This week I am talking to Nate Fox (@NateTheFox) the Chief technology Officer for Ribbon Health (@RibbonHealthAPI) a company connecting the dots in healthcare with data access. Congratulations are also in order as they just received $43.5 Million in Series B funding.
Nate is an engineer by training who worked at Microsoft and got interested in data problems and solving problems with data. He met his co-founder while studying for his MBA at Harvard Business School – both finding a common interest in removing the friction from the healthcare, and specifically the challenge of navigation. Between them they saw different experiences in navigating the healthcare system that even when it was good still required a lot of iteration and work. A process that for many was frustrating and difficult and there were no solutions much less data to help.
Together they formed Ribbon Health to focus on delivering data to others to help them make decisions and navigate the complex world of healthcare with informed decisions. In the original concept they were trying to create a Kayak for healthcare to make the process of finding and selecting clinicians and care as easy as it is for travel choices. They were able to extract “messy” data from a wide variety of sources and start to make sense of it. Not an easy task when you consider that a single doctor will have multiple location and telephone numbers associated with them. As they started sharing the insights on their aggregated data that they processed using Machine Learning and AI tools they developed rank orders and quality indicators that their customers started asking about and they realized that the problem to solve was one of building a data ecosystem to offer to other healthcare companies to enable their solutions.
The Data Plumbers of Healthcare
Aggregating data from thousands of sources they turned plain unstructured PDF files into data rich containers of JSON data using advanced machine learning techniques and then offered this as an API to their customers enabling them to deliver better solutions. Interestingly their model includes customer contributions and feedback on the data that is more advanced than a wiki style approach but rather a machine enabled curated data improvement process
Listen in to hear how Ribbon Health wants to be the connective tissue of healthcare, democratizing access to the data to make healthcare a more frictionless experience or as Nate puts it
The Great Unlock of Digital Health
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Raw Transcript
Nick van Terheyden
And today, I’m delighted to be joined by Nate Fox. He is the chief technology officer at ribbon health. Nate, thanks for joining me today.
Nate Fox
Thank you for having me, Nick. It’s great. It’s great to be here.
Nick van Terheyden
So, before we start, tell us a little bit about your background, how you got to here and some of the journey to this point, if you would.
Nate Fox
Yes, absolutely. So, for me, so my background is I’m the CTO and co founder of ribbon health, I guess maybe just a little bit before I found just my business partner named Matt slack. I first went to school at MIT, where I majored in engineering, I worked at Microsoft for a few years in Seattle, got very interested in startups and data problems. And I was a a software engineer working on sort of projects with the the C suite at a company named unified, which is a ad tech company in New York City, really enjoy kind of a startup world, went to business school at HBS, Morehead net, I met my co founder meet, and we kind of stumbled upon this very interesting and complex problem and healthcare, they were very passionate. So I went together, and we founded, I went actually became ribbon health. That’s that’s sort of the, the high level.
Nick van Terheyden
Okay, so, um, to to help the listeners explain as best as you can, what ribbon health is, and if you can share a little bit about the story of how you got there, because it sounds like this wasn’t a straight line.
