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A Spoonful of Sugar w/ John Bass



Karen Mangia

In this Success from Anywhere blog, you'll meet an author, speaker, and serial entrepreneur building healthier individuals and communities through innovation. Leading change doesn't have to be a tough pill to swallow, according to John Bass, CEO and founder of Hashed Health. Thanks for speaking with me, John.

John Bass

Glad to.

Karen Mangia

One question I like to ask every guest is: what was your first paying job and how did that job inform or inspire your career trajectory?

John Bass

My first job was working picking tobacco one summer in high school. I'm from Nashville, Tennessee. This was in the early ‘90s. Nashville was a small city then. You didn’t have to go too far from town to find farms. We spent a lot of time outside. A couple of friends of mine and I took a farm job one summer. Talk about hard work. That's about the hardest, stickiest, dirtiest job you can find. We were picking tobacco, hanging it in the barn, and drying it. I learned to work hard and attribute much success in my career to working harder than the people around me, especially when communicating well. This allowed me to ladder up in different jobs early in my career.

I only became an entrepreneur in my mid-20s when I stumbled into a job with a startup during the early e-commerce internet B2B stuff. So, I got lucky, but learning to work hard created a foundation in me for success later in my career.

Karen Mangia

And being an entrepreneur is like being a farmhand; it's hands-on work. You do have to roll up your sleeves and dive into the details. What was it about the startup world that appealed to you?

John Bass

It took me a while to figure out what I was good at. I tried a lot of different things. I taught a little bit; I was doing research for a while. I thought I was going to go to medical school and decided that wasn't for me.

While considering medical school, I got into technology with a job at Vanderbilt Medical Center. I was hanging out in the Division of Trauma with surgeons, doctors, and nurses who showed me what it meant to devote my life to medicine in that way. I decided I didn't have that in me, but at the same time, I found this attractive, disruptive new technology area that I wanted to focus on. This was in the late 90s, as the .com stuff started to happen and I built one of Vanderbilt's first websites.

I started thinking about what the Internet could do for healthcare and all the processes and administrative activities around healthcare. I became obsessed with how technology could improve healthcare and drive collaboration to solve some of our problems. That focus led me to join a startup, work hard, and develop my career, which then lead to becoming a Chief Operating Officer, the first Product Manager, then Chief Operating Officer, then CEO, and then the founder of my own company. It took a while. All these stories are about successful entrepreneurs who have an idea in college and start something without a whole lot of real-world experience—that wasn't me. I didn't become a founder and operator of startups until later in my career,

Karen Mangia

To borrow those lyrics, 'the long and winding road.' It makes me think of that phrase, overnight success. We often see the glamorized story of ideas to impact where the founders had such clarity, knew exactly what needed to be created, and were on their path to success. More often than not, this is not the case. What we do to be successful is a process of discovery. What inspired you to discover and found Hashed Health?

John Bass

I was fortunate to be a part of a couple of startups that ultimately did well—the through line of my career before Hashed Health tried to use technology to drive collaboration in healthcare. A lot of healthcare has big problems relating to failures to collaborate. A lot of it has to do with data sharing or multi-party business process optimization and things like that. Many of the costs and access challenges we see in healthcare today are collaboration issues.

The B2B work we were doing at Impact Health, which became Global Healthcare Exchange (GHX), was bringing together a network of providers and suppliers to improve the supply chain. So, rather than phoning and faxing everything, we started using the Internet and creating these networks where all the network members join this flywheel of efficiency gained through the use of this technology.

The hard part about that was not technical—changing how people work together, thinking about a trading partner relationship, and thinking about shared value rather than losing some competitive edge were the hard things. I think that's true with many use cases in healthcare today. Then I grew up with GHX and left there after about nine or ten years to help start another company called InVivoLink, which was about care management for orthopedic episodes. We were asking: how do we put an envelope around the episode of care so that surgeons, their clinics, the hospital, and all the people in the hospital and the patient can work together, creating shared value, outcomes, shared economic interest, and alignment? That's a better way to deliver an episode of care, like a knee replacement or hip replacement, versus everybody doing their little thing and not talking to each other, which is how it's always been. That shift from fee-for-service healthcare to value-based or bundled healthcare is something I focused on at that company, which we grew up and sold after about five years.

