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We talked to a lot of great companies. We talked to Avia, said Sign Health, Verizon BlueJeans. We talked to Definitive Healthcare Impact Health, Ochsner. Lots of great content and none of this is paid content. Here's what I did. I walked the floor and talked to people about what they were doing and tried to identify those things that I thought would be relevant to you, the community.

So go ahead over to today and catch up on some of those other shows that we've started releasing them on Wednesday of last week. On this show, we have a discussion with Glen Toman, the CEO of Trans. Around their recent announcement with Walmart and we also talked about some other topics which I think you'll find interesting.

I always love sitting down with Glen. He is such a great thinker and such a great conversationalist, so I really enjoy sharing this with you, the community. These are audio only, so don't go looking forward. The video, it's not out there. It's just our voice for these couple of episodes. It's great content.

I hope you enjoy. Alright, here we are at the health conference in Boston and we're here with Glen Tolman with Trans Glenn. Welcome back to the show. Looking forward to the conversation. Thank you. It's great to see you and actually physically be with a human being again. I know. Isn't it amazing? Uh, last night they did the, uh, the opening session and so many people came out on stage and they were just looking around going, this feels good.

It looks good. It does. To see that it does, that group of people get that response. I imagine when you're speaking, it's good to just have that back and forth. The, the video just doesn't give you that. Well, it is. I think when we're with each other, we're social animals and, uh, . You know, there is this feeling of talking to a group and, uh, being on stage in front of that many people.

It's funny, it it, for the first time it was almost like starting over again. It's been a year and a half. The, uh, we're gonna cover a lot of things. We're obviously gonna talk the Walmart, uh, deal. That's gonna be interesting. Uh, we'll talk about, uh, . The last time you and Jonathan Bush were on stage together in the red box or short incident, you can because you guys are on stage again today.

We are, we are. And, uh, I'm, I'm curious what, uh, what's gonna be discussed there, but, uh, the last time we spoke, you promised to, uh, put transparent customers and their employees back in charge of care, which I, it was so compelling to me that, uh, I was excited and I was trying to figure out how to take my five person company and grow it to be large enough to, to, to be

A, uh, a participant, but, uh, you took a big step this week with the, uh, Walmart deal. Talk a little bit about that. We did. Well, the idea in much of healthcare is not that we don't have . Wonderful physicians, wonderful surgeons, great medications, wonderful facilities. The issue is always how do you get the right people to the right location at the right time?

How do you get people affordable medications at the right time? And so I always think of healthcare as an information business first and foremost. I mean, what happens when something happens to you or a member of your family? So the first thing you do is you either Google it or you call a physician friend if you have one.

And ask her, or ask him, what should I do? And you want three things. Give me all the information I. Uh, number one. Number two, give me your trusted guidance of what would you do. You are a friend, you're a confidant. I can trust you. And last but not least, once they do, if they say, go to this facility, you say, can you get me in?

So those three questions are what we've tried to solve. A transparent a part of that, and this comes way back, you mentioned Jonathan Bush, way back to my electronic. Health record days and even before that when we worked together. Yep. Electronic prescribing, Allscripts was doing, at the time, hundreds of millions of electronic prescriptions.

And one thing we knew there was almost a perfect correlation between the higher the copay, the less people picked up the met. Yeah, so the idea of Walmart in our relationship there is how can we get there, what they call everyday low pricing, and that's particularly true on meds. How can we get that to the average person?

You might not want to drive for one or two of your meds to a Walmart to just check and see whether you could get a better deal, but if we could tell you, you can save. $50 a month in copays by letting us deliver those meds to your home, it's more convenient and you now get the meds and you have no copay.

That's a win for everyone. So we've been able to bring the buying power of Walmart to the average person, to the average member of transparent to the average employee and their families. It's, you know, it's, it's interesting the last time we talked about this, you, uh, you talked about experience being important.

So I, I what I experience and really cost. So I want you to frame the Walmart deal to people who are sitting there going, well, I already get my meds at Walmart. What's the, what's the big deal? But there is an experience factor and there is a, a cost to the employee employer factor. So talk about those two things.

