How to Get Others to Bet on You
It doesn't get much bigger than working for the President of the United States. And for Aneesh Chopra serving as the country's first Chief Technology Officer as the country embraced open data, innovation and lean startup principles, he was at the heart of the future.
But how do you transition into something new when you've built a two-decade long career in something entirely different? For Aneesh, he knew there was an opportunity to transform health care through the private sector, but an important job with a gigantic title wasn't going to be enough to get investors to bet it all on a first-time entrepreneur tackling one of the hairiest, most complex sectors on the planet: health care.
Aneesh offers a unique look at the way we gain deep insights -- and ultimately test out theories on the public -- through what we've created. Hear how his book Innovative State offered him the chance to publicly share his vision for the future of health care, and served as the 'pitch deck' that has convinced investors, customers and cofounders to join him on a mission to fix the patient experience.
Listen to the Episode below, or see the full transcript of our discussion.
Subscribe, and Listen on:
Interview Transcript ?(apologies for any errors in the automatic transcription):
Aneesh Chopra: I get a call at 5:00, a friend of mine who is in entertainment and says, 'Oh man, you better watch the Daily show tonight.' What of all the people in the world is watching this Jon Stewart team. And so that's what it does. He says 'Today at the White House... it was hilarious.' And he just endless loop of me laughing and it was all embarrassing. Like this guy didn't know what he was doing. It's like keystone cops at the White House, but he ends with 'What's so funny, Indian George Clooney.' My family's mortified that I fumbled my national they and embarrass the President frankly. And so, I walk it, I was a senior staff meeting every morning at 8:30. The senior staff at 25 people gather in the Roosevelt Room and they debate the degree to which, you know, issues of the day matter and make sure it was on the same page. So I walk in scared to death, they're going to say, how dare you embarrassed this administration, you screwed this thing up. And I remember vividly, you know, Rahm Emanuel, who's quite, you know. Yeah. He's to the point. He's not, you know, anyway, he just sorta says Indian George Clooney. And so I start laugh. Everyone's laughing at this.
Eric Koester: Welcome, welcome. Welcome everyone to today's show. You guys are going to get to meet a friend of mine, someone I've had the privilege to get to know for the past couple years, Aneesh Chopra and a niche is incredibly understated. He's an entrepreneur working on a very cool problem trying to solve some of the issues in healthcare, but, but his beginnings are pretty amazing. Aneesh was the first CTO (Chief Technology Officer) of the entire United States of America under Barack Obama, and had some incredible adventures and stories we will hear about some of the adventures including how he got named by John Stewart, the "Indian George Clooney," which is a hilarious story. I love it. You'll hear how a Dwayne Wade, sent a message through him to get to play basketball with Obama. Some crazy things. But what I love about Aneesh's story is that he details how he wrote a book and that book actually helped him form the entire plan for what is now his startup. He really did follow this process of going deep on a problem through a book and using that to become what ultimately is today has started that is now serving millions of patients and all sorts of really interesting things. And he's just fun. He's a really understated and he is handsome. Hence the, Indian George Clooney. But I think you're gonna love it. We had a great time chatting about his adventures now and how his life in the White House, his life, even as a politician and ultimately as an author helped color what he gets to do today. Aneesh Chopra, everyone enjoy the chat.
Eric Koester: How are you, sir?
Aneesh Chopra: I'm doing great. How are you?
Eric Koester: I'm well, thank you. This is, I've always loved when we get back together because that feels like so many things have happened. Like was sort of like these, there's all this stuff happening and then magic happens when we come back. And it's, it's a, it's a thing.
Aneesh Chopra: So the country's moving forward. That's the best news. We've got deviations on some aspects, but some support for the, the startup economy is continuing and it's just, it's fun.
