Counterpoint

This conversation originally aired on Day Zero, a podcast from Think Medium. 

[5 MIN READ | 40 MIN LISTEN] 

Trilliant Health’s President and CEO, Hal Andrews, spoke with Tarun Kapoor, MD, MBA, Senior Vice President and Chief Digital Transformation Officer at Virtua Health on the Day Zero podcast about his mission to improve market analytics, research, and predictions in healthcare. 

Note: The Q&As below are paraphrased from the conversation.

Tarun Kapoor, MD: Hi everyone. My name is Tarun Kapoor, joining you for Day Zero. I'm very excited to kick off this session with none other than Hal Andrews from Trilliant Health. Hal, please introduce yourself to the audience.

Hal Andrews: First Tarun, thanks for inviting me. My name is Hal Andrews. I’m the CEO of Trilliant Health, a healthcare analytics firm in Nashville, TN.

Tarun Kapoor, MD: Hal, before we get into the depths of Trilliant Health, this is not your first rodeo with Trilliant. Do you mind sharing with the audience a little bit about your background, how you’ve done this a couple of times and I'd just love to learn about your journey, and how you even got to day zero of Trilliant?

Hal Andrews: Well, It’s sort of three chapters. The first chapter was as an attorney doing M&A deals for HCA and Surgical Care Affiliates and Health South. The second chapter was as a development executive for healthcare services startup companies. Then the third chapter has been data and technology. The specific way that I got here was, that this is the fourth time, the team has come in to take over a situation that was in dire straits, a broken company, and to try to turn it around and make lemonades out of lemons. So we’ve had experience doing that, going back to 2007. So far so good.

Tarun Kapoor, MD: Hal, So what really got you interested in your first go-round? When you said you were an attorney, you’re doing M&A, you’re working for HCA, not a typical mom and pop shop. And you said, okay, I’m gonna go a little bit deeper in a completely different environment. Can you share a little bit more about that experience?

Hal Andrews: The real story is that I’m from Nashville. I had always intended to be in the music business, which is the real anchor business in Nashville. When I got to the law firm as a first-year associate, I told the partners that I wanted to build a practice in the music business. They said that’s fine; you can do that at night and during the day, you’ll do acquisitions for HCA. So I did that for four years. I worked on every joint venture that HCA did from 1992 to 1996, and after doing the 13th joint venture the exact same way, I thought there must be something better. So I went to the law firm partners and said, I’m going to join a startup in the ambulatory services space. They said you have a great career here and you’ll be on the management committee and then you’ll be on the executive committee and I looked around the room at the partners who were all between 38 and 42 and I asked them which one of them would give up their position on the executive committee for me. And there was a long silence. And I said that’s what I thought. So I decided to jump into the services side on the development side. The seed for that was planted by a guy named Carl George, who used to run development for HCA. When my music business law career ended abruptly, when my client fired me and hired Garth Brooks’s attorney, Carl happened to call me that week and asked me to go to lunch and asked me if I had ever thought about a career on the business side of healthcare. And I told him, no, I’d never even intended to do what I was doing for him. He smiled and said you should think about getting on the business side because you’d be good at it. And so he saw something in me that I didn’t see in myself. Fortunately, he was right.

Tarun Kapoor, MD:  So you start digging down a little bit deeper, you start looking for these opportunities and you said, you’ve gone through a couple of these iterations, finding companies that are maybe good ideas but not necessarily well positioned. Talk to us a little bit more about how you came into Trilliant.

Hal Andrews: I think the dot that I would connect is that I view entrepreneurs like songwriters. Songwriters are the ultimate entrepreneurs. They put their words to music. They stand up on stage. What we all see is the people standing on stage in front of 60,000 people. I’ve been there when it was six and entrepreneurs are like that. They have an idea that they sometimes put down in writing. Sometimes they put it down in code. And they try to convince the world that their idea is a good idea. Where I find myself, is in picking up the pieces where the entrepreneur’s initial idea was pretty good, but the execution was suboptimal. Starting in 2007, we found ourselves in situations where there was a core idea that had some merit, but there were some things missing and it could have been a market fit, it could have been the quality of the product, it could have been an understanding of the market itself. The team figures out how to find the one good nugget in what is, at the point we show up, a disastrous situation, and try to reorient the business around that. So for me, I admire the entrepreneur, just like I, I admire the songwriter. I don’t have the ability to write the music. I very rarely have the seed of the idea that turns into something, but I’ve developed a skill, to find the thing that might work and focus on that.

