“Solutions don't really matter. Problems matter.” – Adrian Aoun
Adrian Aoun is founder and CEO of Forward, which is building an insurance-free healthcare system focused on preventative healthcare from the ground up. Forward was founded in 2017 to invert the typical model of healthcare, which follows the service model where one patient sees a single doctor whenever they need care. Forward is building healthcare focused on health and preventative care that's 1) productized so you can use it anytime, anywhere, 2) scalable so it's affordable to everyone, and 3) always on with help available through the Forward app and a network of offices around the US. This might sound like, well, how healthcare should have been all along, which is the goal.
To be clear, Forward is tackling a massive problem in the United States. In 2021, healthcare spending accounted for a full 19.7% of GDP. That's a full one-fifth. That number is compounding at a rate of 6% to 7% year-over-year, which begs the question, how is that even possible? And what happens when healthcare as a percentage rises to 30% or even 40% of GDP, which is a likely scenario?
Before founding Forward, Adrian worked as an advisor to the White House on the President's Council of Advisors on Science and Technology, as well as a director of special projects for the CEO of Google and the founder of Sidewalk Labs.
This episode is a special one. In it we cover why Adrian is fanatical about being problem-focused rather than solution-focused, what he learned leading special projects for Sergey Brin at Google, and why Forward is focused on productizing healthcare to bring down the cost of treatments, make healthcare available 24/7, help customers manage all aspects of their health, and increase the pace of innovation and iteration.
Adrian shares his perspective on what happens as the percentage of GDP dedicated to healthcare reaches 30% and even 40%, and he talks through how he uses extreme perspectives to pick apart complex issues and come to ground truths.
This episode is our definitive guide to healthcare as a product rather than a service. In it we cover:
- 00:00:00 – Introduction
- 00:02:37 – From Google to Forward
- 00:09:01 – Why founders should be problem-oriented
- 00:12:31 – Advising the President on the future of technology
- 00:17:22 – The root problem of the healthcare industry
- 00:25:24 – Why healthcare should be a product, not a service
- 00:30:01 – The imminent fall of health insurance
- 00:35:06 – Does the healthcare system really matter?
- 00:45:47 – Why medical specialties don’t make sense
- 00:55:02 – How Forward is a mission that happens to have a company attached to it
Listen to the episode on Apple Podcasts, Spotify, Overcast, Google Podcasts, Amazon Music, Castbox, Pocket Casts, Player FM, Podcast Addict, iHeartRadio, or on your favorite podcast platform. You can watch the interview on YouTube here.
Our Favorite Quotes
Here are a few ideas we'll be thinking about weeks and months from now:
- “We have this concept at Forward, which is that we love to beat up ideas. Some people get really uncomfortable with that. They're like, "What do you mean you're beating up my idea." Sometimes people come in, we have a meeting type called the jam where we work through problems, and we attack ideas. We attack them. People are like, "Don't attack my idea. You're attacking me." I'm like, ‘No, I'm not attacking you. I'm attacking the idea.’”
- “You are not your idea. I promise you, you're not.”
- “It turns out problems tend not to change and solutions change all the time. We know this.”
- “You intuitively know that technology scales in a way that humans don't. You intuitively know that hardware and software scales in a way that doctors don't. We only have one insight at Forward that we believe that nobody else believes. We believe healthcare should be a product, not a service. We believe that roughly everything in healthcare should just be a hardware and software problem, not a human problem.”
- “We've created a healthcare system that's only focused on short-term health. The last five times you went to the doctor, how much do you want to bet it was for flu, rashes, stomach aches? Well, okay, guys, but I'm going to die someday. Can we talk about that?”
- “We want to create a platform whereby the entire world of healthcare starts working together and the rate of innovation starts going through the roof, because until we get there, we're never going to get healthcare to go exponential the same way that transportation's got exponential.”
- “We are not a company that happens to have a mission attached. We're a mission that happens to have a company attached.”
5 Ways to Dive Deeper
- R-Zero – Pioneering with 100+ Year Old Technology with Co-Founder and Executive Chairman Ben Boyer: Check out this Outlier Academy episode with Ben Boyer, Co-Founder and Executive Chairman of R-Zero, which designs hospital-grade disinfection solutions utilizing UV-C light. (51 Min)
- Progress Studies with Jason Crawford of Roots of Progress: Jason Crawford is Founder and CEO of The Roots of Progress, a nonprofit dedicated to establishing a new philosophy of progress for the 21st century. In this episode of Outlier Academy, Jason and Daniel discuss progress made in biotech, and whether innovation is actually stagnating. (61 Min)
- Inventing the Future of Vitamins and Data Driven Health with Rachel Sanders of Rootine: In this episode of Outlier Academy, Rachel Sanders, CEO and Co-founder of Rootine, a personalized micronutrient subscription service, discusses the future data-driven health through the lens of the vitamin and supplement industry. (44 Min)
- A Masterclass on Metabolic Health, The Next Frontier in Real-Time Health Optimization with Josh Clemente of Levels: In this episode of Outlier Academy with Josh Clemente, the Founder and President of Levels, we cover using data feedback loops to monitor blood glucose and improve health. (56 Min)
- Visualizing the medical data explosion: This TED Talk with scientific visualization expert Anders Ynnerman introduces high-tech health solutions (like virtual autopsies) that make healthcare a product, rather than a service. (17 Min)
We covered a lot of ground in this interview. Here are links to the stories, articles, and ideas discussed:
- Sidewalk Labs | Urban Innovation
- Larry Page | Wikipedia
- Eric Schmidt | Wikipedia
- Kaiser Permanente | Custom Care & Coverage Just For You
- Elon Musk | Wikipedia
- President’s Council of Advisors on Science and Technology | PCAST
- Introduction to Billing Code Systems | ASHA
- One Medical | Exceptional Primary Care
- Tom Lee | LinkedIn
- goop | A modern lifestyle brand
- method | household cleaners, laundry supplies, personal care + soap
- UnitedHealthcare | Health insurance plans
- Uber | Get Moving
Daniel Scrivner (00:05):
Hello and welcome to another episode of our Outlier Founder Series, where we dig into the ideas, frameworks, and strategies used by the world's best founders. I'm Daniel Scrivner.
Daniel Scrivner (00:15):
On the show today, I'm joined by Adrian Aoun, founder and CEO of Forward, which is building an insurance-free healthcare system focused on preventative healthcare from the ground up. Forward was founded in 2017 to invert the typical model of healthcare, where most healthcare follows the service model where one patient sees a single doctor whenever they need care. Forward is building healthcare focused on health and preventative care that's productized so you can use it anytime, anywhere, scalable so it's affordable to everyone, and always on with help available through the Forward app any network of offices around the US, which might sound like, well, how healthcare should have been all along, which is the goal.
Daniel Scrivner (00:53):
To be clear, Forward is tackling a massive problem in the United States. In 2021, healthcare spending accounted for a full 19.7% of GDP. That's a full one-fifth. That number is compounding at a rate of 6% to 7% year-over-year, which begs the question how is that even possible and what happens when healthcare as a percentage rises to 30% or even 40% of GDP, which is a likely scenario that Adrian talks through in this episode.
Daniel Scrivner (01:21):
Before founding Forward, Adrian worked as an advisor to the White House on the President's Council of Advisors on Science and Technology, as well as a director of special projects for the CEO of Google and the founder of Sidewalk Labs.
Daniel Scrivner (01:34):
This episode is a special one. In it we cover why Adrian is fanatical about being problem-focused rather than solution-focused, what he learned leading special projects for Sergey Brin at Google, why Forward is focused on productizing healthcare to bring down the cost of treatments, make healthcare available 24/7, help customers manage all aspects of their health, and increase the pace of innovation and iteration.
Daniel Scrivner (01:57):
Adrian shares his perspective on what happens as the percentage of GDP dedicated to healthcare reaches 30% and even 40%. Adrian talks through how he uses extreme perspectives to pick apart complex issues and come to ground truths.