Eric Koester: Did you ever think you'd be an entrepreneur like you, you, you know, you sort of came from this big policy. Yeah. So there's big gut when you came from sort of government government. Well maybe you were in like you were in private enterprise. I spent a decade at the advisory board and then government where you were like the man
Aneesh Chopra: I was having a lot of fun. Yeah. No, I, um, I always felt that the key to solving problems was to unleash entrepreneurs and that several will find the magic formula and we can scale what works. And so enough of my commentary about it, I reached a pinnacle where I ran for office under the presumption that I would try to call to action this army of entrepreneurs to solve problems. And, when I came in second place in my race, I was committed to bringing my ideas to life, not as the evangelist, encouraging the entrepreneur, but to be an exemplar exemplar entrepreneur of taking advantage of the opportunities that we see now to build companies on the, on the opportunities that are born out of the opening up of government.
Eric Koester: So do you appreciate the work you did with Startup America? Kind of been building these communities and ecosystems more now that you're in the game?
Aneesh Chopra: Well, I love it because I took for granted whenever you're sitting in a position, I was president Obama's chief technology officer and you report directly to the president had states you've got this unbelief.
Eric Koester: Understand that you're like, you're like a big deal. I don't know, I was like, you, I'm not a big deal, but it was, I had a role that was particularly larger than life. That's right. and the, and the first to a special badge or something. You get a tattoo and you should get like a tattoo, like maybe a neck one, CTA, just bad ass something. I Dunno.
Aneesh Chopra: No, the, you think Washington, you know, you call a meeting, right? Ceos drop what they're doing and within 24 hours they're in Washington. That's where the president now for the CTO, but you get the basic for. And what I realized in the startup America movement was that we think people are listening to the words coming out of our mouth and then everybody knows we're launching this initiative, right? We're all the entrepreneurs. Why are they not participating? And it was so obvious that like we needed to get out there and educate people, mostly reach them in their community as opposed to waiting for them to come to Washington. So when America was conceived, there was a call to action by President Obama. The first theory was let's celebrate entrepreneurs and that was of any variety entrepreneurs who are making photo apps or fixing some restaurant need or whatever.
Aneesh Chopra: And I was playing the role of, wait, I got a specific homework assignment by the president. We need to close the innovation gap in health, energy education, um, financial access to small things, small things like, hey, while there's this evangelism going on and we're celebrating people, what if we like tapped into the subset of those folks who were looking to solve these problems? I bet there's a separate and more robust conversation worth having, which is what barriers or opportunities are there for you to bring your new ideas to life in helping the poor rise up and to create economic opportunity. So that was a two way dialogue and what was great in my view is that I understood and felt some degree of humility that there's a lot of improvement that needs to be done. And now that I'm on the other side, I see why on earth is the government not doing this. Who are those people? And how dare they not make this easier. This makes no sense. So I'm seeing things at a much more granular level that had I seen on the front end, I would have been more aware to tackle those issues. Often I said at this high level and sometimes it's the day to day where there's the need and the friction, right? So
Eric Koester: it's a it and I think even I would say because we've, we first met in San Francisco very briefly for a long, long, many moons ago and it was interesting because I think you were with Eric Ries and it was, and we met and I remember at the time like Eric was this new fangled thing.
Aneesh Chopra: They don't even really know like why the hell is the government have a cto? And I think what's amazing is we may think about all these whatever problems, but sort of amazing how much things have advanced in the last. Was that like less than 10 years? Yeah, there's a conversation if you're a governor or a mayor, a head of state and you don't have a cto role. Right. The political debate is why not? Right. And that's kind of a fascinating thing. We didn't know that we needed it and I'm not so sure it's been fully vetted in terms of exactly what you would do if you had person in that role. Um, what I was Virginia's fourth secretary of technology are we really didn't know that a three governors, but for a fourth secretary, because some were replacing within cycle, the first governor had asked his secretary technology to be a marketing evangelist, go tell Silicon Valley to set up their shop in northern Virginia because that's where the action is. So, and I'm overstating it, but basically a celebratory technology based economic development executive, right? Wildly successful Virginia became a real lord linchpin for a lot of these tech firms.