Because of my experience using the Internet early on, bringing together networks, and thinking about Michael Porter's shared value principles—that's been the throughline throughout those companies I was a part of. I started Hashed with a real focus on blockchain and healthcare; although we've evolved, that's still part of what we do. We've all evolved way beyond just blockchain and healthcare.

The focus at the early stages of Hashed was using this blockchain distributed ledger architecture as an operating system for collaboration, trust, transparency, and incentive alignment for healthcare, businesses, patients, and doctors.

That idea of collaboration—when I started getting into the blockchain space, the crypto space, in about 2014-15, I started to recognize the power of that technology and other technologies as a new framework, a new design space for solving these issues related to collaboration, trust, transparency, and health that I've been wrestling with it throughout my career.

In 2015, I thought I stumbled on a secret no one else knew. I felt like I had found this hidden gem and had to do something with it. I left HCA. I left InVivoLink, where I was running the HCA as a subsidiary of InVivoLink, and started Hashed. Since then, we've been doing a lot of discovery and delivery work in a couple of different modalities. Over the last six or seven years, we've evolved into a venture studio, which we're excited to be now running. It's been a blast.

Karen Mangia

Improved healthcare experience is a collaboration challenge to be solved. I love what you're saying there. We can all relate to the experience of the feeling that doctors aren't talking to one another or that somebody prescribes a medication that interferes with something else. And we thought to ourselves, 'Why can't these providers all be connected so we can have the best care experience and reduce the burden on the patient to be their own advocate and a mini medical expert to get to that desired outcome of improved health?'

Some terms that you have mentioned might be newer to some readers. Explain blockchain and venture studios in a way my soon-to-be 100-year-old grandfather could understand.

John Bass

A blockchain is basically a distributed ledger. What that means is a shared database. It's just what distribution means—it's shared across various participants. A ledger is a chronological log of events, transactions, or data the network participants are interested in.

Traditionally, Bitcoin is what people think about when they think about a crypto asset, a digital asset, or something that is being tracked on a blockchain. Bitcoin is just a packet of data that represents value to a community, and it can be tracked on this chronological ledger, so everyone knows the state of that asset; they know who owns it. They know that it was sold from this person to this person. That's what blockchain does. If there's one thing you must remember, blockchains enable ownership of digital assets. The people who are members of this community all understand who owns this digital thing, and that digital thing can be a cryptocurrency or in the healthcare space; it can be a claim moving through a claim's life cycle; it can be a patient representation of a patient moving through an episode of care; it can be a supply moving through a supply chain. Whatever the community wants to track collectively can be many different things. That's why blockchains are a great operating system for trust and transparency.

Alignment happens because, for the first time, we have these shared data structures where everyone understands what is true about a digital asset. However, that's represented as a community; they're all on the same page. There's this shared source of truth. You can do blockchains in different ways, but if you do an actual blockchain, it's owned by the community. There's no third party who's abusing the members of this network. So, it's great because it can be community-owned and operated, which is interesting. It's borderless, publicly verifiable, and trusted.

Blockchain means different things to different people. However, I became interested in it because I started thinking about all these issues related to collaboration and data sharing where everyone's protective of their data and that we needed to move this data around to make it meaningful and to solve problems. Blockchain, to me, seemed to be this interesting new design space where we can create unique and innovative business models. Here are some examples of that.

Venture studios are a new way of innovating. What we do as a venture studio is have ideas around how to solve big problems in healthcare. Most of the work at Hashed involves creating networks where there's a need for trust, transparency, incentive alignment, and data sharing to solve a big problem that has yet to be solved. And there are lots of these in healthcare. Whether we use a blockchain or not, we gravitate towards those projects. We have many ideas for supply chains, workforce issues, payments, fintech, identity and credentialing, marketplaces, and data exchanges. There are different kinds of ideas to work with here.

What we do is take those ideas and move them through a process of discovery and delivery activities. Every studio has a process of discovery and delivery. The goal is to bring resources and expertise to the beginning of that process so that you do a comprehensive job of validating that idea before you go and waste a bunch of time and money hiring teams, raising capital, recruiting advisory boards, and all the stuff that startups do. In my and many other people's careers, you do all of that early in the process, and then you realize you need product-market fit after you launch the company.