Daniel Scrivner (02:10):
You can find the show notes and transcript for this episode at outlieracademy.com/118. That's 118. You can learn more about Forward at goforward.com. With that, please enjoy my conversation with Adrian Aoun, founder and CEO of Forward.
Daniel Scrivner (02:28):
Adrian, welcome to Outlier Academy. I am so thrilled to have you on to talk about what you're building at Forward. Thank you for the time.
Adrian Aoun (02:34):
Not at all. It's exciting to be here. Thanks so much for having me.
Daniel Scrivner (02:37):
So I want to start, because I can't not start here, with talking about your background, because just to read off a few things, you've worked as an advisor to the White House, on the President's Council of Advisors on Science and Technology. You were the founder of Sidewalk Labs. You were the director of special projects for the CEO at Google. Incredibly impressive. It's not traditional things you find on someone's resume. Give us a quick sketch of your background and your journey through these roles, because they seem disconnected. I'm sure they all make sense somehow.
Adrian Aoun (03:07):
Yeah, sure. So most people, maybe the way they think about their lives is they think about it by industry. They say, "I'm a healthcare person," or, "I'm an education person," or whatnot. I've taken a very different approach. I've always just been fascinated with problems more than solutions. And so, I actually always walk around Forward and I tell people, "Ah, solutions don't really matter. Problems matter," and intimately understand problems.
Adrian Aoun (03:31):
What I've always been interested in is how can I help people? When I look at humanity, when I look at society, I see like, well, oh God, we have so much pain. We have so many problems in the world. When you start to peel back the layers of the onion, you realize that you can solve those problems with so many different facets. You can solve them with policy, you can solve them with AI, you can solve them with education, you can solve them with healthcare. That's what's driven me into so many different sectors.
Adrian Aoun (03:57):
But I've mostly all had the one common thread, which is I've tried to live my life fundamentally just in service of others. I know that sounds really kitschy and it sounds really awful, but in some ways I've, from day one, just always tried to say, well, what can I do to help?
Adrian Aoun (04:12):
Now early on, I dove a lot into computers. Like any good nerd, I got into computers and I spent a lot of time in the world of AI. It turns out that my dad ... My dad was a linguist. He studied under Tomsky. If you think about what linguistics is, it's really trying to just understand how does the brain really understand language?
Adrian Aoun (04:33):
It turns out that what you learn in third, fourth, fifth, sixth-grade English books that teach you language, it turns out you can feed all of those books into a computer and it's still not enough for you to actually understand language. It turns out that your brain is doing something else. This is what linguists are trying to figure out is what is that something else? What do you intuitively know about language?
Adrian Aoun (04:54):
And so, this was my first interest, is if we can figure this out, if we can codify this AI, maybe we can make computers intelligent and have them help us even more. So I spent a bunch of time in the world of AI. In that, I started a company that Google ended up acquiring.
Adrian Aoun (05:11):
Now once I did that, I spent some time at Google. Actually, that started going along this interesting path, because then I said, well, how else can I help people?
Adrian Aoun (05:21):
Our CEO at the time was Larry Page. Larry asked me to come spend some time as his right-hand man. I spent a few years running special projects for all of Google. What I, in essence, did was I spent time creating the Alphabet companies, which was, in essence, basically I was a kid in a candy store. It was like, hey, Google's got a lot of money. Let's see what companies we can create to go solve the world's problems. What could be more fun than that?
Adrian Aoun (05:44):
So you're right. I started Sidewalk Labs, just working on solving urban environment problems. But one of the things that we also did was we said, well, can we take our knowledge of technology and our knowledge of how we operate across the globe? Can we use that to even help out at the White House?
Adrian Aoun (06:00):
So Eric Schmidt, who I'm pretty close to, he said, "Well, why don't we go ahead and get involved," this was during the Obama administration, "and see if we can go give a hand over there?" Now I'm not a policy expert. I know very little about policy. So, in essence, what I did was I just said, "Look, I'm going to go ahead and just give some insight on where I think technology is going."
Adrian Aoun (06:19):
The reality is in the world of policy, this ends up being a paper that goes to a committee, that goes to a policy, that goes to a bill that goes to ... I don't really know. At the end of the day, I'm someone who likes to build. This is why I'm not in politics and probably never will be. So I spent only a little time there. Then basically I said, "Look, this is really great, but I want to go back to building." And so, what I did was I left Google to start this company, Forward.
Adrian Aoun (06:44):
Now the reality is I don't have a background in healthcare. I've never been interested in healthcare. In fact, today I'm not interested in healthcare. In fact, when people come to me and they tell me they're interested in healthcare, I almost look at them like they're a little crazy. I'm like, "What part of this industry interests you? Is it the billing codes? Is it the paperwork? Is it the insurance companies? Literally, it's fucking awful. Why are you interested in this?"
Adrian Aoun (07:07):
On the other hand, I am interested in helping people. And I saw it pretty viscerally. I had a pretty close family member of mine who had a heart attack a few years ago. I went from not paying attention to this to overnight being pretty laser-focused. Then I said, okay, this is broken. This is garbage.
Adrian Aoun (07:24):
In the year 2022, you look around you and you go like, wait a minute, we've got technology in everything. I'll give you an example. You've seen Forward. You've seen what it's like. You walk into our exam rooms and you've got this beautiful touch screen on a wall. You've got a model of your body and all the data's been overlaid on top.
Adrian Aoun (07:40):
I remember right after we launched Forward, I brought the CEO of Kaiser in, the US's largest healthcare. So I bring him in and he looks at Forward. He walks around, he looks at our body scan. He looks at that screen and he says, "I've seen the future." He's like, "This is the most advanced healthcare system I've ever seen."
Adrian Aoun (07:57):
Of course I'm sitting there and I'm thinking, well, of course, because I'm so smart and I'm so great. I'm obviously pretty full of myself and I'm feeling pretty good. But then I take a step back and I'm like wait a minute. We started this company 12 months ago. I have no background in healthcare. What the hell is going on right now?
Adrian Aoun (08:14):
I realize like, wait, you know what? Think about it. You walk into McDonald's and there's a touch screen on the wall. Why wouldn't you walk into healthcare is there no touch screen? It's not that we're so advanced. It's all of healthcare is so fucking backwards. How did we end up in this world? You realize that the healthcare industry is so broken, so backwards that it's just time for us to bring some level of just basic competence to the industry.
Adrian Aoun (08:42):
So one of the things I always think about is can we just not kick you when you walk in the front door? If we don't kick you when you walk in the front door, we're probably doing something right, because at least then we're beating the existing system.
Adrian Aoun (08:54):
So to answer your original question, it might look like I've taken a circuitous route, but in some ways all I've tried to do is just help people along my path.
Daniel Scrivner (09:01):
Yeah. You covered a tremendous amount of ground there. So I want to try to pull on a couple of those threads. One of the things you said at the beginning that intrigues me is that you are focused on problems and that most people are focused on solutions. What do you think is important about being problem-oriented and why is that not something that's more common?
Adrian Aoun (09:20):
Yeah. So think about how we go through life. If one of your friends says, "Hey, I'm leaving my job. I'm going to go start a company," what's the first thing you ask? "What are you doing?" It's Uber for ... I don't know, Uber for kittens. It's like, okay, well, it's my idea. We love our ideas.
Adrian Aoun (09:39):
In fact, think of how often, I don't know, in high school or at your first job, you're like, "Oh, I spent all weekend working on my project and I'm going to come and I'm going to present it." Then somebody pokes a hole in your idea. What do you do? You get all defensive on your idea, "But no, but no." You get emotionally attached. And so, I like to remind people you are not your idea. I promise you, you're not.
Adrian Aoun (09:59):
We have this concept at Forward, which is that we love to beat up ideas. Some people get really uncomfortable with that. They're like, "What do you mean you're beating up my idea." Sometimes people come in, we have a meeting type called the jam where we work through problems, and we attack ideas. We attack them. People are like, "Don't attack my idea. You're attacking me." I'm like, "No, I'm not attacking you. I'm attacking the idea."