Aneesh Chopra: Second governor, Governor Warner said, now I want to flip the switch. Mostly focusing in house. We're not using technology to do the day to day of government are saying we're using outdated computer systems. Mainframes are security is weak or data management is poor. So we've got to do some basic blocking and tackling. So let's upgrade the infrastructure. Ten year, $2,000,000,000 partnerships all managed by the CTO. So the CTO was like a marketing agent on the one hand and then an operational excellence on the other. And then my role, governor Kaine said, well, all that's well and good, but I've, I've, as I was elected to fix transportation, healthcare, education, the environment. Yeah, I've got cabinet secretaries were experts in each of these areas, a niche pair up with to make sure that they're fully, properly a extrapolating the value of technology, data and innovation to do their job.
Aneesh Chopra: So don't do their job, right. Partner in the use of technology, advanced what they think needs to be done. So he called me sort of the chief collaboration officer in a way because it was technology in support of a mission as opposed to unto itself. And that was really the strategy President Obama embraced. So while again I was cto reporting to the president like I did the governor, it was really the collaboration aspects of finding Secretary Arnie Duncan and then launching the open education data initiative and open health aid initiative with Secretary Sebelius at the time and, and, and her deputy todd park, who was my successor. So anyway, we go on and on. But that, that idea of inservice to that says to me, everyone, no matter what their stripe is, has a problem they want solved and they think they have diagnosed the problem because they're experts in the issue and they think they know how to, they're going to tackle it, but then they haven't properly vetted all that.
Aneesh Chopra: The new technologies and innovations are available to make them do what they think they were going to do. Otherwise more complicated, do it more easily and at much lower cost. So that's the vision. Yeah. What was it like to get that call when you're like, Hey, I'd like you to come in. And I mean, it's got to be crazy. I remember forever, right? Like I. Well it was an odd bird for me because I was recruited to the transition team by gentlemen named Julius, Jenna Koski Julius had been the president's law school classmate and buddy had lead, had led the technology strategy for the campaign and had been rumored to naturally be the candidate for first cto. And really we agreed to work for him in the context of writing up his job description and telling him what the role could be. So I actually spent my time in the transition looking to be cto of the Department of Health and Human Services for sure.
Aneesh Chopra: And I think I got the job on day one, but there was a bit of a wrinkle a, it was Tom Daschel who was nominated and then had this hiccup on the confirmation process. Now it seems quaint that he barely handled some miscalculations for see he, you know, I don't know in hindsight, you know, was that a bar having Tom Daschle in versus out big challenge. So I was, not in any hurry. I was gonna wait for the new secretary of Health to be named. I was in Virginia anyway, doing my job for governor Kaine because we were still, you know, in, in our cabinet role. And the new secretary came in and we arranged the next steps. I actually was basically told, hey, a niche, expect to come in on Friday. We're going to give you a call. We think we're going to move forward that this is the lead by the deputy secretary.
Aneesh Chopra: So I, I was like, great. At Friday at four I'm going to get this call, Yay or nay. I feel good about it. I'm super excited. Governor Kaine had spoken to Governor Sebelius. I felt like, wow, this is all lined up at noon. I get a call from the chief of staff to the office of Science and Technology Policy, which is the office that ultimately held the, the CTO. and so jim called and says, Nah, it's a noon call. He says, Hey, can you come to the White House on Monday? I'm like, Oh man, I thought I'm getting the off ramp for now. You're adding more hoops. Do I have to go to just accept the job because know I can't tell you but, but just come by on Monday. By Monday, not everyone gets to college just to come by the White House. So, mostly chief of staff and stakeholders around the chief of staff was the round of meetings.
Aneesh Chopra: Monday, Tuesday they say, come back, you're going to be, um, vetted for all the legality stuff. Did you cheat on your wife? You beat up babies. So they ask you these terrible questions and vetting and then a Wednesday, they're deliberating on whether they're going to extend the offer and then of all people, Senator Mark Warner calls who's my mentor and says, look, I just spoke to the president and he was evaluating you and basically said you're in. And so, you know, you haven't heard it yet, but you're your, oh, he's probably filming a youtube video right now. Anyway, I'll fast forward, but on my 15th anniversary for Johns Hopkins was that Saturday. and of course I found out in between that I got the job in front of all my peers. The youtube video by the president comes out and it says, today I'm announcing the new CTO, whatever.