Tarun Kapoor, MD: So specifically with Trilliant, first of all, take us through a little bit about the concept behind Trilliant and the market that’s looking to enter and disrupt.

Hal Andrews: The idea for Trilliant was actually three companies that were stuck. I had joined the board of a company that was focused on developing relationships with employers on behalf of hospitals. I knew of another company that was focused on digital marketing for healthcare services for hospitals. So if a patient searched for orthopedic surgery that business was to serve up an ad or a link to a health system that was delivering those services in the market. Both of those companies were struggling. One of them was making a little bit of money but was really on a secular decline. The other one was losing money, hand over fist and had an interesting idea. The sort of the Genesis, the idea was that I went to meet with Martin Ventures, which is a venture firm here in Nashville, run by Charlie Martin, who at one point was the president of HCA and then the COO of Health Trust and then the CEO of OrNda and then the CEO of Vanguard. So Charlie’s been in the hospital business since I think 1968. I was meeting with Charlie and the guy who runs that venture firm named Devin Carty. And I said, Charlie, what if we did advisory board in reverse? What I meant by that was that advisory board was really good at research, and then they began to consult with their clients, and then starting in 2007 or 2008, they bought a company called Crimson, down in Austin, TX, and turned that into the Crimson Market Advantage Product, which probably every health system in the country’s subscribed to at least once over the past 20 years. Then in 2011, they rolled up several other companies and were really trying to present a technology platform to the market. We knew something about those technology companies they bought because people involved with Trilliant had been involved in selling three of those companies to Advisory Board. We thought that it was gonna be a challenge to integrate those companies for a variety of reasons and the pitch to Charlie and to Devin was, why don’t we do it in reverse? Why don’t we start with local market data and then we’ll consult with our clients. And then we’ll add research. And the key there is the local market data. For almost 40 years now, since Michael Sachs first went out to start his own company in the mid-eighties, most of the strategic benchmarking and predictions in the industry have been national metrics. They haven’t been focused on dynamics in local markets. From 96 to 2007, when I was doing healthcare services, I visited hundreds and hundreds of markets. In those hundreds and hundreds of market visits, I’ve visited hundreds and hundreds of hospitals. When you do that, you realize that healthcare really is local; it’s one thing to say that, it’s another thing to understand it. It’s a third thing and an entirely different thing to build analytics at the market level so that you can understand what’s happening. If you think about a market that you’re familiar with: the greater Philadelphia area. Philadelphia is one great big CBSA, according to the census bureau, but there are at least five submarkets in Philadelphia. Depending on which submarket you’re in the needs of the population and the ability to serve those needs are vastly different.

Tarun Kapoor, MD: You reference Michael Sachs and an interesting factoid for listeners: That’s where Sg2 comes from. I think it’s Sachs Groups number 2, his second iteration of it. I did not know that until relatively recently the second piece you bring in is a revelation that in healthcare. It’s a revelation to us in healthcare, but it’s probably shocking that it’s a revelation for anyone outside of healthcare in a way, wait a minute, you need local data? You don’t have local data to understand your market? Your local data is just this amalgamation of anything but local data. So is that a finding that you’ve seen as a pattern over and over as you’ve done this specifically in healthcare founding, that maybe there are techniques that the rest of the world takes for granted that healthcare doesn’t?

Hal Andrews: That’s exactly it. We’re trying to bring a level of engineering and data science to healthcare that every other industry’s been doing for years. Particularly marketing, the consumer marketing industry, is certainly the leader in that. I think of a friend that I know who’s worked in the consumer marketing business since the early nineties. When I described to him what we’re doing and the fact that it’s novel in healthcare, he just rolls his eyes and asks me if I’m really serious. And the answer is, yes, I am. There’s an interesting intersection between lots of discussion in healthcare about consumerism and yet a lack of techniques and technologies to really engage with consumers and to understand consumers the way that Amazon or Netflix or Walmart or CVS does.

