This week I am talking to Joshua Titus, CEO of Gozio (@GozioHealth) a company who have an unwavering focus on customer experience and healthcare consumer engagement.
We dive into Joshua’s early work with nVidea and first-person gaming (do you remember the regional MS-DOS First person Shooter game Doom) that allowed him to build a portfolio of technology skills and capabilities.
Thanks to his version of Wilson (the unseen neighbor in Home Improvement who was always full of great advice) living next door Joshua found his way into healthcare
Initially, their work was centered on way-finding or the Waze guidance for getting around a healthcare facility but he and his team quickly discovered that they were only scratching the surface with their solution and there was much more they could do
Together with his team, they started building out connectors and tools to offer an ecosystem or swiss-army knife of capabilities that built digital front doors for hospitals and created a better patient experience with location-based technology. As healthcare continues ot face headwinds in our post-pandemic world facilities need to be focused on building loyalty which will help them sustain growth and deliver better experiences and healthcare despite the rapidly changing consumers’ expectations.
Listen in to hear hear the key learning points for Joshua and his team around flexibility and the importance of building that into their framework and how they expect to expand into the unfulfilled areas of customization unique to the different sites.
Listen live at 4:00 AM, 12:00 Noon, or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
Today, I’m delighted to be joined by Joshua Titus. He is the CEO of Gaussian. Joshua. Thanks for joining me today.
Joshua Titus
Nick, it’s great to see you again. And thank you for having me on your show. So
Nick van Terheyden
as I do with all my guests, I’d like you to just set the stage of how you arrived at this point in your career, a little bit of background about your history, some of the things that you’ve done, and you know, the formation of this idea and this concept, if you would,
Joshua Titus
yeah, and we’re rolling the cloud quite a quite a ways back here, probably 20 2014, probably is when we sort of came out of stealth mode and gazebo, but prior to that, both myself and my co founders were in Silicon Valley, working at fairly low level jobs in terms of way down in the silicon, these are very technical jobs. And whether it was in the software or the hardware side, a lot of them were sort of deeply technical and, you know, move to leadership positions, but still very much focused on the technology side of the house. And, you know, we’re very fortunate, the companies that we were associated with, I, for instance, was at Nvidia did really well, and it put us in a position to go maybe pursue other things that we wanted to pursue in life, which is what I did, but, you know, sort of reflecting on that earlier career. You know, we were selling consumer electronics, we were selling games, first person shooters, these type of things, which, you know, as you begin to reflect it, maybe that’s not the legacy that you actually want to leave to your kids. Right, so, so the really question and the burning question for me was, what can I do with this technology toolbox that I’ve built out over the years, to actually help people to do something that I would want to pass along to my daughter that I wouldn’t be proud of? And that really began the search for what could I do? And it was, strangely enough, it was it was a conversation over over the backyard fence with a neighbor, who had been in health care for many, many years and says, What do you think about something in healthcare, they have an endless supply of juicy problems that need to be solved. Maybe you guys could help out there somewhere. We like the sound of that. And we begin knocking around ideas and pretty quickly landed on since I had was on mobile design team and sort of knew the greasy underbelly of what was going into modern smartphones. Maybe this idea of finding your way around big hospitals, they’ve grown organically over time, they’re super confusing, maybe we could do something there. So that really was the genesis of gazebo, which was, can I give people a hand holding experience, specifically inside these large buildings where GPS doesn’t work. And so while that’s still a key component of our platform, it’s a it’s a smaller part of our platform today, but I’ll walk you through how that sort of changed. So we we focused on Wayfinding, in the early days, built some robots filed a couple of patents, which have now been granted. And became, because we had this sort of shiny, technical thing that we could show off, we became the trusted technical adviser of our early clients. And we launched this thing and we’re happy we think we’re done right? Where we’re Silicon Valley mind, they were like, great, we’ve conquered healthcare at this point, right, we have a deal. And that couldn’t have been further from the truth. What happened instead was our clients go, this is phenomenal. Josh, let me tell you what my real problems are. And that’s when they opened up and really began to share the idea of these are the things that we’re up against as an organization, these are the things that we’re looking to solve. And it really opened our eyes to wow, there’s much larger need here than we had anticipated, really centered around mobile and mobile engagement and is wayfinding part of it, it absolutely is. But our clients today will tell us that’s 25% of the equation, Josh 75% or these other pieces. And so that was really interesting for us to sort of learn and we we learned by doing I’d love to claim that I was sitting on the couch and this was pure genius, but that’s not really true. As a good friend often said to me, you know, you don’t know how the fight is going to go to you start swinging. And so that’s how it was for us. We got in there we started swinging. We we did wayfinding only to realize that there was much more opportunity there and much more need, which is the important part for us. We want to make sure we’re solving a need.
