not about getting to the right answer. That's the problem with AI. AI would be the seventh opinion. Yeah. Yeah. Yeah. OK. Yeah. All right. So look. It's sprawling. It's a little bigger than the typical subject. I think we're going to have to talk again next time you're around. Maybe what we do, we're going to do another healthcare event. We'll announce it soon. Yeah. I love that. You're going to be part of it. So maybe we'll have you back to talk about more things that are great about American healthcare. So, Erin, if people want to get in touch with you and they can look on your name is not spelled exactly the way they expect. So just be aware of that. If you do want to get in touch, what do they do? Is it LinkedIn? Is it email? LinkedIn is the easiest way these days. OK, so hit you at LinkedIn with you. Exactly. And then EME.com, E double M E dot com. And if you want to save a bundle on your health insurance. Tell me you didn't need a gecko. Yeah, exactly. I don't know what the health insurance lizard would be or what its accent would be. Transylvanian. Thank you for coming on. If you want to replace Epic, you should get in touch with Aboard. Yes. Come on, Rich. We love building hospital systems. We really do. We're working with healthcare. I would love to. Honestly, if you told me, hey, take six months, 12 months, just a couple of weeks, really, is all you need. If you told me that I was going to go live in a world where we were rebuilding health systems from first principles and that MyChart could be something that seemed to actually care about the. Like when they say MyChart, they just mean theirs. They don't mean yours. It's not your chart. Not your chart. Anyway, anyway. So Aboard is a system for rapidly assembling and building really complex software. We have very good solution engineers who partner with you. We use AI tools. We ship your stuff. It's sort of like an agency at kind of powered by jet fuel. Yeah. But a platform as well. And we're going to show more and more of that as we go on. Rich, how do people get in touch? Hello at aboard.com. Check out aboard.com. We love to talk. If you have podcast ideas, subscribe to the newsletter. And also, we'd love to build stuff for you. That's right. And LinkedIn is good, too. All right, Erin, thank you so much for coming. Thank you, Aaron. This was great. OK, we'll see you soon. Bye.