Aneesh Chopra: And so the President University stops our luncheon and it's like, by the way, news just broke, blah, blah blah. And it was great. It's awesome. Anyway, lot of fun. Hilarious. But like four months of like back and forth policy discussions to four days of intense scrutiny and boom on the team. Did you ever get speaking to him on the team? I know that there was sort of like a ongoing pickup basketball game. Did you ever get to the play? Is that my claim to fame of, of, of, of, just a few. Is that a claim to fame by the way? I wrote a book with my colleague and college roommate, Ethan Skolnick, who actually is a sportswriter. So Ethan tells me in the course of just our daily catch ups, they say I saw Dwayne Wade, d wade, and he was bumming out because he hadn't been invited by President Obama to pick up to play pickup basketball. So
Eric Koester: Chicago guys too. So I'm Dwayne Wade into marquette. So I'm a Chicago guy.
Aneesh Chopra: Well, I will say thanks to Ethan's feedback I call Reggie love, who was the president's a body man. And next thing I know d dot wade is playing pickup ball. I think Alonzo mourning was in that day. So it was Alonzo d dot wade, the president. Oh Reggie. I was not invited.
Eric Koester: No, but, I facilitate facilitate it. You would like the agent in that point of that. He's my favorite player, so I think you, you did great work there. Thank you. I mean you bring people together. That's the job. That's kind of the job, right? You were the collaborator and Sheena's right? In some ways. That's right. That's pretty amazing. Is in. Did you ever think like, I mean you had to be surprised kind of there was this sort of the timing of it too, right? Like being the CTO and then kind of this, the technology world sort of explodes during this time while you're a cto or brown. The time Facebook goes public. Yes. Twitter becomes this thing that becomes mass market seems sort of like the forces converge. You're like on the daily show and stuff like this are happening probably because, you know, I mean I'm sure like technology stuff was sort of like happened, but it didn't happen in such a public face as during that window.
Aneesh Chopra: Well, and I will say the timing was fascinating when the Arab spring was underway, a twitter had not yet reached the kind of scale that we now know it to be. It was the secretary of State's team under Alec Ross is leadership and Jared Cohen Airlock now by the way, candidate for governor in Maryland. I just spoke to a couple weeks ago. Great Guy. Alec and jared intervene to make sure they don't go down and they were basically going down for updates or whatever. Your maintenance right in the middle of the Arab spring. Interesting. So, so you have this public policy, technology collaboration going on and you know, what do you call that? Is that a government procurement? No, we didn't buy twitter services, right? We're encouraging and collaborating and so you know, all the old playbooks of you buy technology or you regulate technology. They didn't really envision this new concept of a collaborative model where you're working on standards, you're working on the use of data, open data. You're working on innovation and platforms for prizes and competitions to democratize a problem solvers, getting access to the government. So all of that's happening in the first term of the Obama administration and it's fascinating and now we're seeing it like, like I said, it's now a new arm of government. It's a, it's a whole method of problem solving that that is a, it's not left versus right. It's really a kind of problem solvers versus naysayers.
Eric Koester: So I have a funny story. So I prepare for and I googled the person, right? I always like Google. So I Google you and I then I was trying to like find something witty. And so of the first 20 instances, could you want to guess how many times, your, the John Stewart quote about you is what's in it? So, so John Stewart famously calls you the Indian George Clooney. Yeah. Right. So you want to guess of the 20, how many I've found that, that article reference to you in that way. Four of the 20. So you, it is sort of, it's become almost like your tagline that you may, you just may need to own this.
Aneesh Chopra: Well, I, I, it's a flattering and completely ridiculous. The real story is that I thought I was gonna lose my job really, for sure. The context is, the White House communications shop is very managed. Who speaks on behalf of the president. You have to be super trained and in particular in that White House too. I mean we were, we had a well run operation. Things are going wrong and so, you know, policy advisors do their job by writing memos, give advice, you know, go to meetings. I bet you write kick ass, man. Yeah. My wife would come and chief memo officer these poetry. but look, here's the bottom line. The president on day one said I want to have a more open and transparent government and he directs the CTO and the director of his management budget office to come up with a plan. And so we were going to release that plan in December and so they thought, hey, wouldn't that be fun?