Nick van Terheyden
Yeah, so lots lots to sort of unpack there, not least of all because I’ve got to be honest, the visual for me is Home Improvement and Wilson over the fence. I hope you got to see your friend because he obviously steered you in a great direction. I will say that, you know, a legacy of first person shooter games and you know, resources. Something that you build is probably bigger than healthcare in some respects when you look at the number of gamers and you know, certainly a number Have as grown up on some of these things like Doom and you know, things that weren’t all credit to you, thankfully, you’ve gotten into this healthcare space. And I’m, I’m gonna guess you walked in thinking things were maybe a little bit better than they were in terms of the technology, what was your sort of first impressions as you got involved in healthcare.
Joshua Titus
The impressions were really, that the DNA inside these healthcare systems was so well wired for delivery of care, the clinical aspects of things, the focus of it, and indeed, the leadership quite often they come out of that space. So when we come in, and we talk around, talk about patient engagement, or engaging people on mobile, and how to do these things, it just wasn’t in their DNA. And it wasn’t because they weren’t smart, but they were brilliant, right? It’s just that we’re coming at this from a completely different angle. And so the struggle that they had was real. And, you know, they have these, they’ve worked for years to stand up these different sort of, I guess you would call them services and capabilities, but they’re these digital assets, you know, they’ve bought a physician’s database, they even turned on some availability and scheduling with a different vendor, they have an EHR, right? That is absolutely expensive and not easy to stand up. But they have all these pieces. And so where they were stuck was, how do I pull these things all together in a way that people will actually engage with it? And that’s the piece where really, they didn’t have the DNA internally, to answer that, or they did. And what they realized is it was going to be, you know, 40 engineering years to actually make this work. And so now what? So that really was the problem that we came in to solve was, how do I pull these things together in a way that people would engage? And honestly, Nick, if we zoom up just a level, what they’re trying to solve is, they just want to catch up what we do in every other aspect of our digital lives, right, from an open table or a Delta app or Google Maps. That’s what people want in healthcare, right, that and so they were just trying to figure out how do I deliver that level of engagement, which we know what that is? So it’s like, it’s a catch up thing, right? We’re a decade behind? How do we catch up? And that’s really what we began to answer or strive to answer, I would say, and then have answered at this point with gazebo. And why are they doing this? I think this is something else that was really interesting to sort of learn, why do we need to pull these things together? Like, what if we just don’t do this? Is that okay? What’s the real need here? And I think there’s two surveys recently that I think about, it really helped elucidate for me what that driving need is, and it was a combination of one Biocenter, and one of my McKenzie, and the essential one, and these exact numbers are going to be wrong. So don’t quote me on these exact numbers, but they’re pretty close. But I think of it as a medium carrot, big stick problem. The medium care is that 25% of people says, say I am willing to change providers for a better digital experience. In other words, a digital experience is important. 25% less good as a medium care, right? However, and this was the really interesting part 50% of people would be willing to change providers, if they have a negative digital experience. There’s the big stick. So you combine these things, and you kind of get a narrative of I need to do this, and I need to get it right. Right, the penalty for getting it wrong is high. And then you take McKinsey with, I think there’s a 6% of current of people they surveyed say their current health care provider has a mobile offering that meets their needs. You know, math wasn’t my major, but 6% is pretty low. So you combine these studies, and that is really what’s driving it. They know. And and and the patients and visitors and wait consumers right before they receive care. They’re essentially consumer, from our point of view, are telling them what they want. They want the same thing that they’re getting everywhere else. And so that’s the, that’s the need. That’s the burning desire that we have with our clients to help solve. That’s the problem we’re helping solve.