Nate Fox
Yes, absolutely. I maybe actually said, I’ll set the context first. And like how we got to where we are, and I can explain, I maybe I’ll actually begin at the top, we’re healthcare data company. And we provide an API that enables other healthcare companies to build solutions that then enable patients to make better care decisions. Data is really messy and complex, and we offer a platform that helps deal with that challenge, I can go into more of that actually means but I’ll start with kinda like how we got to this point in time. So when he and I had met in business school, we both coming from startup backgrounds, where we really enjoy sort of the startup experience. And we really enjoyed working with each other, I was sort of the technical person who, who knew how to code and he was on the business side, who sort of knew how to, you know, build businesses and also had a very strong product background, and his prior role at data logics before you can HBS. And so we started working on a variety of ideas together, and the thing that got us really, really, we’re very passionate about was actually our experience with the healthcare system. And actually, we had very complementary or sort of very opposite experiences, for for needs, my co founder, his, his mom was actually bounced around the healthcare system, in the Cleveland Clinic area, and this is after need was, had worked in healthcare as a consultant at McKinsey. And he sort of felt like, you know, very empowered after working in healthcare for a few years to help his mom navigate the system, but yet had been surprised at how difficult it was in terms of current game to the right specialist. And so you know, and being in high deductible plan of being eventually sort of paying a lot of money through the system, and in a very financially straining and stressful way, eventually, to just weren’t actually sure arthritis and needed to sort of do some more yoga, or sort of do stretching, because she was a yoga instructor. So that was one end of a kind of very rough experience, the healthcare ecosystem, and being financially straining for an individual where you know, that, that that can be very painful. And then for myself, I actually have a hearing impairment. And, you know, I grew up actually, I was born with it. And I was born in a situation where my parents were actually very able to navigate the healthcare ecosystem to make sure that I could get access to the right kind of health care providers to help me with my hearing impairment. So this meant, you know, a number of audiologists, and speech therapists and other resources in the in the healthcare ecosystem, but helped me sort of navigate and figure out how to deal with being hearing impaired, get the right equipment, get the right training, and sort of being able to sort of make sure that, you know, if I, you know, de risking wearing disabilities, things like that. And so for me, because it’s a very positive experience, you know, I, I, it’s seeing what can be, but also sort of was aware that not everyone has the privilege of having you resources to navigate and sort of figure out how to use the US healthcare system to get the right kind of care that you need to to navigate a certain situation. And so,
Nick van Terheyden
it was a little bit about the, you know, your journey, it sounds like you you had the fortune of navigating the system for your benefit. Well, is that true?
Nate Fox
Yes, yes, absolutely. Definitely. From a place of like I fortune, right. For context, you know, my parents had moved to a school district that had a lot of fun. port in terms of public schooling for folks that have like disabilities. And both my parents come from backgrounds where they knew people that network for medical providers and sort of bias and how to navigate that. So yes, I had a great experience in the healthcare system. But I don’t want to sort of suggest that everyone has access to that, I think, you know, we were very lucky to have access to that.
Nick van Terheyden
No, and I think that’s important, because, you know, by virtue of some parameters that are, for the most part random, you’re finding a pathway through something that is extraordinarily complex. And I can tell you as a physician, so you would think I would know how to navigate this system, I can tell you hands down, that there, there is no instance where I feel I am empowered and enabled, to get what I need quickly and effectively, so much so that I recently posted, you know, my wearable showing my blood pressure increasing, why because I was interacting with the healthcare system, the system that is supposed to keep my blood pressure low, was not. So clearly a combination of two experiences you had with your co founder who had, you know, the opposite with his mother. I’m curious to know, some of the things that you learned and the comparisons that led you to this model that, you know, potentially brings that expertise to bear for those individuals.
Nate Fox
Yep, absolutely. So I think I’m just gonna context a little bit. So Nina, were very passionate sort of trying to solve this problem in trying to bring this sort of the making more feasible for people to navigate the system. And I want to add, actually add one detail, which was, even though I had was very lucky to have good outcomes in the healthcare ecosystem, it was definitely a battle of attrition to some extent, especially for my parents, when I was a little kid. So you know, we went through various audiologist that had two different opinions of the best ways to help me. And you know, different speech therapists that had different diagnoses. And so it was kind of this iterative approach of trying to figure out and find your way so to speak. And specifically had to kind of stumble in the dark to some extent then get to, to to good path. You know, Nae Nae Nae Nae Worldnet meet, we had this background where we kind of thought there should should be like, kayak.com, right? Like, when you’re navigating healthcare, you can go to chi.com, in sort of the click of a button, you can see flights, car rentals, you know, hotel, so forth and so on. Why couldn’t something like that exist in the context of healthcare, bringing all the data together in a seamless way, where it’s all connected with each other, and allowing the patient to sort of navigate and sort of find what they need. And so the first iteration of the company we had founded was something focused on clear navigation, where we had sort of learned in like diving deeper into sort of the healthcare ecosystem, that, you know, there’s been a lot of studies and things that kind of showed this, but that you can actually increase the height, the quality of care, while reducing costs through better care navigation. And so we wanted to sort of make this more tech enabled and sort of empower that to happen. And the way we do that is to build a care navigation platform, with the business model was to offer this as a service, essentially, a care cons to yours, for employees of smaller, medium sized companies where there might be a self insured component, and actually help them navigate to care more effectively. And where, you know, we increase the quality of care while reducing the cost of it, and then, you know, be monetized to like a benefit sort of fee. But then, of course, isn’t the business that we ended up actually building to the state that we are now and I can kind of get into how we sort of ended up stumbling upon the data problem.