Sure. Well, first and foremost, if you already get your meds at Walmart or any other place where you're getting your meds cost effectively, terrific. Walmart has about 200 million people a week who stop at Walmart. Most of those people do not get their meds at Walmart, and many of us grew up thinking you get your meds at the local pharmacy and that's okay.

But you know, in that case,

sorry. Um, in that case, we basically have said we want to give people in every case, more optionality. And so in the case of Walmart, you may be going there every week and not know that you could get two or three of your meds at two or $3 less than your copay for your existing health plan. We want to make that available to you as a choice.

So we're going to say to you, bill, you can keep doing what you're doing. You can stop by your pharmacy, um, pick it up, or you might be able to get it sent to you, which is more convenient. And. Avoid your copay in its entirety. Yeah. And it's the, the story you told me the last time is essentially I could go and the cost of the med is three bucks and my copay is 10 bucks, and I'll end up paying 10 bucks instead of three.

The the $3. Exactly. It's an, it's an amazing thing. I think it's downright wrong that some of the PBMs out there, not all of them. And some of the plans out there charge you the higher of the two of cost or copay. And so basically, you know, we know that certain generic, like a generic statin may cost $5.

Your copay may be $15, and you walk in and if you say you're uninsured, you pay $5. If you say you're insured with one of the major plans, you pay 15 or $20. So who would want to join a club that charges you more for everything? I mean, it's counterintuitive, and yet that's the club most of us are in, but we've never known that.

Now with Transparent, you will know that and you can make a better choice. So I, for clarity, your clients are . Employers Self-pay employers, large self-pay employers at this point, mid-size and large self-paid employers, but also states, local governments and larger federal programs as well are people we're talking with.

Interesting. So this deal with Walmart is not about. Signing them on as a client. It's about really signing them on as a service to your client. That's correct. They have two sides. We do have to keep them separate from a regulatory standpoint, you know that. Yeah. And so we would love them to be a client. I can't really comment on that.

Yeah, right. In the same conversation as. The fact that we are business partners now trying to bring, and I know, you know, the leader of their health and wellness business, Dr. Cheryl Pegas, um, unbelievable visionary, a true commitment to health equity. And this absolutely fits in that fairway of saying, you know, this is something that's gonna make it easier to stay healthy by getting lower cost drugs and making it easier to get those drugs, having them delivered to your house, or being able to pick them up at a Walmart.

So when I, when I think about this deal, and I, I don't wanna mention the other players, but. But you're, you're open to working with the other players, I would assume, because you work for the employers and you're trying really to create the best service for all of them. And while Walmart is a, is a great player, there, there, there are other really good players in that space.

Yeah, that's correct. We, we don't, I like to think of as, uh, as transparent works with members. And that's all of us. That's all of us, our mothers and fathers, our sons and daughters, our friends, and we're trying to make healthcare make it easier to stay healthy and make healthcare more accessible. So if that's Walmart, terrific.

If there's other options, that's terrific. And by the way, I hope. You could go to Walmart and get the same pricing that we're getting, so there's no secret here, but you'd have to do that. We know one of the biggest reasons people don't get healthcare is transportation. We're gonna take that barrier away.

We're gonna take the copay barrier away. And if other people want to do that, that's terrific. And we just want better healthcare 'cause we think it's important to our country. It's important to our businesses and it's important mostly to all of us. We, yeah. We heard, uh, him at Tania last night talk about intentionally building out.

Companies and partnerships to address the gaps that exist in healthcare today to, uh, to address the, uh, burden on GDP being one of the, one of the main things, uh, but also the accessibility of care and those kind of things. Is this so transparent? Has that. As, as its vision. Absolutely. Yeah, that's, Heymont is probably, I think, the hottest, most visionary, uh, venture capitalist in this space today.

Um, general Catalyst, an incredible firm. You know, look at the leadership that he's adding. Ken Schal, um, amazing chairman of the firm, and these are visionaries who aren't just interested in maximizing the number of dollars, but in solving problems. And if you solve those problems, you'll make plenty of dollars.

