Episode Transcript
00;00;00;00 - 00;00;21;05
Welcome back to the Jonathan Keyser Podcast, where we highlight local business leaders here in Arizona that are doing good work in the community. And I'm very honored to have my good friend and CEO and founder of Equality Health, Hugh Lytle, here with me today. Thanks for joining us. Yeah. My pleasure. So could you just give us a little bit of the journey?
00;00;21;09 - 00;00;35;14
Tell us tell us about the vision, because I remember you and I sitting down. I think it was Coffee Bean when you were still just kind of thinking this whole concept off. And now look at it right now. The reality. Yeah. Tell us about the journey. Yeah. You know, it's funny. I didn't know that coffee bean still there?
00;00;35;14 - 00;01;01;16
I think it is. But, yeah, it was, journey Jonathan, that began with, kind of just a frustration with the health care system pilot to somewhat dissimilar and how you started this business with, all the energy being focused on, seniors and government health care. It's all all around Medicare. And you know, we have a very important graying of America that's going on.
00;01;01;16 - 00;01;31;21
It's very important that we focus on that. But unfortunately, diversity was changing just as fast. Yeah. And, this is all kind of when we were talking pre social justice pre George Floyd pre you know kind of the attention that's come on to communities of color and saw that as an important health care trend at the time and said we're doing nothing in this Medicaid program to help these people who need it the most.
00;01;31;24 - 00;01;58;24
You know, thinking back to those days when you for you and I, our health care costs are expensive, but they're within, of our total compensation, the per capita cost of a low income person's growing health care costs on top of multigenerational households becomes untenable. Going to be 50% of their entire income. Walking out the door for just, you know, health care costs just to maintain a decent lifestyle.
00;01;58;26 - 00;02;20;09
So, you know, realized that a lot needs to be changed here. And I got fortunate that, there was a new payment construct starting in America on how we pay for care, for value based care. And really, at the essence, what that is, that's an outcomes based payment. So instead of paying you for a unit of service like I do when I go to the doctor and I have nine minutes with the doctor and I gotta go, they bill for that time.
00;02;20;09 - 00;02;39;09
Instead of doing that, they say, okay, what's the problem? I've got uncontrolled diabetes. All right, we're going to fix the control diabetes. We're going to pay for that entire episode. We're going to pay that upfront. And if you can manage to do that in a more efficient way, you can split what you keep with the physicians and, and the people who helped you and, and lower the ultimate lower.
00;02;39;09 - 00;03;15;28
They make health care much more affordable for the patient. So of the 4.3 trillion spent in health care today, a third is already being spent on day based care, on outcomes based payment, which is definitely showing tremendous results. And so we're one of the pioneers in using that payment mechanism that allows us to now engage a patient who is generally low income Medicaid, apply a care model that we offer that because they're Medicaid focuses on what we call whole person care or their medical care, which you and I go to primary care physician.
00;03;15;28 - 00;03;39;15
But also, if you're low income, you're dealing with things like, behavioral health challenges, you're dealing with substance abuse, potentially you're dealing with any type of food banks, other transportation issues. So what we do is we organize that care journey, and then we help them overcome the barriers that exist to solving those problems.
00;03;39;18 - 00;04;04;21
And that creates an outcome that creates a lower cost, event. And then we work with our health plan partners to put that in motion, originally across a handful of people here in Phoenix. And now, you know, we're in, five states, Arizona, Texas, Tennessee, Louisiana, Virginia. And now next year, launching Michigan in North Carolina. And doing this model, you know, on a national basis.
00;04;04;21 - 00;04;24;04
Now we have about a million lives under management. Wow. Yeah, we just started with that. That's amazing. We've got, you know, we're and we're and we're doing this all, in a way that, you know, lowers health care costs, creates greater access for the patient, improves most importantly, improves the quality of care for low income people.
00;04;24;04 - 00;04;44;05
So what was it that helped you see this vision? Like if if there was this cutting edge program, you identified the need? Look, I mean, what what what enabled you to be, you know, kind of an early adopter of first mover in this space. You know, it sounds corny, but, it was just passion for the community, passion for the issue.
00;04;44;08 - 00;05;06;17
I just think I have this belief that, like, the quality of your health care just should not be dictated by how much money you make. I agree with that. But it it is in this country you have a two tier health care system. You know, health care is a human right. We should be able to take care of each other and, we let politics, we let a lot of silly things get in the way of that, in terms of how things are reimbursed.
00;05;06;21 - 00;05;23;13
So that's what it started was really just dumb belief. And there's got to be a better way. But I'm a population health specialist. That's what I've done my whole career. So I knew I could start applying a model. And I figured I got lucky in that the financial model was changing and there was one that could kind of tie up with it.
00;05;23;15 - 00;05;39;28
The other thing I knew is I come across piece of software that was really important to being able to do this. So when you're working with, you know, we now have almost 4000 primary care physicians in our network, that manage these patients. And, when you're working with these physician, you got to go get them the source of truth.
00;05;39;28 - 00;06;02;25
So here's the condition of this patient. They were in the hospital last night, things like that that you don't get in traditional medicine, traditional practices. And so I came across that I bought this company and had like four employees, but, it ended up being that gave you the data, you gave me the data I needed. So that was really the breakthrough moment was when I went, okay, but I what I saw as an opportunity, as I said, I got the data.
00;06;02;27 - 00;06;20;25
I've got a population that's got massive need. I got a payment transformation model that's taking place now I got to do is put the model together and go out and hope that they'll, you know, the health plans will contract with me and buy my product. But that was another hard thing is I had to figure out how we were learning along with the health plans, how to contract.