Nick van Terheyden
So I think one of the things is layering on at this point is that, you know, 10,000 Baby Boomers are aging out every day into this healthcare space. And pretty much all of them are, I think, having all these great digital experiences outside of healthcare, and they step over this line and go, Wait, why? You’re kidding, right?
Joshua Titus
Sweetie? Where did I put the fax machine? Exactly.
Nick van Terheyden
So, you know, we have a core issue. And you know, I think you articulate really well there’s there’s just a desperate desire to deliver against this but an inability so goes to enters with it. Wayfinding, right, and forgive me if I’m oversimplifying, but you know, it’s, you know, internal GPS ways for a hospital, which, quite frankly, is brilliant. Because if you’ve ever tried to follow those colored lines to the radiology department, you’ll find that they break somewhere and you go, is it that one or that one? So, you know, brilliant, but it wasn’t answering a sort of core question. So when you got in there, and they said, Well, no, we’ve got other problems. What were they saying to you?
Joshua Titus
The the problems that they had were essentially that of having spent and made the huge investments in both time and money on these, these digital services and these capabilities. So those are in place. And maybe that was a positions, database availability and scheduling, like we mentioned, EHR, of course, virtual visits, right. That was that was a piece that, especially during the pandemic was getting turned on quickly. So they’ve made these huge investments. However, when and if they tried to create a mobile experience, the user numbers were abysmal. Two users a day, three users a day, very, very common to see those kinds of numbers. In fact, when we’re a meeting, when we initially meet with prospects, quite often, when you ask, how are the user numbers, you can tell who is responsible for the app? Because they’re the person who stares at their shoes when you ask that question. So and they shouldn’t, and they shouldn’t, they did the right thing. They were missing a key component or two that prevented that from because what we’ve learned is it’s not linear. It’s going to have sort of this hockey stick where you’re going to reach this critical mass, and suddenly you’re off and going. So this person who feels ashamed about these really poor user numbers really, shouldn’t they were directionally correct. They just the magnitude was a little off. And so we come in and shore up the pieces that they’ve missed, and suddenly they’re using numbers go from, and I’m thinking of a system in Texas, you know, they had about two or three a day on their previous mobile app, we rolled out the gazebo platform, and they were hitting 33,000 a day. Right? So giant leap in terms of the level of engagement. And so that is what they’re coming to us for how do we engage our catchment area on level in a way they’ll actually use it? And with large user numbers, I think across gazebo right now we’re seeing on average, about 15 million interactions a day. That’s significant. Yeah, we’re proud of that. So that’s what they come to us for.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today. I’m talking to Joshua Titus. He’s the CEO of gozo, we were just talking about the transition in your world from, you know, an initial problem that you solve for healthcare into this more digitally enabled solutions said and, you know, you describe something that I think almost everybody in healthcare, certainly on one side of the fence would know, and, you know, pretty much the patient’s on the other side, the consumers would have that experience of this very low utilization. And yet, you sort of teased some capabilities that, you know, doesn’t take too much, what is it that you’re bringing to the table? What does Gozo bring, that allows for this acceleration, and, you know, dragging these folks kicking and screaming into the digital age.