Aneesh Chopra: Live webcast from the White House. Kind of cool. Yeah. So, we're giddy about the idea. We've been working on this thing for months. Like we know the content cold and it's like, cool, we're going to announce this live and 10 people are going to be watching the webcast, but it'll be fun. Right? And so everything's fun up until, my colleague and my best friend, my colleague Megan and my best friend Vivek Kundra, who's like a brother to me, he was cio making ran digital strategy. The light goes on that says the cameras live. This isn't like a recording where I can hit pause and start over and apparently I was up first to kind of welcome everybody and make the statement and Oh my goodness, I blank. And I'm like, oh, it's okay. I'll just hit stop and we'll start all over again. Then in my head I'm thinking, you can't say stop, you can't hit stop your live your life.
Aneesh Chopra: So now all I'm doing is in my head thinking about the tragedy that is unfolding before my eyes. I don't know what I'm supposed to say how I'm saying it. So I just started laughing uncontrollably and I had no idea like why my brother wouldn't rescue me and cut it off. After a few seconds say, well, I'm saying and, but we could finish my sentences, I could finish his. Well, he just stares at me in the video for a good minute and a half until I finally composed myself stabilize and then carry on for 45 minutes into a really productive. Just the facts ma'am. Right thing, right? So the first couple minutes were like weird and people are like, Hey, is an issue. Okay? Everything fine when we wrap up, I was embarrassed and I apologized to you. And they're like, Nah, don't worry about it. Whatever.
Aneesh Chopra: It's fine. I got a call at 5:00 from a friend of mine who is in entertainment is, Oh man, you better watch the daily show tonight. What of all the people in the world is watching this, that John Stewart team. And so that's what he does. He says today at the White House. It was hilarious and he just endless loop of me laughing and it was all embarrassing. Like this guy didn't know what he was doing. It's like keystone cops at the White House, but he ends with what's so funny. Indian George Clooney, and so you're like, okay, that's pretty cool. Yeah, I thought I was going to walk. I was in the senior staff that your wife like dig that. They were all mortified. Mortified that I fumbled my national debut and embarrassed the president frankly. And so, I walk it, I was a senior staff meeting every morning at 8:30, the senior staff at 25 people gather in the Roosevelt Room and they debate the degree to which, you know, issues of the day matter and make sure it was on the same page.
Aneesh Chopra: So I walk in scared to death. They're going to say, how dare you embarrassed to say ministration you screwed this thing up. And I remember vividly, you know, Rahm Emanuel, who's quite, you know, yeah, he's to the point, he's not, you know, anyway, he sort says Indian George Clooney. And so I start laugh, everyone's laughing and it was great. And so, once that, once that ice was broken that I didn't embarrass the president, I didn't reflect poorly on the administration. it was great. And so now it's, it's a tagline and it's hilarious and obviously it's not true on the physical side, but I'll take it, I'll take it. It's pretty, it's pretty. So, so, that had to be a quite, quite something that you'll sort of never forget, right? does it, did it, did it make you appreciate the office of the presidents more than you thought of it because you now have an inside look and not few people get to see that level of detail and sort of scrutiny and structure and all that.
Aneesh Chopra: So imagine the hardest decision you've had to make this year. Now imagine a 30 minute meeting where it's presented to you and you have to render judgment. Not once, but eight times in a given day, every day. What you don't appreciate is that the president doesn't have a lot of free time that just, you know, shoot, the breeze is what's going on. How are things when a, when a, when an item is presented to the president, it's because the advisors around the president could not reach consensus that it was so hard to reconcile competing priorities and values. So a, I appreciated the brilliance of President Obama because he prepared for every one of these very difficult decisions by reading the material we presented in advance. When we showed up, he knew exactly how to bring out the tough questions. He posed exactly the issues, surface them in a manner would render the best decision making and he had to become an expert on every subject, every half hour.