Adrian Aoun (10:22):
I mean it makes people really uncomfortable sometimes, because we are so trained to believe that ideas matter more than problems. It's like, no, no, no. So if you go around Forward and you ask people what is Forward, nobody is going to say Forward builds doctor's offices. In fact, we don't. That's not what we do. We get healthcare to billions of people. Why? Well, it turns out problems tend not to change and solutions change all the time. We know this.
Adrian Aoun (10:50):
Because whatever solution you ship, you're going to ship it. You're going to go look at it and you're going to be like, "Okay, this is what I learned. I've got some new data. Now let's ship a new version, a new version, a new version. That's called iteration." So by definition, whatever idea you have, let's just agree it's crap. You just don't know why it's crap yet. And so, we just took the stance from day one, which is like let's focus on the problems, not on the solutions.
Adrian Aoun (11:11):
So Forward's goal, our goal's really simple. We want to get healthcare to billions of people. Now what do we do today? We build doctors' offices and we put doctors in them. Well, you know that healthcare for a billion people doesn't have doctors' offices and doesn't have doctors in it. Our whole goal is to build the world's most scalable healthcare, and we haven't yet figured out how to do it. But we're working along the path to doing so.
Adrian Aoun (11:34):
It's a little like when Elon comes out and says, "I'm going to solve climate change. Here's $140,000 sports car." It's like, well, hold on. What are you doing? It's like it's okay. That's his Model S. One day he's going to figure out his Model 3. And you know what? The Model 3 isn't going to solve climate change. One day he's going to figure out the Model 1. He just hasn't done it yet.
Adrian Aoun (11:50):
This is okay, is you should attach yourself to problems, not solutions. But this is really hard for us because we really like to attach ourself to well-understood concepts. But at Forward, we take a very different stance. We always try to understand what is the problem. We try to more intimately understand the problem than the solution.
Daniel Scrivner (12:10):
Yeah. I love that. I mean for so many reasons, I think one, at least in my experience, people attach themselves to ideas because they feel like it's a competition in some regards, my idea is better than yours. We attach a value to this precious, wonderful little thing we spent 30 seconds thinking up in our mind. I love the way you described why orienting around problems is so important. It's fantastically well said.
Daniel Scrivner (12:31):
I want to ask one more question. You talked about your experience on the President's Council of Advisors on Science and Technology. It sounds like you enjoyed it. You maybe learned some things. Obviously not the place you want to be long term for many well-understood reasons.
Daniel Scrivner (12:44):
One of the things you said was that you had described and shared your perspective on where technology was going. Can you either, one, walk us through some of that, if it's easier to talk through your thinking then, or walk us through your current thinking at a high level of where technology is going? I'm curious to get your perspective there.
Adrian Aoun (13:05):
So basically what I was asked to do ... And to be clear, this was a side project. This is not my day job. But what I was asked to do is basically to just say, "Okay. Hey, Adrian, what's the future of transportation? Hey, Adrian, what's the future of education? Hey, Adrian, what's the future of food?"
Adrian Aoun (13:22):
I'm asked this a lot, frankly. We have to go through this in Forward all the time. Whenever somebody asks me this, one of the things that I do is I have to, in some ways, come up with the definitive right answer on something that's a very long-term question. It's an incredibly hard thing to do. It's like how do you predict technology?
Adrian Aoun (13:43):
And so, what I do is I don't try and predict technology. I just try and predict first principles. And so, let's just ask ourselves ... We can just do this right now. Let's just ask ourselves a really, really simple thing, which is called the thought experiment. So we can do this at Forward. Let's just take healthcare and let's just take things to the limit.
Adrian Aoun (14:00):
So a hundred years from now, a thousand years from now, whatever timeframe you want, but at the limit, do you believe that healthcare will cost a billion dollars per person or zero dollars per person? Which do you think? You think zero dollars per person?
Daniel Scrivner (14:15):
Adrian Aoun (14:16):
Okay. So first thing is we think healthcare is going to get really cheap. Awesome. Do you think that healthcare is going to use all the data or none of the data? Probably all the data. But you know what? I think that healthcare is going to trend towards more and more data. Okay, great.
Adrian Aoun (14:35):
Do we think that healthcare, that you're going to see your doctor once a year or you're going to see your doctor once a minute? Probably once a minute. So we believe that healthcare is going to get more and more connected.
Adrian Aoun (14:47):
Okay. Do we believe that healthcare is going to be in one place in a city called the doctor's office or healthcare is just going to be all around us, and just the technology and the fabric and the infrastructure is going to be everywhere? Probably everywhere. Okay. So we believe there's going to be an infrastructure-based world of healthcare.
Adrian Aoun (15:06):
And so, we go through these thought experiments. Once we list out a whole bunch of parameters, you've got to say, well, look, at the limit, this is what healthcare looks like. You can do this with anything. You can do this with transportation. You can do this with education, et cetera.
Adrian Aoun (15:20):
Look, I can't tell you when. I can't tell you exactly what it's going to look like, but I can give you a rough sketch of where it's going. It's just not that hard. Does that make sense?
Daniel Scrivner (15:29):
No, it totally makes sense. I love the way you describe it as well, too. I mean in some regards, it almost feels like a straw man argument, of choosing these two polar extremes, but it's incredibly clarifying because it usually tends towards one of those extremes or the others. I like the way you framed it as at the extremes, at the edge.
Daniel Scrivner (15:46):
One last question, that special projects for the CEO role sounds very special. Do you have one of those at Forward? If not, why not?
Adrian Aoun (15:55):
Well, first off, I don't think we make $60 billion a quarter. So no. But I'll call you when we do. No, look, the reason that Larry and I created that role, frankly, was because Google had a lot of trouble innovating, a classic Christensen innovator's dilemma notion.
Adrian Aoun (16:17):
You see it today. I love Google, so I'm not trying to speak down to anybody there, but let's be real. Point to the innovative things that Google's doing that they haven't purchased. I'm not sure what they are, and there's a reason I'm not there.
Adrian Aoun (16:29):
Now fundamentally, when you look at a startup like ours, I don't think we need that role. In fact, I think it would be a terrible idea for us to have that role. The entire company is innovating. If the entire company at Forward today is not innovating, we should all pack up and go home, because we're in our infancy. We have not gotten healthcare to a billion people. We haven't figured out the roadmap to do that.
Adrian Aoun (16:54):
One of the things I would say is like go look for companies that hire their chief innovation officer and short them. The second you see us do anything of that sort, you know that it's the beginning of the end. Does that give you a sense of it?
Daniel Scrivner (17:06):
Yes, yes. No, very well said. So I want to start to dive into Forward a little bit more. One of the strings I want to pull on maybe to start is you talked about ... And it's really simple, really elegant framing that what you're building at Forward is trying to build the most scalable version of healthcare.
Daniel Scrivner (17:22):
And so, I want to talk a little bit about, one, why is traditional healthcare not scalable? One of the examples there I thought about before this interview is it feels like healthcare today feels very much like a service model. It's a service industry model versus something that's been productized, something that can truly scale.
Daniel Scrivner (17:37):
In your mind, I guess I want to ask two questions. One is what is the root of that problem and what are you focused on there? What are some of the solutions that you're finding that are starting to help you guys get to more and more scalable versions of healthcare?
Adrian Aoun (17:49):
So if I come up to you and I say, "Hey, I want to get doctors to billions of people. I want to get doctors in the middle of India. I want to get doctors in the middle of Rwanda, to billions of people," you're going to say, "Sounds good, Adrian. Where are you going to get all these doctors and who's going to pay for them?"
Adrian Aoun (18:03):
But if I tell you I want to get smartphones to the whole planet. I want to get smartphones to the middle of India, the middle of Rwanda, to the whole planet, you're going to say, "Adrian, not only do I think it's possible, I think you're a little late to the game. I think it's already happened."