Nick van Terheyden
Yeah. So what what changed? What did you learn that sort of caused that move or shift away? I mean, it still feels, you know, I listen to that and think, Well, do I want kayak for healthcare? Oh, oh, yeah, I do. But you moved a little bit from there. Tell us what happened.
Nate Fox
Right. So I think, um, one thing I want to stress is that the, our mission always remained the same mission to make every health condition be cost effective, high quality and convenient. That’s That’s the mission of the company met, that hasn’t changed. But really just it’s the How To your question to the point of the question that evolved. And so what happened was, when we were working with our clients the way do we, the first thing we learned was making it really easy to book an appointment, or have someone book an appointment on your behalf. Need people engage with the care way more effectively. And so for one of the employees using our platform, this is like when we had gone through Y Combinator. We had a few 100 folks on our platform, we were navigating their care and one of the things we found that was a delightful experience was we said hey, you get a free PCP appointment with your employees health care. We actually found some great doctors near you can we book you an appointment and then once we meet it is easy. a click of a button. Pretty much everyone would say that sounds wonderful, yes, go find me booking an appointment. And so this was a service that we started doing for our end users to drive engagement and adoption of them engaging with their healthcare. And so on the back end, so the user had a delightful experience. But on the back end made nai and HIPAA compliant way, of course, we’re booking appointments on behalf of these patients. So when you see a therapist, you would then go find them, a therapist accepts their insurance, or cardiologist or a PCP appointment. And when we were doing that, we realized just how bad the data was. And so we would say, Okay, we need to find this person, a cardiologist, and we will go through the directories, we say, Okay, this doctor of change states, this doctor is retired, this doctor is actually no longer pricing this location, this doctor is no longer accepting new patients so forth and so on. And so are sort of hidden rates, so to speak of like saying, Okay, we need to find this person care, we will be calling doctor after doctor after doctor until eventually found a good match. And so that’s when we stumbled upon the data problem. And we started aggregating, collecting data from various sources to increase our success rate at finding a doctor for patients. And what was interesting was, was that in our, on our website, we had a demo page of our doctor search of like, kind of displaying all the various data and the quality of it that we had. And other healthcare enterprises came to us and said, hey, you know, what’s about your care, navigation application or experience, but this doctor data were you getting it from? Do you sell that? And that kind of instigated the aha moment that maybe there was a different problem that we should be solving that might be sort of potentially more impactful to the ecosystem to potentially build a data solution for this problem that apparently, a lot of healthcare companies are struggling with?
Nick van Terheyden
You know, that’s really interesting that you started to publish data. And I’ve got to understand, how did you get to it? Because a lot of this information, if it’s available, it’s buried somewhere, or, or in many instances is not what was, what was your strategy to get to that source of data to be able to start to pull it together into a meaningful, I’m going to diminish the value here and call it a spreadsheet? I know, it’s much richer than that. But first thing is, everybody can reconcile against that.
Nate Fox
Yeah, so why don’t we pride ourselves as a ribbon to help at least that we like to be data plumbers, and in a sort of, in this world of data, right, and what that means, honestly, is to reallocate data from, you know, hundreds and 1000s of sources. And where’s comes from is quite buried, right? It could be a PDF that we’ve transformed into structured JSON, right? Like a PDF that’s directory, it can come from a CMS, you know, public data set that is meant to be ingested, right, the number of views was out there is quite varied. And it’s a highly fragmented ecosystem. And so, I would say that the first step, and I’ll get into, like how we use machine learning to sort of figure out what he does good versus bad. But the very first kind of step and infrastructure we built was building a machine that can handle a whole array of different types, and bring all these different sources together in one central place.