Aneesh Chopra: That's unbelievably hard and a gift that we had in President Obama and I would imagine all presidents having to grapple in this same way, but in our administration I can tell you whenever, and it was rare whenever there were issues I worked on that required like usually tech is not controversial so we just sail through the ideas like a pro, you know, they don't have to waste his time, it's fine get it. But when there was a debate, he knew exactly where I was most anxious about the argument because even I was having a hard time to make the case. You knew exactly where that weakness was and he went right after it to try to drill it out and, and help bring people together. So to me there's something inspiring about a person that could take on that role and the kind of brain power that it requires to do it well. Yeah. And we were blessed, I think in the Obama administration have such a hero in that role.
Eric Koester: It does remind me a little bit. I mean not to that degree, like these are not life and death decisions, but a little bit of being a, the Co founder or a CEO, you know, sort of the CEO is that not necessarily agreed but like the fact to make 100 decisions everyday sort of thing and everyone, you know, like sequential. Yeah. So I'm sure in some ways that has sort of must, whether you sort of internalize it or not, I'm sure that ability to kind of like quickly render judgment, make decisions and you sort of make him all the time without the, without the absence of perfect information. That's right. That's right. You know, nine, 10. That's the skill set of a great ceo. Yeah.
Aneesh Chopra: The capacity to absorb limited information and render the best judgment you can given the, you know, you go to war with the army, you have the Rumsfeld quote, right?
Eric Koester: So you made the decisions with the information you have. Right. So it's, so our, our mutual friend Scott Case always says about startups, which I love this. He says the best analogy is like being a high school football coach. Yes. Because you go to, you can't recruit other players. You basically have to pass that you have and you're going to have like the short kid and so, or you're going to have no quarterback. You can't throw your fricking option writing, you know, the option offense at that point on it, which I think is kind of a fun truth. You just, you know, you got what you got. Um, so I do want to talk a little bit about your, this interplay that's, I think, fascinating about the book he wrote and the startup. You now run it how they kind of fit together because I didn't get, we talk a lot about the power of a book in terms of focusing the mind on what matters and what you learned in pink and in some ways you kind of wrote your own plan for the startup space. So talk a little bit about the book and how it's kind of, you know, change the way you think a little bit.
Aneesh Chopra: Well, first, a little bit of a rewind, which is, when I was in Virginia before I went to the White House, Governor Kaine was a Democrat with a very republican legislature. Governor Kaine is a Democrat and I should say, and in the tech space we probably worked together about 20 plus bills that he ultimately signed in the law. That's a lot, well the point in that, but thank you for the light. You know, the, the, the, it was a productive time. The point was a republican had to sponsor the bill for the most part we had out of the 20 plus bills. One was a democratically sponsored bill just because when you're in the minority, it's hard to get your ideas through, right? So we had to come up with a way to work together across the aisle and what struck me then more so at the White House was that for a lot of these issues, the normal left, right divide didn't quite apply.
Aneesh Chopra: And so it was hard to explain like is what I'm doing, like a talking point for a democratic case to why we should be electing Democrats maybe, but a Republican could say the same things and there'd be doing the same work. So, and it was across the board data, innovation, technology, education, tech policy. You could, you could, you could say, we may violently disagree about the future of health care in the context of who pays for the uninsured, but you can agree that we should modernize the system. So we reduce waste technology will, is a great equalizer and solving things and it has the potential to. So the question is how, so there's work. It's not like it magically happens. You've got to work and get it right. So when I, when I was thinking about the next chapter of my life, I've been somewhat anxious that a lot of the things we've worked on that are tech related are really state issues and we at the federal level kind of enabled it.