Tarun Kapoor, MD: Can you give us an example for the listeners of something that we probably would’ve taken for granted, but in healthcare, you were able to at Trilliant, shed some light on.

Hal Andrews: I think the analogy is really back to voting. If you think about the Democratic National Committee or the Republican National Committee, they each have consumer files on all of us. We probably don’t want to think too much about what they really know about us. They have filtered a thousand data elements for each of us down to six or seven that are predictive. Unfortunately for me, their algorithms suggest that I want someone to knock on the door of my house and talk to me about politics, which is not actually the case, but they know who wants to talk to a person they know who wants to receive a text. They know who wants to receive an email. They understand how to diagnose who can be moved, whose decision can be changed, what’s most likely to change it from an issue standpoint, and then what the medium is to motivate that change. We talk a lot about that in healthcare, but then what we do is we think that my chart is a consumer engagement app and of course, I’ve been in the business since 1992. I know that one of the cholesterol numbers is supposed to be high and the other one’s supposed to be low, but I can’t remember which one it is. If I log into my chart I’m completely lost, and I’m more healthcare literate than most. Yet I don’t understand it. So I think, we think as healthcare people in terms of clinical data, instead of thinking about the preferences of consumers. One of the things that we’ve been able to do here is to understand at scale that there are some populations that are psychologically very different and clinically identical. Conversely, there are populations that are psychologically identical and clinically completely different. That manifests in, in lots of ways. When you get to the census block level, it’s really important to understand the needs of the customers in your total addressable market. Our focus is to understand what is really the total addressable market for whatever it is that anybody wants to do? Whether it’s urgent care or telehealth or diabetes or surgery, there are attributes of the consumers in the markets that will influence their willingness to do that thing that you want them to do. Depending on the service line, depending on the population, depending on a number of different variables, you can make really great decisions or really bad decisions with a national view of data, as opposed to a local market view. 

Tarun Kapoor, MD: What I’m going to do is share an example that I use, searching from one of the reports you put out on Trilliant Health. Virtua Health Systems is in New Jersey. You’re referencing the psychometrics profiles out that you have, and New Jersey has the highest percentage of people who obtain medical care, but don’t have a primary care doctor, and probably don’t want a primary care doctor. I think it’s like somewhere around one out of five. So we’re like, okay, what, should we open another primary care practice? No, we don’t need to open another primary care practice. Or if we are, we actually decided to open another primary care practice, but we’re opening a virtual primary care practice. So maybe the person still doesn’t want a primary care doctor, but at least if it’s virtual and it’s super convenient, maybe we have a chance at doing that versus another brick-and-mortar. Is that the type of examples that you would run into with your clients?

Hal Andrews: That’s a great example. It’s analogous to another example with a large system that went out to build standup emergency departments in a market. They did what we’re inclined to do in healthcare, which is they went to the markets where they thought the people with commercial insurance were, and they correctly diagnosed the neighborhoods with wealthy people. What they didn’t understand was that some of those neighborhoods had people who were more focused on the here and now and who are more likely to pick urgent care as opposed to picking an emergency department. When you get to the detail of the psychographic data, there are some people who are always going to urgent care. They’re never going to go into primary care. They’re not even going to the brand name, academic medical center emergency department. At the same time in the same CBSA, there can be people who are completely different. You could put an urgent care by their mailbox and they drive right past it and go to the name brand academic medical center and sit in the emergency department for however long that took, those are not oriented by clinical conditions. They’re oriented by psychology. That psychology is like a lot of other things hardwired into our brain between the ages of 18 and 24. And once you have that mindset, it’s really hard to change the behavioral pattern. The only clinical condition that we see that continuously changes people’s sort of hardwired nature is cancer. And when people are diagnosed with cancer, they change a lot of things. And one of those is they change their approach to the healthcare system, and they become much more willing to follow the direction of a primary care provider or an oncologist than they are at other points in their life.