Nick van Terheyden
Wow, that’s truly amazing. I mean, I think you sort of describe much of the existing problem in data sources in healthcare very eloquently. For those of you just joining, I’m Dr. Nick the incrementalist today, I’m talking to Nate Fox, he’s the Chief Technology Officer at ribbon health, and also a data plumber of healthcare data. I’m excited to meet a plumber of healthcare data. Because if there’s one thing that’s very apparent in this business and industry is without data, we can’t make informed and useful decisions. You’ve clearly gone at this, you’ve created an infrastructure that starts to solve a problem that’s very real, which is we can’t bring it all together, you’ve done that. Tell us a little bit about the sort of the move now to where you are and what you’re sort of offering because it sounds like this is much more than just navigation. There’s there’s a much deeper insight. How’s that unfolded?
Nate Fox
Yep, absolutely. So once we aggregate all the different data points, there are sort of three other areas in which we I think you’re providing value to a lot of the people that use our data. The first is that we then use machine learning to figure out what data is good versus bad, because it’s a lot of data, but most of its noisy and not correct. We can see hundreds of locations per single doctor easily and hundreds if not 1000s of phone numbers. The second thing is that we decided to have an epi first approach instead of having like a saw a traditional software front end application and Making an API meet are the way to integrate with end users spread. And applications are products or companies far more adaptable and flexible and dynamic in a very sort of fragmented healthcare ecosystem where there’s a lot of different ways people make healthcare decisions. And the third thing is that, we realize that as good as our models and our machine learning could get, and all the data we could collect, our data will never be 100% perfect all the time. And so we made it possible in our API, or in our product, for our clients to actually edit the data and be empowered to change it themselves. And so that we come to the table with great data. But if we’re wrong, and you find it wrong, we’re gonna let you change it. And then you can contribute to the overall data asset and make it more accurate as a whole.
Nick van Terheyden
So let me be sure I understand that correctly, you’re essentially creating a group contributed data set. So if I was a participant, I would be authorized almost like a wiki of healthcare data. Is that true?
Nate Fox
Direction directionally? Absolutely. Yes, I’m putting my CTO hat and being you know, putting so there’s a technical nuance there a little bit, which is that when someone makes edit, so every every end user of ribbons datasets has their own sort of copy and instance ribbon data, especially because for a few reasons. One is everyone’s use cases a little bit different in the way they want to use healthcare data. And so maybe the reason that someone deletes a location pertains to you, because, you know, for their use case, that location for a provider is incorrect. However, that signal still usefulness to an aggregate. So we do add the data as as a whole. But it’s not that such that if you make an edit, that’s going to propagate to everyone using it. But our overall machine becomes more intelligent and sort of incorporating signal and figuring out directionally How do you should be such that eventually, when we update we do we do this thing called thinking where like, we are constantly updating everyone’s copy of Urban’s data based on our latest knowledge and information that we have.
Nick van Terheyden
I think that’s really important. So this is not just, Hey, I see something wrong, I update it, which, you know, we’ve seen some of the challenges with wiki with people who have a different vested interest, let’s put it that way. Yes. In what things are presented, I think what you’re doing is, hey, you’ve got it, you can work with it. But you’re you are taking that feedback, but then curating that feedback. With some automation, it sounds like that says, this is useful, we’re going to apply that. And it also sounds like some of that learning is about the changes, because that starts to inform your whole process of data input and how you present it to your hope your customers and clients.
Nate Fox
Yes, absolutely. No, I think I think you know, the quite a bit that they’ve just curation, sort of, you know, us figuring out what to do with the data. And not all, not all data from our clients is the same. And so we’re kind of being intelligent about how we how we use that data. Like, I’ll give you an exam, like on one hand, some clients, some clients are like, discreetly editing, where we call ribbon, core ribbon fields, right fields that we manage, and have models around, right, like the location of where a doctor practices. And then you have other fields that clients can even create, right, so maybe a certain healthcare client, you know, ribbon doesn’t, you know, have a certain special regional, either white designation or sort of star rating, but they had that data. And so they can put that data in their instance of the ribbon API or the ribbon dataset, so that they can use it. And we need, maybe we’ll take it, maybe we’ll use it one day. But a lot of times, a lot of clients have these custom fields that they created for sort of that last mile of healthcare data that pertains to just the use case, that sometimes you know, we don’t have add the box to direct solution. Because, again, healthcare is incredibly complex and nuanced. And so we build a platform to be very flexible to that end.