Aneesh Chopra: So you want to change your energy policy. Well, who regulates the utilities? It's the state you want to really get into healthcare. Who regulates the doctors, hospitals, the insurance programs. It's the state ended up. So you look at the big three issues of our generation and it's like, wow, this thing is clearly a going to be done at the state level. So I thought, okay, how can I find a way to support states in a manner where we, we don't fight all the time, but we actually come together, right? So I said, okay, if I could run for Lieutenant Governor of Virginia and had the opportunity to bring these ideas forward, while there might have been a partisan battle at the governor level, we might reach coalitions on a whole range of issues that may take a decade to come to fruition. And so I thought about it, I said, how can I make the case that there's this non ideological forward looking coalition to be made?
Aneesh Chopra: And so I wrote this book trying to outline the Vision, contextualize it based on the u s history, and to look specifically around the tools and techniques available so that the government can get its act together in collaboration with this vibrant, dynamic, entrepreneurial private sector. And you have this piece in. I mean that it I think is interesting too is you almost to your point earlier about it's not a left and right. You have this moment in the very first chapter where you say you're writing this for bureaucrats who sort of don't lose hope almost. So yeah, I think it's really interesting. I hadn't sort of process it until you said it, but it is. These issues are not partisan. These are issues of like and technology can be bb. That innovation can be the great hope. I now see why you wrote it. It's a but it's a powerful statement that these are just issues for our future.
Aneesh Chopra: Not. We can have a debate about who subsidizes the cost of healthcare, but if we take the cost of healthcare down 30 percent, it makes that easier to swallow. That's interesting. Okay. So, so there you go. And so punchline is I wanted to capture and argument that you can't really make in a 32nd campaign ad or in a few minutes stump speech. Right? And so that took time and the benefit of that process is that it helped me crystallize. I could sit in any chair at a table where I could be at the center of the table as the elected official. I could be a staff person or a bureaucrat to the side that looks at where I fit to solve this with asked the incumbent industries, the utility companies, the hospitals, the doctors offices, and I could see myself as the entrepreneur and if everyone's at the table really trying to optimize all these tools, I think we can make a big difference.
Aneesh Chopra: So that was the kind of theory I had written it, assuming I'd be sitting at one seat in the table, right? When I lost my campaign. Yeah, I moved seats, but and, and the blessing there is that, um, I had a campaign supporter who's another dear friend of mine who was my partner Songy Bunzl who co founded a company called micro strategy and had been wildly successful entrepreneur and he said, look, the everything you're describing we can do from private sector, change the seat. I'll support the effort. I'll recruit your co founder. Let's put a team together. Now we've got 20 plus people. Humans are humans out here cranking away. We help a healthcare delivery systems that are looking to take on the responsibility of lowering the costs of boosting quality, these accountable care organizations and we see them as our number one customer and we support 48 of them in the country today.
Aneesh Chopra: A little over medical million Medicare patients that we service. And that's a humbling and exciting a, a role to play. It's awesome to watch. I mean, not yet because I've gotten the seat from. I remember when you were first talking about the book and then you sort of were talking about the journey of the patient and I was like, I believed you, but I didn't quite understand it. And then to sort of be seeing it's like a, you were right. Like I mean, you know, there's obviously changes, but like this sort of idea. You talked about this a journey and you didn't call it the journal. I did, right? Did you always talked about his journey and sort. It's interesting to see how that has evolved and it's Kinda cool to create it and that, that level of it changes the dynamic when you look at a person.
Aneesh Chopra: So the technical underpinning of this is there was an mit team in the nineties that wrote a paper called the Guardian Angel and they wrote it as an unsolicited proposal to Darpa and they said, imagine a person that had a digital guardian angel that can consume all the data feeds that are available to that person and you could use that in the healthcare context and beyond. So now imagine it could process all of that information and whisper in your ear decisions you should make. You should see this doctor, not this doctor. You should pursue that line of therapy, not therapy, and that is now starting to come to life in healthcare where I'm being guided through my journey, not, hey, I'm calling a doctor [inaudible], I got back pain and that's going to be down one road and then I've got this underlying diabetic condition. It's going to be down a different road and they're related and they're not being treated the same way.
