Rebrand: Introducing Open Source Health

Rebrand alert! Hosts Tripp Johnson and Marcus Shumate introduce "Open Source Healthcare," a podcast dedicated to transparency and sharing in the healthcare industry. They delve into the rationale behind the rebranding and the mission to openly share their journey, insights, and challenges in transforming healthcare. The discussion highlights the importance of building scalable solutions, the necessity of regulation, and the ethical considerations in for-profit healthcare. The hosts emphasize the value of community, the role of data in improving patient outcomes, and the need for continuous communication within their organization. Future episodes promise deeper dives into specific topics, including policy implications, economic principles in healthcare, and personal stories from their team.

Key Topics:

• The significance of rebranding to "Open Source Healthcare"
• The vision of creating a scalable model in healthcare
• Challenges and benefits of transparency and open sharing in the healthcare industry
• The role of regulation and ethical considerations in for-profit healthcare
• Importance of data and patient matching in improving care
• Building community and continuous communication within the organization
• Future episode previews and upcoming topics

Find us on the web:

• Advaita Integrated Medicine
• Green Hill Recovery

Transcript

Marcus Shumate (00:03.766)
Alright. That's not. Thank God. And we'll get a new song and everything.

Tripp Johnson (00:06.255)
Re -bran. It's not Trip Talks anymore.

Yeah. I didn't, I didn't like trip talks anyway.

Marcus Shumate (00:16.94)
Yeah, I don't think any of us liked it. It's good. But yeah, so think this is fun, right? I think this is one of the things where we've launched into this process, tried to figure out what organically kind of reveals itself. And then the thing we kind of landed on is what we're all passionate about here and what we're interested in is like healthcare, right? Like how to change and improve healthcare. And so we've toyed with this idea that you've done blogs before in the past by your own admission, pretty premature, but...

like open source healthcare. And so we're rebranding the podcast, right? To open source healthcare. Why? What's the thinking?

Tripp Johnson (00:56.719)
Yeah. Well, I mean, you know, long ago, we said our the whole vision was to be a model of health care. And that was really crazy to say at the time and still is kind of crazy. But I believe there's like a lot of value in sharing the journey along the way and like what we're learning. And hopefully, I do think

we're putting together some unique pieces, at least, you know, from where we started as an organization. And I think there are lot of other healthcare organizations, treatment programs, et cetera, that are out there that could really benefit from some of the information that we've learned over the last few years. And I just really enjoy sharing what we've learned to help like other people solve problems because, you know, just at a very personal level, solving problems feels like it's very fun and gratifying for me.

Marcus Shumate (01:49.494)
Yeah, right.

Tripp Johnson (01:50.317)
And then like being the person who people credit with helping them solve a problem is great for my ego and our ego. We love it. I think like this is really this was always the mission of not just the company, but especially like my blogging and writing and the podcast is to maybe dispel some myths and hopefully build kind of a coalition for change around important areas in health care.

Marcus Shumate (01:56.888)
Yeah.

Marcus Shumate (02:18.072)
Yeah, I dig this, right? Like I think this felt really good when it kind of landed on what our voice is and what we're trying to accomplish with this whole thing. I love the idea of open source healthcare, right? Like there's this weird notion, I think a lot of times in healthcare startups or healthcare industry, behavioral health, whatever you want to call this. It's like sort of almost like a sense of like proprietary knowledge or something.

I'd be curious to hear you speak about that a little bit, right? I think this is kind of unusual in the sense that most people don't... You go to the doctor, you have a baby or something and you come out, you've got $60 ,000 of medical bills and you don't know why. There's like this whole opaque process, it's insane and yada, yada, yada. But all of these things become this guarded gatekeeping thing that nobody has access to or information to. I don't really know the reasons for that, but I'd be curious.

But what like why like what aren't you afraid like are there reasons? Yeah that you should be afraid of making everything as public and open and transparent as

Tripp Johnson (03:16.377)
Well...