Joshua Titus
I think the the piece that we really bring to the table, is we think of it as a foundational framework. And what does this mean? What this means is, you know, Nick, if we set out to design a mobile application together, there’s going to be some key pieces that we just need, right, we’re going to need to know how to work with Apple and work with Google Jack, we’re going to need to probably have something in the cloud, right. And if we’re gonna have a bunch of content, you have to manage that somewhere. So we’re gonna have to stand up a Content Manager of some sort. And that’s probably going to live in the cloud. So I got to know how to work with Amazon, too. And boy, it should be good to know what people are actually doing. So let’s get some analytics out of that. And these things are going to talk to each other. And we’re gonna need to be able to update these things, right at this point, you have about 34 engineering years into this thing. And you haven’t anything for healthcare yet. These are just the plumbing that goes into a solid mobile application, a mobile experience. And when I say solid, I’m talking about against the open tables, the deltas, the Google Maps that this is a this is not just a one off app that you build once and throw away. This is a legitimate platform. But there’s this foundational piece that you have to have. And to have every single hospital out there slaving away working on things like what’s the latest Apple API just makes no sense whatsoever. So it goes do comes in with this platform. We’ve already built it. It’s ready to go. And we have connectors in it so that we go off the shelf. What do you have for your physicians database? What do you have for availability and scheduling? And these just plug in to that base platform? So really What we’re doing, the way we’re able to accelerate is that we can amortize that work that is common across really all hospital systems. And when we walk in on day one, it’s ready. I mentioned that hospital system earlier then went from three to 33,000. They were in a hurry COVID was was heating up. We were we were in that crucible of COVID. They said, Josh, we have to go fast from contract signed to that mobile application, which was brand new for their hospital. And for all the different pieces that they had, that they could operationalize were integrated into this was 10 days. 10 days in Silicon Valley is fast. And healthcare is lightspeed. Right, so that’s accretive. So that is, what we’re able to accelerate is the foundational police plate, the foundational piece was already in place. So we’re just plugging these things in branding and appropriately, and pressing the bill. But, essentially, so that’s how we’re able to move quickly, which is important. The other thing that’s so important about a foundational piece, like this is flexibility, right? virtual visit, couldn’t find a home, you know, two or 3% of visits were virtual COVID hits, they reimburse for virtual, it’s 25% of all visits, right. And then depending on you know, what happens with legislation and whatnot, it’s gonna go back to about where it was, maybe a couple of specialties will be different, but so the environment shifts under you. So flexibility is also absolutely paramount. And when you’re flexible, that means you can set it up quickly. And you can also respond to the changing environment. So that is really what we’re bringing in, in terms of how are we able to accelerate, it’s really that that foundational piece that we have in place. And something that’s interesting, and took us a little while to kind of wrap our head around was, every healthcare system is different. And they really are, you know, you’ve heard the things like, if you’ve seen one health care system, you’ve seen one health care system. And no one has problems like we do, right, we hear this all the time. And those are true, those are true. However, when you zoom back just a little bit, what you realize is that many of these unique problems are just different flavors of the same problems, you’re gonna have to have a physician database, right of some sort, you’re gonna have to have any HR, you’re gonna have to have availability and scheduling if you really want to engage people. And that’s provided by two or three or four different vendors. But so yeah, they’re their unique problems at these hospital systems. But there’s enough overlap, that goes, you can come in with our framework, and go ahead and knock out that 80% of what they need off the shelf. And that’s, that’s how we’re able to go fast. And then the 20%, we fill in through various means and integrations and connectors and this this sort of thing. But that foundational piece, is how we’re able to accelerate.
Nick van Terheyden
So as I think about this, it’s something of a Swiss army knife to insert into this complex environment. You answered one of the questions or the push backs that I hear repeatedly, which is, yeah, well, that’s great for hospital a, but you know, hospital B were completely different, right. And, you know, recognize that embedded within there is, you know, a little bit of a failure to accept reality. But it’s not that they’re not quite as different as they like to make believe. But there are differences. So you’re you’re adjusting for that, as you look back over the course of this, what have been some of the inflection points and the learnings that you’ve gathered from this that have really made a difference to the solution. And the speed with which you’re able to roll this out, because it was critical in in that crucible of COVID. As
Joshua Titus