And I've gotten lucky in my career by having successes. 90% of startups fail, and a lot of them fail because they don't understand the space they're getting into.

Entrepreneurs are dreamers; they fall in love with a dream and go after it. That's awesome, and we need that. I do that, too. But it's essential to take those dreams and validate them before you go and spend a bunch of time and resources building a company. Studios strive to bring an idea, validate it internally and externally, do a lot of prototyping, do a lot of business modeling, and ensure that you're not building something the world isn’t ready for.

Many companies that started—for example, Blockchain companies — when I began Hashed in 2016 are dead now because they went all in on medical records on the blockchain. In contrast, we just stayed very flexible and listened to the market. We only built the things that we knew were valid. So, by the time you see us, we have moved through this process of discovery and delivery. Discovery meaning validation, delivery meaning building the product, recruiting a team, recruiting customers, and recruiting investors.

When you see us spin out the company, we have all those boxes checked. We have a backable, fundable co-founder who will run the company; we have customers who will use a product; we have a product that we know works; we have a business model that has been validated. We have investors who are excited to support the commercialization of the new company. That discovery-delivery process maximizes the value and minimizes the risk at the seed stage of a new organization. That's what, that's what a venture studio does, at least for Hash; that's what we strive to do.

Karen Mangia

I hear you say that the best idea leaders and innovators who create viable businesses are flexible within a framework, meaning they want to explore ideas. There needs to be some framework in place to make sure that you use your words. There's a ready-made market for investors and customers to consume that idea, and often, being flexible within a framework begins with core values or beliefs and reconnecting with those. You've got six core beliefs that are important to you. Tell us more about those.

John Bass

I'll pick out a couple that are really important. There are things you see in everyone's beliefs, but one unique and essential is the idea of radical collaboration. This is a big one.

Radical collaboration is required to solve the big problems we want to solve. We're taking big swings. We're not building dog-walking apps here. We're making things that affect patients, improve efficiency, decrease costs, and improve access to care for many people. This is what we do, and we don't think you can do that without thinking very differently and thinking via radical collaboration, creating new and innovative ways to bring constituents and healthcare together to solve foundational healthcare problems and create shared value through these communities and these networks.

Another one is this idea around endurance and evolution. There are things that I have fallen in love with, like these ideas. If you run an honest validation process, you'll have a broken heart because the world is just not ready for some of your great ideas.

I can think of several of these over the last six years where, although I knew this was the right thing to do, I didn't think we shouldn't build it now as when we did begin a validation process — and it just is hard —either we can't find the right co-founder, or we can't get the minimal viable network of constituents to join that network. We have one or two constituents — for example, a pharma company — that are excited, but the payer is not interested. So, we have to put things on a shelf or shoot them in the head because the world is just not ready for them. We're just not quite there yet. And so this idea of endurance and evolution is something we think about a lot as a core value.

How do we have endurance? How do we think long-term but consider bridges from today's world to our dreamy futures? And how do we evolve our thinking through feedback from the market? So, a lot of it is things that you talk about frequently. It is a learning mindset. How do you come in daily and listen, learn, evolve your thinking, and create enduring companies? Those are a couple of beliefs important to our success at Hashed, and the decisions we make and the things we do in our process fall from those core beliefs.

Karen Mangia

Thank you for bringing up the mindset. It would be easy for people to look at a heavily regulated industry like healthcare and resign themselves to the belief that you can't evolve something, especially with technology that has so much regulation tied to it. And yet, you're innovating in that space.

How do you step back and assess the partners you need to be successful and build the kind of compelling business case that gets them excited to participate with you or at least show up for a conversation?

John Bass

It depends on the specific use case. There's a difference between B2B and B2C. It is hard in healthcare; we've been good at the status quo. We've built a model of healthcare that is working as designed. For example, if you look at the top publicly traded companies by revenue 15 years ago, there were no healthcare companies on that list. Now, they are eight. The eight on there are these big legacy pipeline businesses; they look like dinosaurs compared to other companies like Apple, Google, and others. All of the innovation that's been going into healthcare, and many of the things that I've done honestly before Hashed, focuses on what Clayton Christensen would say is 'efficiency or sustaining innovations.' All the innovation has primarily gone towards making those big organizations focused on the old healthcare world more efficient and sustainable and reinforcing the status quo. That's been working, but it's also been driving up the cost of care to where we're 20% of GDP. It's on an unsustainable pathway. We're entering a golden age of healthcare innovation because costs are uncontrollable. Regulatory forces are starting to drive consumerism and employer engagement. They're going things like the chain, like the move from fee-for-service to value-based care where you're changing how people get paid, which is a fundamental driver of change. You've got the introduction of blockchain and AI and ML and all these new technologies enabling innovative new business models of the world as never before.