Tarun Kapoor, MD: That’s absolutely fascinating stuff, Hal. Thanks for sharing that. Now that we understand, the audience understands, a little bit more about Trilliant Health and what you’re trying to do there, let’s dive in a little bit more about how, as a leader within this organization as well as compared to the other organizations you’ve served, how you’ve had to evolve your leadership style to fit the needs of the company or is that an assumption, incorrect assumption on my point? You’ve been able to bring the same approach all the way through.

Hal Andrews: Your first assumption is the right assumption. I think there is. The number of changes that I’ve made in the past 15 or 20 years are probably too many to count. My wife would think that I haven’t changed that much. I think in the workplace, they call it an adaptive personality. When as a young lawyer, I was surrounded by people who are supposed to have the answer. And so your orientation is that you’re supposed to have the answer, and if you don’t have the answer, you’re supposed to go get the answer. And then you’re supposed to be confident of it a little bit like a physician. It’s important to convince people that you’re credible. That’s fine in a law firm when you’re surrounded by a bunch of other Type A personalities, all of whom think they’re correct. When you get to the real world, it’s very different. I can remember a conversation with a former boss in 1997, when he called me into the office, and I was in a, let’s call it a debate, with one of the operators in the field. And he called me in and said, you just can’t. You can’t talk to people like that, right? She’s not a lawyer. She’s a nurse and she’s coming from a completely different perspective. And you’re not gonna convince her of anything with that approach. I’d say the fact that I remember that first from 25 years ago means it made a mark. When I became a CEO for the first time in 2007, I remember being aware that I probably wasn’t prepared. I talked to a private equity friend at the time who was in the loop about me potentially taking this role. I remember a call that I had with him, saying, I’m not ready for this. His answer, which was a wise one, was, you’re right, you’re not, but you’re as ready as you’re gonna be before you do it for the first time. Being a first-time CEO of anything is really hard. It’s difficult because you’ve never done it before. The most difficult part is the loneliness of it. There are things that you know, that you can’t tell anybody. You can’t tell anybody at work because they’ll worry. They might lose confidence. They might wonder about whether you’re gonna make it or not. You can’t tell your spouse because your spouse would think that you’re crazy for having that job and maybe you should leave and go get another job. I’ve had that conversation a couple of times over the years. The next thing is as a first-time CEO, I tried to do everything. I followed the if you want it done, do it yourself approach, which is, A, incorrect, and B, wears out your team. And so to think about the evolution, probably the most important word I’d use as culture. I learned a trick from a guy named Jack Lord, who used to be the Chief Innovation Officer of Humana and the Chief Medical Officer of Humana, an experienced board executive.

And Jack taught me a trick about culture in terms of documenting it every day. And I stole it from him and he knows I stole it from him. And I’ve been doing that since 2013. It’s called the Daily Update. So every day at the end of the day, I send everybody in the company an email and now, because of slack, I have to send it in slack too, they read slack in their read email and I’ve modified the daily update.

So the daily update is an excerpt from The Daily Drucker which I think is an amazing book of business wisdom. There’s a section called Progress, which is everything that I did that day. So this podcast we’re doing right now will be in today’s Daily Update. The third thing is takeaways, which is what did I learn? And sometimes the takeaways are internal. They’re just things I learned about our customers or our business practices. Sometimes they’re external. Occasionally we broaden it to things going on in the world and talk about those and how that affects us. Then the last piece, which is the most important piece is gratitude. I think that those things have done more to change me as a leader because they force me to be transparent with everybody at the same time every day. Yes, I do send it every day. People don’t believe that you could actually do that every day. After being here five and a half years, I wonder some days if I’ll run out of material, but so far so good. The world keeps producing enough drama for me to have takeaways every day,

Tarun Kapoor, MD: Every day. So you’ve done it every day for five and a half years.

Hal Andrews: Every day.

Tarun Kapoor, MD: Kudos to you.