Adrian Aoun (18:15):
So what do you intuitively know? Well, you intuitively know that technology scales in a way that humans don't. You intuitively know that hardware and software scales in a way that doctors don't. Another way to say it is exactly what you said. We only have one insight at Forward that we believe that nobody else believes. We believe healthcare should be a product, not a service. We just believe that roughly everything in healthcare should just be a hardware and software problem, not a human problem.
Adrian Aoun (18:42):
So all we want to do is take roughly 99% of what doctors and nurses, et cetera, do and just move it into hardware and software and free them up, like build them the world's best tools so that they can go off and do interesting things, not all the nonsense that they do today.
Adrian Aoun (18:56):
Now you ask, well, okay, but how do you do that? This is a really simple equation. All you do is you build doctor's offices. We've got, I don't know, an order of about ... I think we're live in 25 cities or something of that ilk, and we watch everything that happens inside of them. You come in, you sit in the exam chair, you talk to your doctor about the flu. Great, let's go ahead and move that into the mobile app. Now you don't have to come in, sit in the exam chair, and talk to the doctor about the flu.
Adrian Aoun (19:19):
Next person comes in. They talk to their doctor about the heart issues. Build a body scanner. Next person comes in. They talk to their doctor about their skin issues. Let's go ahead and let's build a skin scanner.
Adrian Aoun (19:29):
Slowly but surely what you realize we're doing is we're just building hardware and software for every part of the healthcare system until one day you're left with there's just hardware and software. That's the route that we're going down. That's the path that we want to take. Does that give you a good sense of it?
Daniel Scrivner (19:46):
Yes. So why then do you think that traditional healthcare is so anchored to this service model and/or, maybe said another way, why does it seem like we're stuck in that, in traditional healthcare, and that it's never been productized?
Adrian Aoun (19:59):
Well, let's start ... Whenever you see this sort of stuff, I always start by saying, well, follow the dollars, my friend. So it just turns out ... So remember I told you about that visit from the CEO of Kaiser. One of the things he looked at was he looked at my body scanner. He was like, "That body scanner is so cool. I've got," I don't know, "40,000 nurses just doing the same thing that your body scanner does." I was sitting there and I was like, "What just happened?" We just built this body scanner, let's be real, some number of months.
Adrian Aoun (20:24):
Again, obviously I'm thinking we're so badass. We're so cool. We're so awesome. But let's be real, like, come on. Something systemically broke here. We're not that badass. And so, then I asked myself, well, hold on. How's the healthcare system work?
Adrian Aoun (20:38):
What you realize is, and this is going to blow your mind, he would make less money if he had our body scanner. Less money. You're like, "What are you talking about? No, Adrian. He would say he would make more money because he would save those 40,000 nurses, obviously." Nope, because he wouldn't have a billing code. He wouldn't have a billing code. What the fuck?
Adrian Aoun (21:03):
So before starting Forward, when I was at Alphabet and I was running my special projects thing, I went and I asked Tom Lee, really nice guy. He's the founder of One Medical. I asked him to grab lunch because, honestly, I was pretty interested in just buying One Medical. I didn't want to start for it. I was just going to buy One Medical, give him a billion dollars and say, "Okay, go change healthcare."
Adrian Aoun (21:24):
So I had lunch with him and I said, "Okay, Tom, imagine you had a billion dollars, hypothetically. What would you do with it?" He said, "Oh, well, in healthcare, technology investment is not ROI-positive."
Adrian Aoun (21:37):
Now let me be clear. Tom is a really nice guy, but this is the dumbest statement I've ever heard in my entire life. In healthcare, technology investments not ROI. But in gardening, its ROI-positive. What the fuck are you talking about? But think about what he was saying. He was saying he doesn't get the money back because the billing codes don't change. He has no incentive to do the right thing for people. That's fucked up, man. That's bad.
Adrian Aoun (22:04):
And so, what did we say? Well, the first act of Forward. Get insurance companies out of the ball game. Literally get billing codes out of every part of what we do. So that was step one. Step two was to understand that employers are just a bigger problem in this.
Adrian Aoun (22:25):
Do you ever notice when you're at Square or whatever, like I'm sure Square was coming up to you being like, "Hey, Daniel," once a year, like, "Time to get your flu shot. Time to get your flu shot. Time to get your flu shot." I don't know, Dan. Is there some big rash of flu deaths going on that I don't know about? How many of your friends are dying of the flu? How many? Come on. None. Not a single one. So what the hell?
Adrian Aoun (22:48):
But how many of your friends are dying of, I don't know, heart disease? Cancer? Okay, they are. But did Square ever walk up to you and be like, "Daniel, time to talk about your cholesterol. Come on. You've got to get it down"? Nope. Not a single time. Not a single time. Why?
Adrian Aoun (23:02):
Well, it just turns out that the average Square employee was with Square for, I don't know, probably two years, maybe three. So here's the deal. You get the flu. You're out some couple days of work. Maybe you take somebody with you. They're out some money. But let's be real. That cholesterol, that heart disease, that's going to affect you in 30 years. They don't want to know about it. Literally, they'd rather la, la, la, let's pretend we didn't hear about it, because that's going to cost them money to start preventing it. Think of how fucked up that is. They're not trying to keep you healthy. They're trying to keep you healthy right now.
Adrian Aoun (23:35):
You know this. You actually intuitively know this because if one of your friends comes up to you and they're like, "Oh, I didn't get my checkup this year. I skipped it. I didn't go to the doctor for my checkup," you're not like, "Oh geez, Bobby's going to die." No. You're like, "Whatever, Bobby. It doesn't make a difference." You know going to the doctor doesn't matter.
Adrian Aoun (23:51):
In fact, you know it so viscerally that all your friends are like, "Oh, I'm going to go read Goop or buy an organic smoothie to prevent cancer." Like what the fuck are you talking about? You think an organic smoothie's going to prevent cancer? Method soap is going to prevent cancer? That's how desperate we are, literally.
Adrian Aoun (24:07):
We don't go to our doctors to prevent cancer. This is how desperate we are. In fact, the only time you get a cancer doctor is after you get cancer. Well, do you put brakes on your car after the accidents? This is fucked up. This is bad. We've created a healthcare system that's only focused on short-term health.
Adrian Aoun (24:26):
The last five times you went to the doctor, how much do you want to bet it was for flues, rashes, stomach aches? Well, okay, guys, but I'm going to die someday. Can we talk about that?
Daniel Scrivner (24:35):
I mean you covered so much interesting territory there. I want to go back to something that you said at the beginning, which was around getting the health codes out of Forward. Because part of that, I imagine, I want to try to link that approach and that goal with the membership model that you have, because obviously if I was in your shoes, Forward is a membership model. You answered one of the questions that I hadn't really articulated in my own mind, which is why does a membership model make sense?
Daniel Scrivner (25:00):
Part of it is, one ... I won't go into it. There are some wonderful books. One of my favorites is ... It gets called ... Oh God, I'm going to have to think of the title and put it in the show notes. But it's something like Lessons of a Pricing Man or something like that. But it's basically a book all around pricing. One of the things that you learn is anytime you have a membership, you're just highly incentivized to be able to go and to utilize it. You want to use it as much as possible.
Daniel Scrivner (25:24):
So clearly that maybe is one positive angle. But another is changing it from billing for individual codes to just, no, you're going to sign up for a subscription and we're going to get some revenue for you being a part of Forward, some revenue for you being a part of our network. Talk about the link between the membership model. Is that related to getting the billing codes out of Forward? Because I'm guessing it is.
Adrian Aoun (25:45):
Okay. So if your goal is to keep somebody healthy and the first thing that you say is, "I'm going to charge you to use the service," think of how fucked up that is. Sorry, I don't know how G-rated your podcast is, but clearly I cursed too much. But I apologize. But think of how fucked up that is. Like, hi, I want to keep you healthy. Step one, charge you every time you want to engage your doctor. It's like, come on. They're not even subtle about it, between copays and high deductibles. It's like, come on, guys. Can you at least pretend? Can you at least lie to me about it?