Tripp Johnson (03:22.233)
Well, I think it's kind of like this is true in any business, right? Like, quite frankly, you know, everybody holds on, you know, theoretically holds their business secrets tight. And that's like when you build relationships in the field, though, like, that's when you know that, you know, you have a real relationship because you're sharing real problems with other people who might be going through the same thing.

And specific to healthcare, think healthcare is even more opaque because it is a highly regulated field. It's very confusing between insurance and funding sources. It's naturally a more complex field. And then you've got the whole thing where it is a, I guess any business is gonna be a business and...

Marcus Shumate (03:56.398)
We're

Tripp Johnson (04:10.157)
with healthcare, there just a lot more nuances, you know, both politically and just in the way it's delivered licensure, things like that. So there are there are more barriers to entry in healthcare. And I think some of those people think they need to protect those barriers to entry. And then I think, you know, a lot of times, like, again, you think of healthcare, as you think of like doctors, nurses, and then in behavioral health, add in your

Marcus Shumate (04:23.362)
Mm

Tripp Johnson (04:35.811)
or PAs, NP's, in behavioral health you're adding in therapists and peer support, not in social workers and counselors. And they each have their own kind of unique profile. So to talk about healthcare as a whole in some ways doesn't even necessarily make sense, but there are some like business principles around healthcare that regardless of whether you're

you know, in a hospital or, you know, an outpatient addiction treatment provider, you know, you have certain people with certain licenses that bill a certain amount and that's how you, you sustain yourself. So I think a lot of times, you know, people like in any business, again, people are usually scared. I think our bet, my bet on the fact that like, we can be really open about this is one, it's a lot harder than people think. Like we can pretty much give the entire playbook away and

still going to be very hard. I'm going to keep going on this tangent because it's something we've mentioned before is the idea that, again, this is like, this is really hard. I lost my train of thought there, but this is really hard. We could give the whole playbook, but part of this, and I don't even mean special sauce is in we're special,

in order for us to get over the hill or over the hump, whatever you want to say, in the last couple of years took me taking enormous personal risk. And at a very kind of early stage in my career and having these ethos around this open source, like we need to fix the system at the same time. we're just, mean, we just happened to be in a pretty unique place relative to our general kind of experience.

Also to not have private investors or public investors at all. It's a different dynamic that is very kind of rare. And so I definitely want people to kind of copy certain principles. I also want them to avoid some of the near -death experiences that we've had.

Marcus Shumate (06:40.942)
Right. So in short, like the purpose of this now, right, like it's and it's explicit purpose is for us to build in the open, right? Like, and I like going forward, what we're looking at, what we're thinking about is what are our processes? How do we make this available to anyone that's interested? Our successes, failures? What are we learning? What's the our experience happening? I think also just like more broadly, what are we like, what are the things that we're interested in in healthcare? Like how do

Tripp Johnson (06:50.385)
Yeah, 100%.

Tripp Johnson (07:09.296)
Yeah.

Marcus Shumate (07:10.798)
contribute to conversation, elevate that, create power, leverage for change that benefits society. Let's be real clear, this is like preposterous sort of claim and I like one of us should be wearing a black turtleneck, a mock turtleneck or something. hopefully we don't. Yeah, so do I, probably have hookworms.

Tripp Johnson (07:28.419)
I'm walking around barefoot enough as it is.

Tripp Johnson (07:33.603)
Well, the you know, the other kind of, you know, interesting thing, I'm just going to go out, I'm going to either pat myself on the back here or say how, you know, I think we've each experienced like this feeling like we were working on something important for a long time, but that we were kind of looked at in the small private pay world that we came from, like we were crazy.

I mean, quite frankly, like we called a few years ago, like this whole private pay treatment industry is in for a reckoning. Because again, and the reason I believe like the fundamental reason for that is, I mean, just information asymmetry. Previously, people didn't have that much information about treatment. And there wasn't as much treatment locally, there weren't as many outpatient providers. Everything's changed dramatically.