Hal Andrews: Going back to the first time I did it, I remember on my one-year anniversary at the first company that I did this, there was an engineer who worked remotely, whom I’d never met, and he didn’t say much, and I’d talked to him maybe once and on the one-year anniversary, he sent me a note and said I guess you’re serious about doing this every day since you’ve done it for a year. I don’t get a lot of responses to the Daily Update, partially because I think people are sometimes worried about responding to me in that format. But the fact that he watched for an entire year and then sent the note, said a lot about the impact it was making on the culture.

Tarun Kapoor, MD: Hal I can’t even imagine the magnitude of the impact that this creates. Just a little more tactical, how long does it take you to put that together? How long is it? Or are those proprietary Hal Andrew’s secrets?

Hal Andrews: No, sometimes as I tell the team,  they write themselves. Occasionally we have an early edition where something’s happened by 10 o’clock in the morning where it doesn’t matter what else happens the rest of the day. This is the 'one thing' as Curly says in City Slickers. Sometimes they take an hour. I think back to the pandemic, the summer of 2020, when we had the health crisis and the financial crisis, and the social crisis, some days those took two hours. And that was really trying to keep people focused on the things that we can control and to be thoughtful about the things that we can’t control, but not to be lost in the things that are beyond our control. So I would say on a slow day, it takes 15 minutes, on a long day, it may take an hour. But probably on average, 20 to 30 minutes.

Tarun Kapoor, MD: Okay. Thank you so much. I’m gonna have to commit to doing something similar and challenge myself to do it as well. And I’m sure almost all the listeners are gonna say, my goodness, this is a CEO of a busy company who does this. Huge lesson learned for all of us listening today. Hal, actually this is a perfect pivot point, because you referenced 2020, three massive changes in society, between healthcare and social and political. Let’s talk a little bit about the current environment that Trilliant is operating in, under some of these,  with the input of data, new sets of data coming in, have been very beneficial for Trilliant or opening your customer’s eyes to the benefit that Trilliant can bring. But it’s also now amidst of very likely, very possibly, a recession coming down the pipeline, the pullback in some very frothy valuations. Reality has set in whereas the Warren Buffett 'the tide has gone out and, hopefully, we’re all not just wearing our underwear. We’re wearing at least underwear.' What are you thinking about in the current atmosphere, the current milieu, that has you hopeful for Trilliant, but also potentially keeps you up a little bit?

Hal Andrews: I would start at the macro level. I remember going to a presentation; It has to have been 15 or 20 years ago. For years, the congressional seat in Nashville has been held by Jim Cooper, and Jim is a very bright person, very thoughtful about healthcare. Jim was involved in the mid-nineties in trying to craft legislation to change healthcare. I remember a conversation in that meeting where he was talking about the true unfunded liabilities relating to healthcare in this country. The numbers were incomprehensible then, and they’re even worse now. And I look at this first as a problem for America. There are plenty of studies out there about how it’s not affordable and it’s the most expensive and on. I think about maybe a simpler idea of the system breaking and if I go back to where I started my career, I did a number of deals for HealthTrust, which spun out of HCA in 1987. HealthTrust was really the rural hospital company in the country, the largest rural hospital company. I went to a number of those markets to try to do deals and in some of those markets, you could get a deal done. And in some cases, those markets were just immature. So, one market that HealthTrust had was in Northwest Tucson. In 1987, it was immature; today, the city’s grown up around it. But for every market that was just a little bit immature, there were a lot that were just distressed. And they were in small communities, and ultimately the community couldn’t support a hospital. We started Trilliant with a focus on hospitals because I have seen what happens to a community when a hospital closes. Everybody knows that hospitals are usually a large employer market. Everybody knows that hospital wages are good wages in a market. Unless you’ve seen a hospital close, you don’t understand what happens to the market when the hospital closes. You lose the largest or the second or the third largest employer in town, you lose the best wage payer in town and you lose access to healthcare. How do you keep those vital community assets open to be there for the community? How do you keep them open for the jobs that drive the economy? I understand the Triple Aim, and I understand the goal of that. Frankly, wherever the summit of the Triple Aim is not attainable for hundreds of hospitals in this country, maybe even thousands. Our starting point was if we don’t do something different, we’re going to have an access crisis in this country that’s very different than what people talk about in terms of a lack of access today. From that, you say what are the things that impact that? The simple reality is that a hundred people can’t change $4 trillion of the United States economy. The US healthcare economy is larger than every economy in the world, except for Japan and China. So how are a hundred people going to do that? Our part is to try to get people to use data more strategically. One of the problems that I see is a focus on benchmarking that is incomplete and lagging in time. The thing the pandemic really brought into focus is that it broke apart the fallacy that nothing in healthcare ever changes. On March 15th, 2020, everything in healthcare changed dramatically overnight in ways that I haven’t seen anybody predict or even could have predicted. To think that, all of a sudden, surgery would be verboten for 60 days is just unbelievable. The restrictions about telehealth. My second venture back startup was a teleradiology company in 1998. When we were moving MRIs on phone lines, which is much harder than it is today To think about all the regulations that overnight just fell apart, practice across state lines, licensure, credentialing, all that stuff just overnight gone. I think that’s what brought to bear how bad it could be. Now I think human nature is to try to forget that stuff. Math is regression to the mean, and to say, well, that was a Black Swan event and that’s not going to happen, and everything will snap back to normal. Things are not snapping back to normal. The American consumer is not coming back to the healthcare system. The peak of primary care in this country was in October of 2019. We’re not back to those metrics. We’re not even close. That has an impact on every stakeholder in the health economy, whether it’s a hospital or an urgent care company or a telehealth provider or pharma or medical device or payers, everyone is impacted by the things that have not come back to normal since March of 2020.