Nick van Terheyden
Interesting. So you’ve now created this data set that continues to grow benefits from all the use cases, and the users. So you know, the additional value of bringing customers on board adds additional value to everybody else that’s already on the platform. So obviously, you’re encouraged to participate. Where is this going? And give us some examples of some of the use cases of how this is being action because it sounds like this is really helping solve that problem in a way that I think is extraordinarily valuable and exciting.
Nate Fox
Yeah, absolutely. So I think like when we think about it, in terms of like, where things are going, we’re going to continue to sort of evolve the product to make it easier to use in variety of use cases. And we also want to kind of become a sort of connective tissue of the very fine metadata that exists out there today. So today, we kind of talk about right now we’re talking about just this, like, you know, this general data driven has to start. But one way that our sort of our product offerings evolving is actually we have some data partners that we’re working with, where they’re actually partnering with us to distribute their data to our end clients. And so we can kind of become the sort of pipe so to speak of the data, making it easier and more seamless to disseminate and distribute all sorts of data, things like, does this doctor have telemedicine provider, today have a online booking that they can use, and, you know, the, the sort of number of use cases, you know, varies quite a bit. And so we really think about infrastructure and really enabling that connectivity across a variety of data types. And the other thing we think about is also making it very easy to use, what we call our API. That is, is that’s the thing that developers use to integrate our technology into the back end. But not everyone has a team of developers on staff to integrate our technology. And so we’re exploring other ways to sort of enable people to use the ribbon platform where perhaps they don’t have a developer integrate the API. But you know, they want to tap into the data and maybe have a front end that ribbon offers to make it easy for a care navigator, let’s say, to use it.
Nick van Terheyden
Interesting. So clearly an exciting space lots going on. But it feels like just early part of the journey. Where are you going? What are you excited about.
Nate Fox
So I’m incredibly excited to continue surprised, like so I think the thing that the entire team and ribbon health. And then I the reason we pivot into this data platform, is that we got so excited about democratizing access to this healthcare data, making it so much easier to innovate in the space. provider data and the complexities of that is not everyone’s core competency. And we want to make it more frictionless for people to sort of innovate in healthcare, and worry less about this privacy focused on their other core competencies that they are good at focusing on. And so we get really excited about working with customers like oh, sweet health, or decent or health advocate, and Firefly, which are very, a mix of very innovative healthcare companies in the space of, you know, diabetes care, new health plans, care, navigation offering on a variety of ways. And we want to help empower companies like that to innovate in new, really exciting ways to help bring better care to their end users and their patients.
Nick van Terheyden
Exciting stuff. So if if you were to look at the year ahead, where do you think that those trends are going? What is what is our future? Hold it? Because there’s a part of me that’s a little bit cynical, and says everybody’s gonna say, Well, no, I’m not letting you know, they don’t want to share, because there’s some anti competitive elements to this clearly. Where are we going?
Nate Fox
So I think what we’re seeing is, so our investor, from Andreessen, who’s her, her name is Julie you. And she has some like, great sort of themes around what she kind of labeled as the great unlock, and digital healthcare, where in the last year or two, we’re seeing an incredible explosion of innovation and activity happening, where almost everyone surprised, things are becoming more interconnected. People are sort of opening up sort of connections and figuring out how to navigate the complexity. And so I think we’re gonna see in the coming years, much more interconnectivity across a variety of experiences and innovation happening in the space where there’s now new software that makes things that used to be incredibly complex way easier, in a way that we made the complex aspect for buyer data management, much more simplified UI and API. So I think when you have all these tools, you’ll have people that are so empowered to sort of innovate at a speed that we’ve never seen before. So they were going to see the speed of innovation change in a space, and quite an in quite a bit, and in quite a big way.
Nick van Terheyden
Fantastic. What an exciting point to end on. As usual. Unfortunately, we’ve run out of time. So just remains for me to thank you for joining me on the show night. It’s been a real pleasure. I’m excited to watch it. And quite frankly, I’m excited to use it and see some of this data in action because I think we’ve had a paucity of data in healthcare. This seems like a real solution that’s artful in the way that it goes off, grabs, it pulls it makes it useful, and then presents it in a way that anybody can use it now. Thanks for joining me today.
Nate Fox
Nick, it was absolute pleasure. Thank you so much for your excellent questions and really enjoy the time with you today.