But people weren't paying attention to the shifting landscape. And we called that, and we made a very deliberate move from a particular niche in the field, which has historically high profit margins. It's, quote, known for quality, although you can't back up those claims. And it's known for these deep relationships and trust and this and that, which again, I don't think you can back up the claims.

Marcus Shumate (08:48.097)
Yeah.

Tripp Johnson (08:51.269)
But the macroeconomic condition shifted. And I think we were pretty early from the cohort of people who were in the private pay segment to say, hey, no, this is not where it's going. And just over the last year or so, we've seen those shifts. And I think it's kind of cool. I feel for anyone who's had their job disrupted because of these changes.

But this was somewhat predictable. And I think we're also starting to see people are coming to us and asking like, Hey, this, like, we heard you talking about this, and we see what you've done. Would you would you share some more information? And we're like, Hell yeah, like, that's what we want to do. Like, because the things we believe in about health care, we want others to believe in, right? Because we want the good guys to have a seat at the table, too. And we need to articulate

Marcus Shumate (09:30.894)
Yeah, yeah, yeah,

Tripp Johnson (09:43.151)
like and build that coalition about how we change this, you know, for the better. Because there are always going to be plenty of good actors and some bad actors, but we need to get on the same page and not have the same scarcity mindset.

Marcus Shumate (09:57.346)
Yeah, we've talked about this too. think one of the pitfalls of private pay healthcare and whatever that looks like is there's no scalability, right? Like we could take something like a Green Hill and slap pink on it and call it a women's pro, like women's Green Hill for women or whatever, right? And then you just, all you're doing is compounding the same fragility and you just stack that on top

stacking on top of itself. And there's ways to make that work. But basically what you're opting into is stepping on a hamster wheel that you can never get off, right? Like you will never be able to adjust, change, innovate. I like, frankly, those just aren't interesting problems to solve, right? Like I don't think there's a whole lot of societal benefit for it. And I'm not saying they don't do good, right? Like I've, is where I cut my teeth. That's where I spent a lot of time. I think there's a lot of, you know, people, relatively speaking, they would say, yeah, you were helpful. you

for whatever that means, I don't know. So I'm not saying it's not without value, but what I'm saying is the value is very limited relative to the amount of energy it takes to sustain something like that. And it's not really scalable. You can't really impact healthcare. You can't change healthcare. You're not going to get a seat at the table because there's nothing scalable about it. And so I think part of this idea too is can we create an open source for information so

Maybe some of the better people, better actors can get a seat at the table. If they can learn something from our mistakes where we screw up, like are they able to gain some sort of power or leverage that would allow them to have some influence over some of this stuff? And that's great for everyone. It benefits

Tripp Johnson (11:40.303)
Yeah, and just to kind of riff on some of that, my, you know, like I think I told you, I was talking to a state senator yesterday and I've gotten, I'm very interested in the policy implications because I don't believe you can expect a for -profit company in healthcare, anything else to regulate itself. I like to think we are setting a gold standard for like the you know, the policing.

Marcus Shumate (12:04.426)
Nah.

Tripp Johnson (12:06.213)
But I don't think that's fair. This is something I stole from kind of Scott Galloway. Like that's the purpose of regulation. Like we cannot ignore that a business owner or shareholders, their incentive is to make money. And so we need regulation. We need regulation to protect the consumers or in this case, the patients.

I want to do and what I believe is important about this building the open process is showing that we can actually run a for -profit company with pretty good margins where everyone's made better off and prove that there is a better way to do this without pretending like,

investors don't want to make money. Pretend that, you know, like we got to work within the constraints of the system. And so I think it's very important to show that it is possible to make these stakeholders happy.

and do right by everyone. And furthermore, what I'll say is like, my goal is to share a lot of the, not really background, but I majored in economics and I think in economic terms a lot of times, and I don't mean financial terms, I mean trade -offs. I mean understanding concepts like opportunity cost, comparative advantage, things that are like fundamental to the way I view the world.