Tarun Kapoor, MD: So Hal, I want to make sure I’m hearing this correctly, right? You’re advocating that for some startup, any company entering into the healthcare economy, this ecosystem, how do you bring value to the ecosystem? Maybe yes, you can disrupt the ecosystem, but you can’t destroy the ecosystem. Is that what I’m hearing?

Hal Andrews: Yes. I think the only thing that would destroy the ecosystem, in a creative destruction format would be the repeal of the tax deduction for employer-sponsored health insurance. If we did that, then chaos would ensue for two or three years, and then things would settle out. There are large political and business interests that keep that from happening. So back to what enterprises and other parts of the economy do, they get as much data as they can, and they make predictions about the future as best they can. They adapt on the fly. So health systems are a particularly interesting example. Right now, it’s July 18th. Almost every health system that’s on a calendar year fiscal year is in the midst of budget planning. They’ve all had to go back and ask their data vendor for access to the system because they haven’t logged in for 12 months since the last time they went through the strategy process. We make these plans and we make these budgets once a year. We don’t adjust during the year except for a crisis. There’s no dynamic planning. There’s no dynamic forecasting. There’s no “if we’re going to do this then we need to validate these assumptions.” And you think about how we make decisions, most strategic decisions in the healthcare industry are made from inpatient data, which represents less than half the volume of services in the country and less than half of the revenue. We make that off of data that’s 18 to 24 months old, now, for next year. Healthcare’s making decisions on incomplete data that’s two to three years old. Netflix is making data decisions based on things they collected yesterday, last week, and last month, and last quarter, and then they’re adapting on the fly. So is everybody else. Amazon, Walmart, Target, Proctor and Gamble, every other really consumer-focused business changes their direction when the data changes, and the data changes daily. We’re not oriented that way in healthcare. Our little contribution, we’re not even trying to get people to change based on daily data. We’re just trying to get them to look at it monthly and to make changes in decisions about what happened 45 days ago instead of 36 months.

Tarun Kapoor, MD: Some really poignant lessons there that, you and I have chatted in the past, but I continue to learn from you every time I hear you talk. So thank you so much for that, Hal. Let’s close out with a couple of little factoids. Where did Trilliant Health come from? Where did the term, the name?