They demonstrated that. Um, with Livongo, we did a good thing. We had more than when I left, more than a million people using various Livongo software to treat and manage their diabetes, their hypertension, their weight management, their behavioral health issues. So we're very proud of that, first and foremost.

And interestingly, when we closed an 18 and a half billion dollar transaction. Most of the people in the company were most excited that we had just crossed a million users of the software and, and again, but why was that? Because a third of our employees either had diabetes or another chronic condition, or had a family member who did.

They were committed to making a difference, not just to making money. And I think . We've gotta understand that first and foremost in healthcare, we have to get back to this commitment to solving the problems in healthcare. Well, Heman and, uh, Ken Frazier, Merck, uh, chairman talked a lot about health equities, whatnot.

Talk about how transparent thinks through and how you are . Trying to lead in the area of health equities. Well, first I just want to say a word about Ken Frazier, who's also joining the General Catalyst. Um, these are visionaries. I mean, he is a visionary leader that, you know, has been out front and some of the things they're doing in terms of.

Making their medications available, uh, around the world and solving not only the availability problem because you can say this med's available, but how do you get it to the last mile? And they're working on both those issues. And so that's, you know, we sometimes want to. You know, uh uh, criticize pharma, but pharma is the solution.

Pharma is kind of take two of these and don't call me in the morning. When you look at what they've done in hepatitis C, they found a cure. I mean, this is amazing. Now we gotta figure out how do we get our healthcare system to use that for everybody? Because yes, there's a big upfront cost, but if you look at it over five to 10 years, it's a reduction in cost and an improvement in the quality of life.

So now we have to figure out how do we finance these meds? How do we pay for 'em? So Ken Frazier, you know, terrific. And uh, um, you know, in terms of what they're doing, I mean, I think it's, it's gonna be transformational, you know, that's what they were talking about. So the Walmart deal takes care of a certain class of meds, but there's another class of meds that's

For, for some parts of the population, extremely expensive. Is that another area that you'll try to address? Well, I think some of those are covered, so let's take insulin as an example. Walmart's announcement that they will now have, and I'll put quotes around this branded. Insulin so people can get the exact same insulin made by the exact manufacturer they're currently using for something like a hundred to $200 less.

I mean it, it's extraordinary. And I don't think we're done with insulin. I think there's gonna be. More pricing, innovation, and insulin. There are other meds that I'm sure you're referring to, biologics that we still have work to do. One, we ought to make sure they're absolutely necessary to be used. And then two, we have to figure out how to get biologics to be more price of price competitive.

Because you know Alan Lavin, who, uh, runs Caremark, one of the big PBMs working for CVS, he was on stage yesterday and was talking about, um, the fact that even though we have multiple biologics now, instead of driving the price down, they've all standardized on a very expensive price. How do we get competition back into that space?

And that's a big challenge. So, so again, I thought he was right to point that out. Yeah. His comments were interesting. He said, you know that, that once you get like the seventh or eighth player in a certain space, the the price does come down. Precipitously, but it, it, it's, how do you get the seventh and eighth player in that space?

Well, and that hasn't happened. I mean, I think he was right to point out it hasn't happened in biologics. Right. So what we used to see happening doesn't happen, and we're gonna have to force the market in some ways. I love, um, um. You know, some of the efforts that are going on around the market, um, to actually create competition and in some cases manufacture drugs to force these high cost drug prices down.

So, you know, I think we're gonna see more and more of that. Glenn, I'm gonna ask you this question probably every time you come on the show, and it's how should care providers think about Transcare? I. Well, I think they should think of transparent as making it easier for people to get information on high quality health services.

So from that perspective, we believe if all we did was shift the lower half of the market to the, the higher end of the market. Lower quality providers facilities, more expensive drugs to the other extreme, high quality, making sure that their second opinions done, making sure every surgery is necessary.