Adrian Aoun (26:24):
So we just started really basic, which is like, no, we actually want you to use the service. But then there's another element that's really important to understand, which is like think about why they're in that business, why they're in the business of charging. It's because, again, they can't afford it. They can't afford to keep you healthy. It's because they're a service. And so, it only makes sense to live in a world where you're pushing utilization of your product if it's a technology product.
Adrian Aoun (26:53):
Think about it this way. You have health insurance. Why do you have health insurance? Well, I don't know. I might get hit by a bus. I might have to use it a lot. Do you have Gmail insurance? No, but I might send you a thousand emails today. You don't know. Yeah, but you don't care, because the incremental cost of a thousand emails is like 0.0001 penny, like who cares? Google's not like we're going to charge you more.
Adrian Aoun (27:16):
And so, the fundamental insight is like it only works if the cost of providing that product or that service is truly, truly roughly zero. And so, the whole trick of Forward is we have to figure out how to keep you healthy for roughly zero cost. If it is expensive for us to keep you healthy, none of this works.
Adrian Aoun (27:40):
So we wanted, from day one, our incentives to be both to keep you healthy and to make it cheap. In fact, what's really awesome is the cheaper we can make it, the healthier you get. The more your retention goes up, the more money we make. Think of how awesome this is. Yeah. Great.
Adrian Aoun (28:01):
So what you have is here's our competition. You've got a healthcare system today where every year the price is going up, the price going up, and literally they're giving you less and less value between high deductibles and copays.
Adrian Aoun (28:15):
Now Forward, think of us, every year we're giving you more value. Literally, we want to lower our price. Like any tech company, we're just like we'll just keep driving the cost down. We're $149 a month. We're going to $99, $79, $59. So at some point you're like it's not a question of if. It's a question of when. It's inevitable that at some point the entire world will be on Forward. Unless Forward dies at some point, you will all move to this model, whether it's Forward or some other company that does it. Of course, you're going to move to healthcare as a product. It's inevitable.
Adrian Aoun (28:47):
That's what we wanted. We wanted to have the right incentives because, look, One Medical's got, I don't know, a hundred engineers. United healthcare has a thousand ... I don't know, 2,000, 5,000 engineer. But all these people are working on billing codes, ways to bill you. All my engineers, they're working on ways to keep you alive. Literally, I have engineers working on cancer prevention programs. I have engineers working on blood pressure programs, engineers working on skin cancer programs, working on diabetes programs, working on mental health programs. That's what my engineers work on. They literally work on ways to keep you alive.
Adrian Aoun (29:24):
Do you know how many engineers I have working on billing software? I don't know. One maybe. Half of one? A quarter of one? I mean our building's really easy. It's like we bill you once a month. That's it. I don't know, we haven't touched it in a while. It's not that interesting.
Daniel Scrivner (29:39):
I mean when you talk about this divergence ... Which is true. I mean one of the stats that staggered me when I was ... I think everyone knows that healthcare is broken in summer regard. One of the stats digging in preparing for this interview that is mind-boggling, to be super frank, is that at the national level, in the US, we spend around 20% of GDP on healthcare. Internationally, if you look at many other countries, it's something like 3% to 5%.
Daniel Scrivner (30:01):
Then I think about your analogy of every single year, healthcare is getting more expensive and you're getting less for it, which has definitely been my experience. What you're trying to provide is a decreasing cost and an increasing benefit.
Daniel Scrivner (30:12):
I feel like if this was happening in any other space, like if this was happening in crypto, if this was happening in finance, people would say this is unsustainable. This is going to blow up and start making predictions. Why is that conversation not happening with healthcare? How much more can this take up of our national GDP and where does this end?
Adrian Aoun (30:33):
So let me give you my contrarian view that nobody agrees with me on. I think that health insurance is not going to exist in the US in the next few decades. I think it's going to topple. Let me tell you why. Because of exactly what you said.
Adrian Aoun (30:46):
So let's just take a step back. You have to ask why are we not talking about it. We're not talking about it because the reason it's so successful at stealing money from all of us is because it's regulatory capture. We don't negotiate it. It's negotiated by our employers and, frankly, they don't negotiate it because they can't really do anything about it.
Adrian Aoun (31:08):
It's like I'm an employer. I have to pay for health insurance. I've got three options. So you know what? Fuck it, I'm going to do it. They go up every year and I don't really have a choice. So that's it.
Adrian Aoun (31:17):
So at the end of the day, the employee can't negotiate it well, the employer can't negotiate it well. So we're all fucked. In fact, it's even worse. You ever been in an ambulance and gotten a bill for thousands of dollars? You ever take a step back and just think about like ... Do you ever think about why? It's really fascinating.
Adrian Aoun (31:33):
So just imagine if Uber ran ambulances. So it's like UberX, $10, UberBLACK, $35, Uber ambulance, $4,000. What was that delta? Where did the $3,900 come from? It's like, okay, is an ambulance a $2 million vehicle? No. An ambulance is roughly the same cost as an SUV.
Adrian Aoun (31:54):
But the paramedic inside is way more expensive than an SUV driver. No, not really. They're about the same. Well, is the consumables, like are the meds and the cotton balls they gave you really expensive? No, it's about like, I don't know, $10, $20. So what the fuck? Where did all this money go? You quickly realize it's just that you couldn't negotiate it. And so, all of a sudden you realize all of this is just robbery. It's literally just robbery.
Adrian Aoun (32:19):
And so, what I iterate to is like there's no fundamental actual reason for it. There's no first principles reason. None of us have the ability to actually negotiate. We all know this. We all know, ah, I've got a medical bill. I just got totally taken and stolen from, in essence.
Adrian Aoun (32:41):
And so, at some point, what you realize is we all hate the insurance industry so much that they're pushing their luck. And so, if I were the insurance industry, actually what I would do right now is just stop. I just keep it where it is and just be like 20% is really ... I'm literally like I've got a good deal. I should just not fuck with it.
Adrian Aoun (33:03):
But they're not stopping. In fact, they're not stopping to the point of increasing roughly 6% to 7% year-over-year. Doesn't sound that bad except you know what the doubling time of that is? Roughly 11 years, which means in 11 years, it's going to be 40%. One decade from now, it's going to be 40% of GDP.
Adrian Aoun (33:20):
That sounds abstract so let's say that in another way. 40% of your paycheck. For you, I'm not that worried. How about the guy at McDonald's? I worry. That's revolt time. That's riot time. You know what I mean? That's like this isn't okay.
Adrian Aoun (33:37):
So I actually think what you're going to find is you're going to find it pretty material. They're opening up their own attack vector. They're literally ... I tell people Forward's marketing opportunity just gets better every year. All I have to do is just do the same exact ... Even if I just kept my product the same, more and more customers will come to me every year because it's literally cheaper than using your deductible. It's insane.
Adrian Aoun (34:04):
And so, yeah, I actually think that what they're doing is incredibly stupid for themselves. What you're going to find is that we start to push back as consumers much harder in the coming decades.
Daniel Scrivner (34:17):
Well, I think that makes sense. So count me as maybe one other person that agrees with you on that. I mean the thing that's staggering as well too is not only has that ... As you talked about, that's inflated 6% to 7% year-over-year. So it's roughly doubling every 11 years, which is staggering. I mean if this was an investment opportunity, people would be leaping up to invest in this healthcare profit margin or revenue that's going up every single year.
Daniel Scrivner (34:41):
Then you compare that with has America gotten healthier or has America gotten less healthy? What you see is America has gotten shockingly less healthy and less well decade over decade over decade.
Daniel Scrivner (34:52):
And so, one of the questions I wanted to ask, and this is one of the reasons I was so excited to have you on, is this idea that there's reactive healthcare and then there's proactive health maintenance or proactive health. They seem very, very, very different.