And I don't hear a lot of people talking about healthcare and in our field behavioral health with enough nuance around these like real economic issues. And I hope that like we can, you know, put forth a few arguments here and there and get other people excited about them because there are just a lot of misnomers. And if people know how to do things better, I do think we could have more, you know, healthy

Tripp Johnson (13:57.189)
financial organizations, also healthier people throughout the country.

Marcus Shumate (14:01.602)
Yeah, I think something that was interesting I was talking with someone today about was, you know, this central, this idea that's sort of accepted in healthcare, that healthcare providers are, you know, either you're kind of taking like a semi -vowel of poverty to be of use to people, right? Like we've talked about this before, community mental health people, they don't have to tell you they're in it for the right reasons, because they could go do other stuff and make a lot more money, right? Like they're in it for the right reasons.

close enough to whatever the right reasons may be. This is of the things I find interesting. People that want to be of value to their fellow man, to society, to help people, to see people get well, there's this general expectation that they do it in a way that they're undercompensated and expected

throw themselves on the grenade over and over again and burn out. And there's this sort of general idea and expectation of fatigue. This is somewhat tangential, but I think this wraps into the whole spirit of what we're talking about. Again, you and I and the organization right now, we're pretty hot on data. And we're trying to figure out what do we do with all of this sort of patient data so that we can stay in alignment with these sort of things that we're talking about. And one of the things in particular is talking about

like patient matching. Do we have the mechanisms to figure out the right data to make sure that patients are landing with the right therapist or landing with the right psychiatrist? How do we structure that? How do we get to that sort of stuff? And one of the things that I think about with that is one of the biggest burnout points for me as a therapist was I'm just throwing shit at a wall, right? Like, you sit down with a client, you hope something works and sometimes it does and someone tells you it was great, they loved you.

you know, hopefully that means something, who knows, right? Like they certainly felt good, but you know, we have all this like, we're just sort of scratching around in the dark. I mean, it's like in draining is morally fatiguing. And it's like, yeah, I get why burnout happens. I understand the idea of like moral injury. And so like, if we can create some sort of process or system or offer something that, that serves the clients better, serves the providers better that creates

Marcus Shumate (16:25.954)
more power, more stakeholder to be able to leverage and do scalable healthcare that really helps ease human suffering to some degree. Like, fuck yeah, that's awesome, right? It's cool. It's a fun problem to try to solve.

Tripp Johnson (16:44.399)
Yeah. And it's also like, I think what we were talking about earlier was it feels very substantive now, which is just like refreshing for me. And it's been, it was very scary in some ways to focus on substance for so long, because you don't really know if there's a payoff, not just like financial, but is it going to work? Right. Or like, cause I would say like we've from my general peers,

from the private pay space at least.

I bucked whatever trend was happening. We went a complete opposite direction. I would say most people start out more community focused. Say like you're a guy in recovery, you start a sober living. Eventually you might have an IOP and then you start raising your prices and buying nicer things. And then all of a sudden you're going to these Natsap IECA conferences, working with consultants. And we did the opposite. We went from

going to Natsap and ICA and working with consultants and we still do some but not attending conferences. But we went from that to saying, no, we're going to go the other direction. Like, we're actually in some ways like making this a harder challenge on the financial front, at least in the transition period. But ultimately, like that scalability piece matters to us, it's also going to like it's going to be good for the business side of things.

But, we weren't looking at the margins and how we could juice things. And that's not the trend. Like we didn't add more levels of care, just add another population. Because quite frankly, I don't think Green Hill, I don't, let me make a provocative statement. I don't think anyone in the Natsap, Natap, IECA, anyone in this world, no one actually has something that they can prove is worth scaling.

Tripp Johnson (18:40.921)
And I don't want to work on problems that I don't think have the potential to scale. And so no one's doing it in that field. They might be helping people. They might feel good about themselves. And I thank them for it. I really do. But not my cup of tea. I personally just can't ride the wave of census and scarcity mindset. And I also can't go around like hocking

you know, treatment that costs thousands and thousands of dollars out of pocket on top of whatever your insurance is paying. And look at myself in the mirror without like a really knowing it quote worked. And so I'd rather do something that feels like more of a product market fit, capture a lot of data, improve our patient outcomes slowly over time, and build this infrastructure to actually tell us what's going on and tell us what's, you know, going to work.