he learns, boy, there have been so many, this has been such an educational journey for me and for the team. So to pick out just one maybe maybe a little bit tricky. Pick out a few. I think one that was really driven home early on and continues to be true, and we touched on it earlier, is flexibility. You can’t be rigid, right? When we really have this frank discussions with the leaders at these various hospital systems and, and maybe it’s over a beer, when they really tell you what they’re thinking. They don’t know exactly what it’s going to look like in three months or six months, right? So when I’m asked things like, Gosh, what’s the next killer feature? The answer is I don’t I have no idea. Because I don’t know what the needs gonna be. But I do know this. I do know that if I’m going to remain the center of your of your mobile strategy, I need to be able to anticipate to some degree what that what that is going to be and be flexible enough to deliver in a timely manner. So for instance, messaging, this is a great example. We did a roadshow in 2019. We’d like to go to our clients and run you know, basically, hey, here’s what we’re thinking about for our roadmap. What do you guys think right and get their feedback. And we rolled out this feature that was going to be push notifications geofence you draw a circle around the area, whether it’s a building a city, a state, and we can do push notifications to a phone with whatever message that you want, including linking into things inside them. Mobile App including giving navigation, so you click it and will literally begin taking you to some destination, right. So really, really slick, we thought in 2019. And so we sit down in front of our clients and we roll this out, hey guys push notifications, fairly aggressive, it’s going to pop up on their phone. And you can say whatever you want. And every single client that we pitch this to said, that’s fantastic idea, we would love to see something like this and we say perfect, what would you what would you say? What would you what message? Would you send crickets every single time? We don’t we? Well, we don’t want to we don’t want to spam people. Right? We don’t want to, we don’t want to tell them about hot yoga on Sunday, probably that’s not worthy of. And so it sort of died on the vine right there. Right? We had this great idea, technically, we thought, but there was no place for your comms COVID. And I’m getting two phone calls a day, which is trash, we are shutting this place down, there’s going to be patients only no visitors, zero visitors. And I have no way to tell my catchment area about this, right, we update our webpage. And, you know, it will post to Facebook and hope people see this because what a huge dissatisfy that, you know, manna and Grandpa can’t come in the hospital with me, right, they’re literally going to have to drop me off. So suddenly, this communication piece becomes absolutely paramount. And we were able to on the fly and free of charge for all of our clients, we just enabled messaging forever. So again, the idea of you need to be flexible, was really driven home for us through that. And there’s a couple of things chatbots suddenly finding a home as they were doing triage for COVID symptoms, those type of things. But the flexibility, we just began to understand that the scene that we deliver fundamentally is going to be the flexible framework. It’s not an individual feature. And that really shifted our thinking in terms of what we’re building and what we’re delivering, as opposed to, we can do Wayfinding. And we can do, you know, integration with virtual visits, those individual things are true, but most important part is flexibility.
Nick van Terheyden
And I think, as I understand it, what you’re offering is essentially behind the scenes, I mean, this is something that’s going on that is branded by each of the individual sites that they say this is ours, it’s almost invisible. You’re the sort of power behind. Is that true? And where do you see this going?
Joshua Titus
That’s exactly right. Yeah, it is branded for that hospital system. We want when people are looking to go to let’s say Piedmont, you go to the app store and you search for Piedmont, right, you don’t search for gazebo, you know search from some other company, it feels very much as Piedmont has created and crafted this experience for you, for you in their catchment area. And the takeaway will be they get me there reducing friction between me and my healthcare system. And that builds loyalty. And that really is where we see sort of the the after effects of having this great digital experience is people will come back to you when I do a search for follow up care, I’m remaining within your system. Right? So revenue leakage and all these other benefits come along with providing a great digital experience.
Nick van Terheyden
As you think about the future, where are you going next? What are the opportunities?
Joshua Titus
The big thing for us is to we have traditionally done all the development on our platform. And so what we have done in 23, and this is what the entire year is focused on in my entire engineering and product teams are focused on right now is the idea that, yeah, we can get that 80% done right off the bat, like we talked about. But there’s 20% that may be unique to various clients, but also are they’re still important to that client. And so rather than saying we can’t do this, or yes, but we’ll do it in 18 months, we’re opening up this framework. Any developer that wants to come in and design on top of this is going to be allowed to do that. And we will help facilitate that. So when that client has something that’s really important for their system that really is unique to their system, we will either connect them with a third party that can do the development, we have a couple of trusted partners that we work with and recommend. Or they have an internal dev team that’s now focused on something that really adds value to that system. They’re not having to do the whole thing, right, they’re not worried about the plumbing so to speak, but they aren’t coming in and doing that point solution, that means a ton to that, that specific catchment area in that system. And so the opening up of our platform and opening up with that framework, to external developers to finish out that 20% that we weren’t hitting before in terms of the overlap and all the needs that a system had is really what 23 is about for us.
Nick van Terheyden
Well, you know, overall, exciting times, you know, we’re grateful to your neighbor Wilson across the way if you’re into this, this is certainly something that you know, we all need in health care. glad that you’re here. Glad that we’re seeing this. Unfortunately, as we do each and every week we’ve run out of time just remains for me to thank you for joining us, Joshua. Thanks for joining us.
Joshua Titus
My pleasure to be here. Great to see you again and looking forward to future conversation. sheets Thank you