You have this perfect storm of things going on. Now, in post-COVID, all of that stuff got accelerated. Whereas pre-COVID, you were looking at getting pulled more towards efficiency and sustaining innovations, post-COVID, there is more of an appetite for partnering with even bigger organizations around disruptive innovation. People are waking up to the fact that what's happening is not sustainable, and there are these macro trends that are accelerating, and they need to get on board.

Collaboration has always been hard in healthcare partnering. Only 15% of innovation initiatives at healthcare enterprises are successful. Most of them go there to die. We could have a better track record of especially disruptive innovation in healthcare, but that will change over the next decade. There's a real thirst for doing things differently; there's all these drivers. It's taken a lot of years off my life, this focus on collaboration in healthcare, but I think we are hitting our peak right at the right time, where we think there's an enormous opportunity for thinking more collaboratively and more in a partnership and networking mindset, then, even a couple of years ago,

Karen Mangia

We are entering the golden age of healthcare; I love that thought. What is the most transformative trend in the future of healthcare that we should all be watching right now?

John Bass

I think it's hard to pick one just because, as I said a few minutes ago, there are so many exciting things: the introduction of technology and these regulatory changes around how people are getting paid and the ability to take risks and move to value, and the kind of the trend towards consumerism. At the end of the day, things that empower the consumer are going to change healthcare the most.

If you think about the technologies that empower consumers — it's your mobile phone, it's mobile devices; it's bringing AI to the decision-making process for patients. It's arming and equipping patients with their data and their medical identity and allowing them to be more active and accountable participants in their care. That's not one thing that's blending AI and mobile and lots of different things. Just generally, I think healthcare probably won't change a lot until the consumers are truly empowered. Then, suddenly, you'll see a lot happening at once, and I think that's part of what's starting now.

Karen Mangia

The power of healthcare is in all of our hands. We like to ask virtual water cooler questions because people say they miss these spontaneous interactions in the break rooms around the water coolers. This part of the interview is designed to be five quick questions where you say the first thing that comes to mind to help us get to know you a little bit better. Are you ready?

John Bass

I think so.

Karen Mangia

For you as an entrepreneur, what time of day do you do your best work?

John Bass

7AM.

Karen Mangia

Speaking of time now, imagine every day has 25 hours rather than 24. What are you going to do with your extra hour?

John Bass

I plan to hang out with my children. I have three daughters, and I'm really enjoying them right now.

Karen Mangia

That's awesome. And I'm sure they'd love another hour with you. If you had to eat one meal every day for the rest of your life, what would it be?

John Bass

Tacos?

Karen Mangia

Oh, you and Jake Miller from Engineered Innovation Group share that choice. He's an awesome, awesome leader. Now, imagine the zombie apocalypse is coming. Who are the three people you want on your team?

John Bass

I immediately thought about my family. I'll have to go with that.

Karen Mangia

Great answer. And how can readers learn more about you and your company and stay connected with what you're discovering?

John Bass

We do a good job innovating in the open and talking openly about what we're working on. Talk is cheap, but it's the ability to execute hard things. So we don't take ideas or hold ideas too close. Sharing that information helps bring community and resources to each of our initiatives in the studio. That's how we find partners, co-founders, and supporters. And so, we tried to use our website; we've got a great VP of Marketing, Stacey Blakey, helping us improve how we do that. The best way is to follow our website and subscribe to our newsletter. I post everything on LinkedIn. LinkedIn is the primary social outlet where you see what we're up to.

Karen Mangia

Thank you to John Bass, founder and CEO of Hashed Health, for sharing your insights for Success from Anywhere. Because success is not a destination. Success is not a location. Success is available to anyone, anytime, anywhere.


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