Hal Andrews: We were merging three companies together, and so everybody fixated on Tri. The first thing that came back from somebody who was there in the early days was T R I A S. We all said that out loud and thought, nope, that’s probably not what we want to call it. Devin Carty at Martin Ventures said what about Trilliant? It’ll be brilliant with a T. I said, great, we’ll do that. So the conversation lasted almost five minutes, and we just were off to the races.

Tarun Kapoor, MD: Haven’t looked back since then. What do you think makes you most excited regarding Trilliant in the upcoming years? Months, years, you know, it’s like, as you’re seeing what’s happening in the healthcare economy, seeing a lot of clouds, dark clouds in the healthcare economy, what gets you most excited, most hopeful for the company?

Hal Andrews: I think for the company, it is that we’ve just finished an amazing amount of work that’s been ongoing for three years on the data engineering side. I think one of the fallacies of healthcare technology is that it’s about the data science. Data science is functionally a labeling exercise against which you run computing power. It works in small batches. It’s hard to make it work at scale if you don’t have data engineering. Part of our progression, when we started down this path a few years ago, was to get data to the customers, to actually process the data took 36 days. We’ve been working on that all along, “we need 36 days” was going to make it hard for us to get information to people every 30 days. We now have that down to six hours. We have almost two petabytes of data in the database, and we can process it in six hours. That speed and that scale allow us to respond to customer requests at unprecedented speed and scale. A large system last week asked us if we could for all the physicians in a three-state area, give a summary of all the prescriptions they wrote. We ran it the next day and gave it to them and then said, “the problem is, it’s 70 million rows, and y’all don’t have an ability to ingest that.” So for us, it is the ability to respond to the ever-changing needs of the customers. The chaos and the challenges that the healthcare economy faces are forcing people to think about things in a different way. We were founded to help people think about things in a different way. So there’s an opportunity there that is broader than I ever imagined five years ago. As I tell the team, and I tell our board, potential means you haven’t done it yet, so there’s potential. But there’s also a lot of work ahead of us.

Tarun Kapoor, MD: Hal, closing question here. You know, given our Day Zero podcast is really geared towards so many people who are in the early stages, who won’t understand what it’s like to found a company, some pieces of advice that you’d like to offer. You’ve already given us probably at least a half dozen, Are any other ones that top of mind, or you just wanted to reiterate that because they were so crucial to your development?

Hal Andrews: I’m going to go back to my boss who called me into his office and told me I couldn’t talk to the nurse that way; that was 1997. In February of 2000, we went to eat breakfast at this little pancake place in Nashville called the Pancake Pantry, which if you haven’t been to Nashville, make sure you go there when you come. He told me the most important thing to do is to find your passion and not chase the money. I was thinking about that this morning, as I was preparing for this, I think the way that I would rephrase that is, it’s a lot easier to find a job where you make a lot of money than it is to find something that you’re passionate about and there you can always make more money. It’s really hard to find something that you’re excited about every day when you wake up. My history is to follow the muse. I got here inclined to just follow my own instincts and what I thought was interesting and not chase the most money, which is different than, you know, I’m a capitalist too, but there are lots of things that you can do where you make your living, but they don’t stir your passion, and you don’t have a noble purpose as we call it around here. For anybody who wants to do that, I would first say, find something you’re passionate about. Don’t find something that’s just a good idea or a clever way to arbitrage the fact that the regulatory environment hasn’t caught up to what’s really going on. Find something that really is almost like oxygen to you, that you’re willing to give up a lot to chase. Because it takes a lot of sacrifice to chase an entrepreneurial vision. The second thing is, and I’ll end with this, there’s an old saying that there are two things that are certain in life: death and taxes. I would tell every entrepreneur, that there are actually four things that are certain there’s death, there’s taxes, there’s the fact that it’s going to take more money and the fact that it’s going to take more time than you thought and whatever you think it is in terms of money, double or triple that. Whatever you think it is in terms of time, double that and you’ll maybe be close to correct if things go your way.

Tarun Kapoor, MD: What a great way to finish our conversation. Hal Andrews, Trilliant Health, on behalf of the entire team at the Day Zero Studios and podcasts, thank you so much for your time.

Hal Andrews: Thank you.