Aneesh Chopra: Yeah. It's fascinating you say too, because I think it's. I think the technology's enabling this new way to coach humans in a personalized way. You can see it with what I'm doing, right? I'm coaching these people from using technology to coach them to educational outcomes. I think we're going to see this big wave happening of exactly that. I'm the Guardian Angels. Interesting thing, but it's exactly what humans are best when their coach. That's why in sports it works so well and why can't we apply this to other places, so we're going to do it. We're going to see a pick up bend the cost curve, improve outcomes, and sort of see what we can do. Health education, do you think of it like my child, we'll take a thousand standardized questions before she graduates high school. That's the Virginia standards of learning and maybe it drops a little bit where this is all months from mom, so she'll do well, right.
Aneesh Chopra: Mom, mom's definitely given her the smarts. Now she'll have a different profile of what skills she's mastered and which ones she's struggling with. Imagine if every day she could subscribe to the Khan Academy where it knew exactly where her gaps were, right? And it preloaded the films or the videos that would be meant for her. What was the gap that doesn't exist today because you have to separately log in. They're trying to take their exam, start from scratch and they're two different frameworks. So if I had one framework and I could connect people to my longitudinal repository of information than maybe I could get better support. That's the theory. I love it. Do you think that there are things that you observed from now kind of working with governments, you think a sort of, you now would have gone back and advised yourself a few years to changed that sort of be, especially in the healthcare side because what I take for granted as we presumed when we walk in the door that government does a bunch of things and it's just doing what it does and we're mostly focusing on what new things to do, right or changes to make, right.
Aneesh Chopra: We don't really appreciate. The thing we've been doing for 20 years has been woefully ineffective and we don't get that signal as often as I could. So it's like a low grade migraine that just have all the time. You'll think about it, but yeah, I think is what occupies that. Emma's, what's the new thing? What's the new procedure, new approach, new policy. So, I think the new policy creation role in the White House is well staffed, might even be overstaffed, but the, what are the things that we're already doing and we could do better, more efficiently. That's done the increments in a structured. Yeah, we're, we're not, we're not cleaning up the underbrush, right? We're, we're mostly adding to the top line if you will, new initiatives, new roles, new services. And I think in hindsight I'd probably say we should balance that equation a bit more with like cleaning up the underbelly.
Aneesh Chopra: Do you think that some of the stuff you guys did with usds and atnf kind of like hell because it, that to me, I think if you look back on the Obama Administration's legacy 20 years from now, we may find that to be one of the biggest things that help. And that happened after my tenure. So you were sort of part of that whole thing of embracing it. So, you know, in my tenure we ran a bunch of experiments. Everything was an experiment. Yeah. We'd heard loud and clear from device manufacturers that the FDA is stifling innovation and it's cramping our style and it was an extremely loud voice and there were so many stories. Dean Kamen, who became a friend, Dean was like, I've built this artificial limb that I can give to veterans and I can't get FDA approval because it, you know, it's no different than, than a walking cane or whatever.
Aneesh Chopra: Yeah, whatever the analogy was, he was angry. But here's the point, the secretary of hhs, then the commissioner of the FDA, and then the head of the device, a division of the FDA when you break it all down, they saw this problem and while I was there to provide air cover, ultimately they needed a team of entrepreneurs and innovators to join hands with the entrepreneurs, innovators inside government. It's the marriage of the two that was magical. So, I think the experience we learned in the, we call it entrepreneurs and residents program really said, okay, any layer of government can have a team of people define a problem and bring in experts from the outside and inside to work together on the issue and make a difference. So now after healthcare dot Gov is fiasco, we just put a bunch of flood the zone right?
Aneesh Chopra: Resources. So we have like 200 people in US digital service. They can, we had a team before like, oh, you got scaled now and, and, hundreds more in 18 f. So now there's capacity. So even if it doesn't make the president's desk yet, let's do this initiative everyday. Parts of government can be materially better on account of this new formula. I love it, man. Thanks for having me. Of course. Now is awesome. Thanks for doing this. Alright. Yeah, it's fun. I think, these are, these are fun to do. So I'm glad I appreciate you for hanging out with.