Making sure, making sure they're getting their, their meds. Their meds, getting their meds. So one, remember. All of those are healthcare issues, equity issues, and health issues. If all we did was that we'd solve our healthcare problem in this country, and that's what we need to do, we know that as an example, healthcare is the number one cause of consumer bankruptcy in the country.

So when Transparent comes along and says, we're gonna pay providers in advance for a surgery, number one, and we're gonna have no copay, but also no co-insurance. No co-insurance. That's what's driving bankruptcies. You know, you or I might go in for a $50,000 knee surgery and we might have great insurance.

It covers 90%. Well, that means that 10% or $5,000 we have to pick up, 90% of Americans don't have a thousand dollars in their savings. So when you say it's $5,000. You know, as you know somebody who might have a family, you have to make trade-offs. You might say, I'm just not gonna get it. Well, if that's a heart surgery, that's not good for anybody.

So we've gotta take those barriers away, and that's what we're doing at Transparent. So in one respect, if you're a surgeon, we're making it easier for you to get a surgery if it's necessary. 30% of all surgeries are deemed unnecessary, so we also don't want anybody cutting into your body. Unless it's absolutely necessary.

Yeah. It's interesting the . Yeah, my, my daughter called me up and she had, uh, a health event and she said, dad, I, I, I still owe $5,000. And she's, you know, mid twenties, uh, lit on her own, that kinda stuff. She goes, I don't have that money. I mean, I thought I was getting care. I thought it was gonna be covered by my insurance.

And that's the conversation that you'll have. I assume ahead of time with these people? Absolutely. If they're, well, I think first of all, your daughter's experience is the experience that's happening all over America, but everybody doesn't have a dad to call, right? Everybody doesn't have a secondary source to go to.

That's what's driving these bad events, whether it be a bankruptcy or avoidance of a necessary surgery that only is gonna get worse. That's what's driving people not taking their insulin and they end up with an amputation. Because they couldn't afford to take their insulin. So how was that? How did that make any economic sense?

It doesn't, how does it make any. Quality of life sense, it doesn't. So what we would say to your daughter is, look, we can get you to a high quality surgeon or whatever other procedure she had and have no cost whatsoever, and no bill. We'll just get you taken care of because that's the best thing for you and that's the best thing for your insurer as well.

So you guys, uh, the thing I like about this is. A lot of companies decide, well, we're gonna be a health company, or we're gonna be a healthcare company. You guys are right in between those two things. Talk about how you, you know, we're, we're seeing some announcements on the, the healthcare side. What is the, what does the health side look like?

And I'm not asking for like, free announcements, I'm just saying, what, what, how are you thinking about I, I think what, what, and I'm, I'm happy to, uh, to talk about kind of what our future looks like. But you know, we have traditionally thought of healthcare as one . Entity and that was really, uh, wait till it breaks and fix it.

So first and foremost, we want to keep people healthy. Part of the way you do that is you give them affordable medications. You make it easier for them to get treatment when they need it. You make it easier for them to do the appropriate testing when it's necessary, and then when they need care, get 'em to high quality facilities.

Well, what's high quality? Well, first, do they need the surgery? Second, what's the facility like? Is it twice the infection rate is the one next door? Well then send 'em to the one with a lower infection rate. We do know that and we track it, and yet every day we send people to the wrong facilities. Should it be not a hospital, but an ambulatory surgery center?

Um, because again, ambulatory surgery centers, if all you're doing is knees and hips, um, . You're gonna have a lower infection rate than a hospital that has every known disease and issue going on. It's not the hospital's fault, but it's simply the reality of what they're dealing with. So if we can get people, make sure they need it, right facility, and then high quality physicians, if we can do that again, we can address it.

Now, you notice I didn't mention cost in any of that, right? But in fact, every step along the way. Has an impact on cost that's positive. If you don't need the surgery, you're happier and it doesn't cost any money. If you need the surgery, but you get it in the right site, it tends to be lower cost. And last but not least, if you get it done by the right physician.

And she has a very high quality rating. Chances are you won't have to redo it. So in every case, quality pays, but you have to start with quality first. And no one has confidence today when they go to their payer, that their payer has that view in mind. In fact, we all know the payer is looking for the lowest cost solution.