And also just look at the, you know, look at some theoretical models that make a little bit more sense to a broader population and then get specific with the person. Like don't tell me you're, yeah, again, that super specific program or profile and like you just knock it out of the park because it doesn't

Marcus Shumate (19:57.325)
Yeah. Right. Yeah. You said something that's interesting, right? Like I think a lot of the, you you kind of described the pathway into getting how someone gets into like private pay something, or they develop something boutique and they've now got it and they've got to sustain it keep it going. And then you develop all these sort of mechanisms for that you, you've entered the hamster wheel and now you can't get off, right? Like you've got to keep it going.

Tripp Johnson (20:25.296)
Yeah.

Marcus Shumate (20:28.179)
And you're right, right? Like it doesn't have scalability. And it's just not our cup of tea, right? Like this, it's just not an interesting problem to solve. Like, you know, like

Tripp Johnson (20:36.923)
Because, well, let me just like, you and I, like, phone on just a pure personal level are like very interested in like the concept of capital T truth, like what is real, and what applies. And I think like, even in our work, we bring some energy or curiosity about like, what are like these kind of perennial truths about people and, you know, more specifically about healthcare, that can be, you know, once you understand those, you can apply them very broadly.

Marcus Shumate (21:04.576)
Ugh.

Tripp Johnson (21:05.01)
And I think like that, that's the pursuit that's like at that deeper level, very satisfying to feel like we're pursuing truth at like in a meaningful sense, not just like we're building a business and we're trying or we're trying to, you know, like we're working with patients so we can feel good about it. Like we want to do that. Plus we hope to refine our craft over time and

If we're not doing a good job, we're not afraid to just be like, we're not doing a good job. And we need to change these things. But now we have the data to support we're not doing a good

Marcus Shumate (21:34.766)
Yeah.

Right. And here's our data, take it, use it, play with it, where it's helpful for you. Like no problems. don't run with it. Maybe it's useful for you and it helps your organization or helps what you're trying to do in some capacity. Even if it's a meta lesson, right? Like some giant lesson that we learned and you can extrapolate from it. Great. Take it. More specific call, ask, we'll see what we can do to try to help. Like whatever. don't know, but like, you can only do that

Tripp Johnson (21:42.363)
Total.

Tripp Johnson (22:04.773)
I'm interested.

Marcus Shumate (22:09.634)
by having something that has scalability, right?

Tripp Johnson (22:15.867)
So yeah, well, I think I got to go pretty soon. open source health, that's what we're going to be going with. think next week we might even have one of our clinicians

we like ran into each other in the hall and somehow three of us got in a conversation really around death and then around stoicism. you know, really like kind of brought it back to that human level of it's really cool to have these conversations. So even if we're sometimes skeptical of the therapy side of things and just like, what is the mechanism for change? There's something like undeniably really cool about having

you know, people that you work with and you get to talk about these really deep, meaningful, you know, life situations and issues. So hopefully next week we'll have Kristen on and we'll get to hear, we'll talk a little stoicism and, you know, maybe a little more internal kind of what we've got going on at AIM.

because over time, definitely hope that we're gonna start sharing more probably on blogs and whatnot, surveys that we're sending out to our team, the results that we're getting, and then how we're kind of taking action based on feedback from our team members. And that's the building in the open. It's gonna be showing all of our warts and birthmarks or whatever blemishes, and then just how we're trying to address it because I think,

One of the things I found that I did really poorly over the last year was just keep communicating even

Tripp Johnson (23:49.805)
even when you didn't have that much to say or you thought other people were saying it, I think there's something really powerful. You just got to keep the lines of communication open. You don't have to solve everyone's problem. But if they know that you're trying to, it goes a long way. So that's the nugget I've got for myself recently. And yeah, we'll do it again soon. Woo.

Marcus Shumate (24:12.078)
Rock on.