Daniel Scrivner (35:06):
So I guess one of the questions I was just curious to ask is what are you hearing from the average everyday consumer? Because I feel like there's a pretty small percentage of people, I would say generally, that are focused in a real way in their life on health, meaning they're trying to exercise every single day. They're eating well every single day. They're just trying to make good, smart choices. You talked about some of the silly examples of that, whether it's Method soap or an organic smoothie being the difference, which definitely is not.
Daniel Scrivner (35:34):
What are you seeing in terms of what needs to change about the way people approach health in general and how do you think you can shape that at Forward? How are you trying to shape that at Forward?
Adrian Aoun (35:43):
So I want to push back a little. You said people are getting less healthy, and I'm not sure that's true. If I use the metric of just how long are we living as a really naive metric-
Daniel Scrivner (35:57):
The lifespan's true, but like diabetes, weight gain, obesity.
Adrian Aoun (36:00):
Yeah, those are going to correlate obviously with the duration that we live. But let me just go a step further, which is let's just take a step back. I want to ask you a question, but let me just take a step back.
Adrian Aoun (36:11):
I actually want to take maybe a different posit, which is I'm not sure the healthcare system matters. By that what I mean is if you took that 20% of GDP, that entire healthcare system today, and literally just leveled it, just said close every hospital, close every doctor's office, close everything, I'm not sure it matters. Let me give you a way to think about it.
Adrian Aoun (36:32):
If I look at data going as far back as humanly possible, I go back to the Bronze Age, the Neolithic Age, how long did people live?
Daniel Scrivner (36:40):
30 years? 20 years?
Adrian Aoun (36:41):
No, it's actually pretty amazing. So infant mortality was pretty high. Like you died on the vine with high probability. If you didn't die on the vine ... So there was roughly about a third of kids died on the vine. If you didn't die on the vine, you know how long you lived? 47 years on average. You know today? Today, 72 on average. Less than 50% roughly.
Adrian Aoun (37:04):
Now let's compare that to something else. In the Neolithic Age, you walked around on literally bare feet. Best in a day, you could walk, oh, five, 10 miles. A few years later, we created shoes. Actually, about a thousand years later, we created shoes. Now we could walk 10 or 20 miles.
Adrian Aoun (37:23):
Then we created river boats. We could get 50 miles. Then what'd we do? Then we learn to tame horses, 50 miles, maybe even a hundred miles.
Adrian Aoun (37:33):
Then think of all the advancements. Then we created hot air balloons. We started to get like, I don't know, 300 miles. Then we created planes. We started to get hundreds, like literally a thousand miles. We eventually created trains across countries. We created space shuttles that took us to the moon.
Adrian Aoun (37:55):
Now we literally are working on ... Like SpaceX is trying to take us to Mars. We've gone from like five miles to 125 million miles. It's not like, oh, we went 50% increase. We went orders upon orders upon orders of magnitude in terms of the distance we can travel. At the same time, over roughly that same ... Let's call it about 7,000-year period, we increased our lifespan by 45%, 50%.
Adrian Aoun (38:28):
What it shows you is that the healthcare industry is roughly doing nothing at this point. I mean really it's trivial. A global pandemic occurred and the first thing we said is put a piece of paper over your mouth. That's our solution. We're in the shoes phase. We're nowhere.
Adrian Aoun (38:42):
And so, now you have to ask yourself, it's like, yeah, we can go ahead and debate about what are the incentives and what is this and what is that, but at some point we don't have the products. The product is immature and the product is crap. And so, I think, in some ways, the number one most important thing is we need the rate of innovation to really fundamentally change.
Adrian Aoun (39:02):
If you look at transportation, transportation in the last roughly 200 years went through this massive inflection. You literally went from planes, trains, and automobiles and you just skyrocketed, no pun intended. Well, where's my spaceships and rockets? Where's my skyrocketing in healthcare? It has yet to occur.
Adrian Aoun (39:24):
This is what technology brings to bear. When I walk up to a doctor and I say, "Do you know something? Hey, did you hear the latest about blah?" they download a PDF and they read it. Well, that's bullshit. PDFs in the year 2022 is the way we communicate knowledge. Where are my apps? Where's my infrastructure? This is what we need. We need technology in the world of healthcare, but nobody's created the tools.
Adrian Aoun (39:51):
That's what we want to create at Forward. We want to create a platform whereby the entire world of healthcare starts working together and the rate of innovation starts going through the roof, because until we get there, we're never going to get healthcare to go exponential the same way that transportation's got exponential.
Adrian Aoun (40:08):
If I came up to you in ancient Greece and said I'm going to Mexico for a weekend, you'd be like that's the most absurd thing I've ever said. But today, of course, it's like that's a common phrase. In fact, in 10 or 20 years, going to Mars might be a, "Of course I'm going to Mars. Sure. Why not?"
Adrian Aoun (40:23):
But today if I tell you like, "Hey, I'm going to live to 300," you're like, "Yeah, that's insane." Well, why? Why is living to 300 insane? That should be a very common thing. It's just we have never inflected the arc of time in the same way we've inflected the arc of travel. That's something that we need to do.
Adrian Aoun (40:39):
And so, I think where we're really missing the boat right now is fundamentally we have yet to create the tools necessary to truly get healthcare to the point that it needs to be at. That's the part that I'm most excited by, far more than the incentives, far more than the system that we have today.
Adrian Aoun (41:01):
Now then you said, okay, but what's the difference between the sick care and the healthcare? I think that's important. But fundamentally those become the byproduct of having the right product underneath. Today, when you want healthcare, you buy a smoothie and you go to Peloton. When you want sick care, you go to Kaiser.
Adrian Aoun (41:20):
But fundamentally, when I look at all of these, I go, sure, those are great behaviors, but they're all the shitty product. Give me the best product, and then go layer those behaviors on top.
Daniel Scrivner (41:30):
I mean I love that you zoned in, I think, in a very correct way on the rate of innovation and the rate of change. I mean because what it makes obvious is, one, there hasn't been really any iteration. If healthcare was a traditional technology company, it would've imploded many, many, many decades ago because it wouldn't have gone anywhere.
Daniel Scrivner (41:51):
And so, what you're focused on is the rate of innovation, the rate of change, the rate of iteration. Obviously that immediately makes sense as soon as you apply that to products and to technology and you take that approach.
Daniel Scrivner (42:01):
I want to wrap up with two questions, and then talk a little bit about lessons learned. One of the questions I want to ask is when you talk about this experience that you're creating, this experience you've already created for patients at Forward, it very clearly sounds like a superior experience for patients.
Daniel Scrivner (42:16):
Obviously on the other side of that equation are doctors. The goal is obviously, one, to get doctors to actually have leverage, which I imagine, as a doctor, I would like. I know about all this data. I know about all this technology. Let me use it and let it help me become superhuman in my capabilities. That obviously frees up time. What do you hope, what do you think that doctors will be able to do with freed up time with actual leverage?
Adrian Aoun (42:40):
Yeah. So one of the things that you have to ask yourself is what do you want to spend your days doing? So I'm an engineer, I'm a nerd. And so, when I was growing up, I used to be the neighborhood kid who fixed computers. I don't know if you remember when you were growing up, you remember Best Buy had I think what they call ... They called them the Geek Squad, the guys in the blue shirts that would drive to your house.
Daniel Scrivner (43:06):
They still have them.
Adrian Aoun (43:06):
They still have them? Okay. So this is actually funny, because they would like ... Everybody called them. They'd come to your house, they'd fix your computer. I haven't called them in ages. I don't know anybody who's called them in ages. I don't even know how you know they still exist because I've never seen them around.
Daniel Scrivner (43:19):
I think I've seen their van.