So imagine if your daughter called you and um, said, dad, I need a procedure. And you said, I'll find the lowest. Priced person in the country, I'll find that she would look at you and say, what are you talking about? And yet, that is our healthcare system today. Last question. So, uh, today's session is you and Jonathan Bush on stage, which is as close to must see TV in healthcare as as you get.

Because the last time one of you was in red boxer shorts on the stage. Uh, I'll, I'll just leave that there. Um, what can we expect from the session today? What do you think? Well, let me clarify. I wasn't in red boxer shorts, . Um, look, Jonathan is kind of an iconic figure. He's, uh, a fun figure. He is a controversial figure, and we were, we were competitors.

And I say that with quotes around it because, you know, Jonathan had started an upstart company and they wanted to be competitors. We weren't really competitors. Um, that said, Jonathan pushed the envelope, he drove a lot of innovation. And so this is a little bit of round two. In respect that um, you know, Jonathan has reentered with a company that is trying to help healthcare organizations and providers in particular redo their infrastructure.

We're in the front end of the consumer market, so we're not really Yeah, you're not really what we do mean Zeus and doesn't touch transparent aren't really. Yeah. So those don't really touch and I think. You know, it's necessary. It's just not, we're focused on how do we actually fundamentally change healthcare.

So it should be a fun conversation. The boxer shorts came from, uh, it was gonna be a head on head. I ended up, uh, being projected and it was a little like that Apple commercial where I apparently my image was like 20 feet tall and he was looking up and, and it was. It was, I think, a challenging day for him.

Someone took a picture and it looked like, you know, Jonathan was like three inches tall and there was a hundred foot barrier, and it was, uh, it was a fun event. And everybody seems to remember that image. Well, it's, the internet doesn't forget, you know, it's, the picture is still out there. That's right. Um, I think if I were doing the Chrissy Farts doing the interview, which will, which will be great, but the, uh, if I were doing the interview, I, I think what I would do is ask you guys Okay.

I, I just heard the announcement. Wow, that, uh, Judy Faulkner has decided to come into your business and open up in your space. And I, I, I'd wanna see if any, like sweats broke out a across the two of you or not, you know? Well, I think, um, you know, I, I hope she does ask about Epic and, uh, I won't make it personal, but look, I think Epic has, has not been a friend to healthcare and to the industry.

Um, there's very few industries in the world that say our software is so complex, you have to hire somebody because you couldn't possibly figure out to use it. Imagine if to use Google or Airbnb or, uh, you know, Lyft or any service that we love to use. Imagine if someone said, you have to call somebody who will use the software and you tell 'em what to do, and yet somehow

In healthcare, like a lot of other broken things in healthcare, we seem to have accepted that software that is so complex to use that slows down physicians has become a standard. Um, I think the second thing is for years we've been talking about, um, interoperability. And they have fought it in every case, and that's hurt patient care.

So even if you go to two different hospitals using an epic system, they often can't exchange information. And that's just a shame. It's not good for patients. And that's the ultimate me. So look, I, you know, I acknowledge that. You know, the, the leaders of that industry have left, um, you know, Cerner's no longer led by, by Neil May rest in peace.

And, and Jonathan drove, you know, uh, new ideas in the industry and was ahead of his time. And of course, all Scripts was a leader in innovation, particularly for small practices for electronic prescribing. Um, and yeah, and I, I would say interoperability and the interoperability, the API. Uh, set that we had from Allscripts was, was extremely forward thinking for its time.

That's right. We opened up the system. Um, we wanted to do that and we did it for a simple reason. We wanted to make healthcare better, and I think that's the difference and that's what's most missing from healthcare. And that hasn't changed the payers, I think. Have stepped away from this idea of how do we make the experience better for the average person who buys our product?

And that's what's missing. And how do we get better aligned with the people who pay for it today? That's all of us and our employers. And they've done neither. Yeah. And that's what Transparent is about fixing that problem. Glenn, thank you for your time. Really appreciate it. Well, thank you. It's always great.

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