Adrian Aoun (43:20):
Okay. Okay. But ask yourself. They were super common back then and they're not super common now. So why? What changed? What you realize is Geek Squad still exists. They just exist in a very different form. It's like these days there's a thousand people at Apple sitting in a room watching a whole bunch of monitors, just going, "Oh, look, these 20 million iPhones are running out of space. Let's deploy a fix. These 20 million iPhones have malware. Let's deploy a fix. These 20 million iPhones, whatever, they're slowing down. Let's deploy a fix."
Adrian Aoun (43:57):
So we went from we fixed computers one at a time to we design systems that fix computers. Now, yeah, sometimes it's like, oh, it turns out we can't fix this one remotely. Let's go ahead. Bring it in. It's called the genius. But these days we've become massively more efficient. We've gone from, I don't know, the IT person that fixes one at a time to let's just build systems for all.
Adrian Aoun (44:21):
Now think about like me. So I was at Google. I worked on the search engine. When I sat down to work, I sat down at this thing called the laptop, which is like, let's be real, some culmination of all human advancement in this beautiful two-pound device. When I sat down to work, I could write code that, I shit you not, literally went out to three billion people later today. Three billion people. When a doctor sits down to work, they can affect one person. One. One. That's fucked up.
Daniel Scrivner (44:51):
Adrian Aoun (44:51):
Daniel Scrivner (44:53):
Adrian Aoun (44:53):
Now ask yourself why. Is it because I'm smarter than doctors? No. Because I'm more altruistic obviously. No, it's quite the opposite. Oh, clearly it's because I'm more educated. I went to more school. No, the opposite. Why? Oh, it's simple. I have better tools. That's it. I just have better tools.
Adrian Aoun (45:08):
So if you build the doctors better tools, what you realize is they will get out of dealing with your fucking flu and sniffly nose and all that crap and they start moving into the more interesting stuff. If they're going to go to med school for 10 years, dear God, why are they dealing with your runny nose? It's absurd. Have them deal with cancers. Have them deal with heart disease. Have them deal with the stuff that matters, not your runny nose.
Daniel Scrivner (45:37):
It's well said. I want to ask one more question, and it speaks a little bit to the model that you guys have at Forward. We didn't touch on this in the interview, and I just want to make sure that we cover it.
Daniel Scrivner (45:47):
One of the things that's also fascinating to me about what you're doing is you're trying to bring every specialty in-house in one location. What I mean by that is if you go to a Forward appointment, you're going to get your heart looked at. You're going to have a conversation about your blood pressure. They're going to look at your weight. They're also going to look and monitor things like skin cancer, where today that doesn't happen at all in a doctor's office.
Daniel Scrivner (46:07):
To your point, I'm probably only going to go and find a dermatologist if I'm freaked out about something and things are already bad. So clearly just playing that out for 30 seconds makes no sense.
Daniel Scrivner (46:18):
How much of a revelation was it to try to move everything in under one house, under one location? Did you have to push back against, I don't know, doctors saying, "Well, I don't do that," or, "I want to be a specialist"? What did you have to change or mold or shape to be able to do that?
Adrian Aoun (46:33):
Well, if you take a step back, specialties don't really make sense for a bunch of different reasons, but let's go with one or two of them. The first is specialties presume independence between body systems, and I've never understood this.
Adrian Aoun (46:48):
So if you have a local issue, I've got something on my skin, great. Go to the dermatologist. You're good to go. But the second you have a complex issue ... I actually do. I've got an issue that manifests, where my skin has some issues and it turns out I get dizzy. It turns out that those are the exact same issue. They're a sensitive nerve issue that manifests with both. Great. What doctor do I go to? Well, you go to the skin doctor and they push you to the other doctor, who pushes you back, and they push you ...
Adrian Aoun (47:21):
Well, it just turns out your body's not all filled with independent systems. Your body's one body. So now what do you do? You see this all the time. Go to any healthcare system and you just see the person get bounced back and forth and bounced back and forth and bounced back and forth.
Adrian Aoun (47:35):
So then you start asking yourself, wait a minute, from first principles, why did we iterate to this? How did we even end up with the specialty concept? Does it make sense? Is it right? I'll tell you.
Adrian Aoun (47:46):
It turns out that the ancient Greeks and Romans totally fucked us on this one. So if you were in Mesopotamia back ... Sorry, this is my history lesson for the day. If you were in Mesopotamia back in the day, and you were part of the aristocratic class, you were fairly wealthy, and you wanted to go to school, it's called college, you went to ... This is what's called you got a liberal arts education. This is where the phrase came from. It turns out that there were seven subjects, which are what called the trivium and the quadrivium, three and four subjects.
Adrian Aoun (48:17):
Now imagine at the time that these subjects ... There weren't a whole bunch of books. So imagine that there were three books and four books. There were seven books laid out on a table and these were the seven subjects. You read these seven books and you were the liberal arts scholar.
Adrian Aoun (48:30):
Then somebody a little later keeps researching. He's like, "But I've got some new knowledge. I want to go put something on one of these stacks." Remember, there's only seven subjects. It's like rhetoric and writing and math, et cetera. So they come and they take their body of knowledge and they put it on top of one of these books.
Adrian Aoun (48:50):
Now imagine one of these books is biology. It turns out it wasn't. That one came a few hundred years later, but we'll pretend. So now this biology starts branching out, human biology. Human biology branches out and eventually becomes, whatever, cardiology and nephrology, et cetera. You start branching into subjects, because the human mind isn't good at understanding everything and researching everything. But that's very different than saying that's how the human body works.
Adrian Aoun (49:17):
Just because you can't learn everything, it doesn't mean that's how we operate. And yet this is the education system that we've created. The education system, frankly, makes no sense.
Adrian Aoun (49:29):
And so, the first thing that we realized is exactly what you and I discussed earlier. We've created a healthcare system that practices by solution, not by problem. That's a mistake.
Adrian Aoun (49:41):
So what we realized is you don't actually want a dermatologist and a cardiologist. What you want is to prevent heart attacks. Now you might prevent heart attacks by changing your diet, by exercising, by whatever it is.
Adrian Aoun (49:59):
For example, you want a cancer prevention app, or cancer prevention problem. Now how do you prevent cancer? Well, it might be a vaccine. It might be sequencing your DNA. It might be putting sunscreen on. Each of those has different solutions. Do you see how those cross boundaries, those cross domains? You've seen this play out in your life.
Adrian Aoun (50:17):
So before your iPhone, you had a digital camera, you had a Walkman and you had a Garmin GPS unit. Let's just think of each of those as solutions. Then as soon as you got your iPhone, what'd they do? They migrated those over. I had the maps app, the camera app, and the music app. Again, all very solution-specific.
Adrian Aoun (50:36):
But then over time what'd they do? Well, they realized, developers realized, yeah, those are solutions. It's more interesting to work on problems. So they started to innovate. Now the most popular apps are, I don't know, TikTok. Well, what is TikTok? Is it the camera app? Is it the music app? Is it the ... Well, it's all of these combined. What you realize is we are too attached to the solution, not attached enough to the problem.
Adrian Aoun (51:02):
And so, at Forward, from the beginning, we said it makes no sense to presume that all these things are independent, because that's just not how we operate as humans.
Daniel Scrivner (51:10):
Very well said. I want to ask two final questions. One is you just talked a second ago about focusing on problems again and not solutions. So I'm curious if you can share what are the most interesting problems that you're working on now at Forward? We obviously talked about the meta problem, that's probably not going to change, which is creating the world's most scalable healthcare system.
Daniel Scrivner (51:32):
But I imagine ... Again, as we talked about, you're always innovating. I imagine you're working on some interesting problems now. What are some of those problem spaces?
Adrian Aoun (51:39):
Yeah. Man, we're working on a lot. One of the biggest things we are working on right now, without giving too much detail away, is there's ... I'll give you two problems. The first is how do you expand the reach of Forward?
Adrian Aoun (51:55):
So if you think of healthcare as an infrastructure problem, how do I make it so I can put Forward on every street corner? How do I put Forward all around you? How do I make it so that healthcare truly, truly is everywhere that you want to be. This is a really hard problem.
Adrian Aoun (52:14):
Today Kaiser is 75 years old and has 700 locations. But what if I told you that I wanted Forward to have 7,000 locations? What would that look like? How do you even think about it? That's the first problem.
Adrian Aoun (52:27):
Then the second one that we're spending a lot of time thinking about is what you and I talked about earlier, which is how do we increase the rate of innovation in healthcare? I think the ICD-10, which is the billing code system, which I hate. But it's one of the only place-
Daniel Scrivner (52:43):
It's got a wonderful name.
Adrian Aoun (52:47):
Yeah. Yeah, it's true. It's one of the only places where I could find somebody that just gives me a list of diagnoses outside of the DSM, which is just mental disorders. So the ICD-10 has, I think, an order of 14,000 diagnoses codes.
Adrian Aoun (53:01):
So you go up to any doctor, if they know 14,000 diagnoses off the top of their head, it'd blow my mind. So now you have to ask yourself, okay, now imagine you wanted to create the world's best solution for 14,000 issues.
Adrian Aoun (53:17):
By the way, that's, as you said, 14,000 sick care issues. There's no healthcare issues. There's no run a faster marathon in there. There's no become more empathetic in there. Obviously we're just barely scratching the surface.
Adrian Aoun (53:29):
But now ask yourself, even if you started with the most basic, most trivial definition of these issues, which is 14,000 ... I think there should be 140,000, but let's start with 14,000 ... how do I get to a world where we have defined the world's most perfect solution for those 14,000 issues? Most healthcare systems today, they sit around and they say, "Well, how am I going to define the solution for 10 issues? How am I going to do my breast cancer, my heart disease, my skin cancer?" It very quickly starts to trail off after your first five or 10.
Adrian Aoun (54:03):
But that's not the world we live in. The world we live in is the internet has millions and billions of websites. Your phone has millions of apps. How do we get to that world? That doesn't exist in the world of healthcare today.
Adrian Aoun (54:18):
Now how do we get to a world where not only have we defined those, but we're innovating on them so rapidly that we become best in class in all of them immediately or overnight? That's what we're thinking about.
Adrian Aoun (54:31):
The trick is we don't believe at Forward that we're going to have the answers to all these, but we believe that we might be able to power a world where if all of us come together across society, we can come to the best answers for all of these.
Daniel Scrivner (54:44):
Yeah. I feel like I've heard that second problem where basically what you're saying is you want to approach it systematically. You want to be able to address a truly massive scale of symptoms and of problems and of data. It's almost like building the machine that builds the machine. And so, you're working on that aspect of building Forward, which is really interesting.
Daniel Scrivner (55:02):
The last question I want to ask ... And thank you so much for the time. I could ask you a thousand other questions. It's been a fascinating conversation. But if I had to ask just one more question, I would love to talk for a second about Forward's culture.
Daniel Scrivner (55:14):
You talked at the beginning about problem orientation. That seems like a fascinating pillar of a company, of a culture. You talked about one of the ways that happens at Forward, which is in these jam sessions, where you beat up on ideas and you focus everybody on the problem and reorient everybody. I'm sure it's probably painful for new people that join Forward.
Daniel Scrivner (55:31):
Are there other aspects of Forward that are interesting and that are similarly diametrically opposed to how most companies are run or how most people think about approaching stuff?
Adrian Aoun (55:41):
Yeah. So those aren't the ones that truly matter. Those are things we do. But I'm going to tell you, there's only one thing that truly, truly, truly matters, which is we are at Forward for the mission. When I say that, there are a lot of companies that say we're a mission-oriented company. We're not a mission-oriented company. I want to be super clear.
Adrian Aoun (56:01):
We are not a company that happens to have a mission attached. We're a mission that happens to have a company attached. If you told me tomorrow the best way to get healthcare to a billion people is to crash the company, well, by God, let's fucking crash the company.
Adrian Aoun (56:13):
We are here to get healthcare to a billion people. We'll either get healthcare to a billion people, or we will leave an enormous crater of destruction in our path to do so. That's why we're here.
Adrian Aoun (56:24):
You know what? I'm going to be candid, because there's a lot of people who might listen to this who are like, "Oh, I want to go work at Forward." Well, let's just be really clear. It fucking sucks. It really does. It's really awesome. Everybody's like, "I want to go work at a mission-oriented company." No. No, you don't. It sucks. Because think about it. You know what? Here's what it's like.
Adrian Aoun (56:42):
Imagine you walked up to your coach and you're like, "I want to win gold at the Olympics." Awesome. Sounds great. "You know what, coach? I'm willing to do whatever it takes, except I only want to work 9:00 to 5:00 and I want to take seven weeks of vacation. I want to eat Cheetos and I want to ... " No, you don't get to do all that. You're not going to win gold at the Olympics.
Adrian Aoun (57:01):
It's fucking hard. What we want to do is really, really, really hard. We're trying to win gold. And you know what? We don't deserve to get healthcare to a billion people. We don't deserve to change the world. It's really hard. And so, it takes material sacrifice.
Adrian Aoun (57:16):
And so, the reality is we are here for people that aren't us. We are here in service of others. The only thing that matters at Forward, the only thing that matters more than anything else, truly, is that we're here not for ourselves. That's uncomfortable, especially in Silicon Valley, where we all have become, let's be real, pretty fucking entitled these days.
Adrian Aoun (57:38):
But the reality is we're not here because we care about the IPO. We're not here because we care about our careers. We're not here because we care about our, I don't know, this, that, and the other. We're here because the truth is there's actual people with real problems. There's kids dying in Rwanda and India. I know that sounds really kitschy, but it's real. You and I don't have trouble putting food on the table.
Adrian Aoun (57:59):
And so, that's why we're here. Everything we do is in service of that. So when you say, "Why do you focus on the problem rather than solution?" it's in service of that. Why do you focus on beating up the ideas? Well, it's in service of that. Everything we do is in service of our mission. That's it. That's all I care about.
Daniel Scrivner (58:15):
Super well said. I mean it makes me think of the military. It makes me think of competing in a sport at the highest levels. All of it requires enormous amount of skin in the game, enormous sacrifice, and it's very painful to get there. The wonderful things are just byproducts of all the hard work and all the pain and all the suffering. So I love that you shared that in the very unvarnished way that you did.
Daniel Scrivner (58:35):
Thank you so much for coming on, Adrian. This has been fascinating. I hope that people listened, obviously have learned about your unique approach to building Forward. I hope that people listening try. If you have a Forward in your city, go and look at it, give it a try. I think you'll be really impressed and really fascinated. Thank you for the time, Adrian.
Adrian Aoun (58:52):
Not at all. It's a pleasure, man.
Daniel Scrivner (58:55):
Thank you so much for listening to this episode. You can find the show notes and transcript at outlieracademy.com/118. That's 118. You can learn more about Forward at goforward.com. You can follow Adrian on twitter, @adrianaoun.
Daniel Scrivner (59:11):
At outlieracademy.com, you can find all of our other founder interviews, profiling, incredible companies like Eight Sleep, Common Stock, Varda Space Industries, Superhuman, PromoKitchen, 1-800-GOT-JUNK? and many, many others. In every interview, we deconstruct the ideas, frameworks, and strategies these founders use to build these incredible companies.
Daniel Scrivner (59:32):
You can also find all of our video interviews on YouTube at youtube.com/outlieracademy. On our channel, you'll find all of our full-length interviews, as well as our favorite short clips from every episode, including this one. So make sure to subscribe. We post new videos and clips every single week. If you haven't already, follow us on Twitter and LinkedIn under the handle Outlier Academy.
Daniel Scrivner (59:52):
Thank you so much for listening. We'll see you right here with a brand new episode next Wednesday.
On Outlier Academy, Daniel Scrivner explores the tactics, routines, and habits of world-class performers working at the edge—in business, investing, entertainment, and more. In each episode, he decodes what they've mastered and what they've learned along the way. Start learning from the world’s best today.
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