00;06;20;28 - 00;06;40;19
Right. So early days, it was like, how do you administer this contract? How do you put it together? How do you measure it? It's a very technical business, as you can imagine, a lot of actuarial science and measuring, you know, medical spend and, and cost. But we were able to do that, you know, in its early stage with a really great team that was committed and passionate.
00;06;40;22 - 00;07;07;06
And now we've been able to scale that up, basically talk a little bit about that scale, right. Like going from a few people in the local community to where you're at today, which is, you know, significant and then and then talk about where you're going. Yeah. You know, the, the scaling, scaling is hard because it really comes down to, our and we brought in new financial partners who really helped us with this.
00;07;07;06 - 00;07;31;03
It really comes down to, really understanding what they call your unit economics. Like how you break down your business into, the componentry that can move across markets. And we were able to really understand what moves our business and then use like what's we understood that we could also say what's the minimum investment when we go into a market.
00;07;31;03 - 00;07;51;16
So then we have that giant J curve of being negative on earnings for a really long time, which this business can do because you have like 12 months of claims that have to come in before you can now look and say, okay, what happened? So we get paid like every 18 months, basically almost every two years. So because of that, you have to really, be able to manage your working capital.
00;07;51;17 - 00;08;12;10
Got it. And you got to be able to like lay out the, the unit economics. So a lot of it was understanding that. Second was staffing, finding leadership in new states, making sure our model fit, making sure there were plenty of independent physicians, making sure that their value based policies at the state make sense. And we were able to put that together, in a way that now we can create a much more uniform experience market to market.
00;08;12;12 - 00;08;32;25
Even with every state having different things they focus on, on Medicaid, we can adjust our model because the core framework is consistent, if that makes sense. It does. And so we're we're going forward in the future is, we want to speed up the number of states that we're doing. So, we do 1 to 2 new states a year.
00;08;32;25 - 00;08;56;24
We can easily do 3 to 4. So we'll be increasing the pace on states. We want to get to 25, 30 states, maybe 40, if we can find the ones. They won't all be the same on how we underwrite them, but ultimately we want to be in 40. Are you not able to be in some states, some regulations, some states don't have managed care, some states don't have, you know, they don't hand it off their Medicaid program to a UnitedHealthCare or something like that.
00;08;56;24 - 00;09;18;00
Who can contract with us? And some states just don't have any value based policy at all. They're not all paying fee for service on everything. And those are obviously much less attractive states. Maybe in time it'll happen. But, but anyways, the goal is to roll out to a majority of the states. And then, the other thing I'm working on hard is, well, every state.
00;09;18;03 - 00;09;40;09
One of the challenges in Medicaid is that at the federal level, they tend to just kick it back to the states. What's the state issue? It's a state issue, but that's not the right answer for a program. That is the largest government program we have, bigger than Medicare, any or any other program. Now, 90 million people on the program, a third of the country almost.
00;09;40;12 - 00;10;01;23
You have 50% of all babies born in this country to this Medicaid program. And yet you have very little federal attention to it. At an innovation level. So what we are trying to do is we're I'm trying to spend my time working with the federal government to say, this is a really important program. It's a safety net program for our country.
00;10;01;25 - 00;10;27;10
You may not believe in universal coverage, I understand that, but you should. And if you don't, here's at least an alternative that you can do to shore up some of the uninsured in this country. It's a very safe and easy to implement program. And so try to push a lot. And DC for consistency on how they contract consistency and how they, reward providers for participating in this program.
00;10;27;12 - 00;10;57;20
And, you know, so that's that's the other big one. And then, obviously the other thing is we will be likely as we grow now, we've been almost 100% organic. We'll probably be more acquisitive in our future. And the simple way I would tell you that is that today, if you take the premium dollar that comes in for Medicaid, patient, we participate and say roughly 50% of that, in the future will maybe take it.
00;10;57;21 - 00;11;26;22
Well, maybe take 80%. Of the risk instead of 50% of the risk. So in the future, we're looking at being much more of a risk partner to our health plans, because we've got all the care delivery below it and and more integrated infrastructure. They would infrastructure. So what I might want to do then is I might we call it the Big Ten strategy so we can take and then we can help these health plans contract with these smaller groups who want these same kind of value based care contracts, but have a small number of membership.
00;11;26;24 - 00;11;57;12
We can consolidate them and administer it for them and then start to integrate the care. So we have a big strategy on organizing. Value based within a health plan, taking more of the premium but delivering more risk or taking more risk, but providing more, using more of that premium for care delivery and and then potentially acquiring components of that like high risk, maternity like behavioral health that are real challenges for these health plans because they're not integrated.
00;11;57;14 - 00;12;29;18
And then creating the chassis underneath that, they can be turnkey as we scale up. So. Do you have significant competitors today that are trying to do what you're doing in the same sort of, you know, 40 plus state strategy? No, we don't have our biggest competitor is status quo. I mean, people who just want to keep fee for service and don't really rock the boat, don't be based, you know, ultimately, I think they lose the mindshare provider.
00;12;29;18 - 00;13;01;28
So physicians can't barely make a living at all on Medicaid. So they've got to have an opportunity to share in some of the collective savings that they create. By creating a better health outcome. Physicians need skin in the game to be successful. Basically. And I think that, you know, the other thing is, when you're running in Medicaid, we've been often, called the, you know, the, the, Publix or the grocery store of, of, of health care because we run it so small margin, high transaction.
00;13;01;28 - 00;13;25;10
A lot of members make it up in volume, small margins. Right. So so we we we we are very are a are our operating costs are 20%, 30% of what a Medicare will be. So there are companies that do what we do in diabetes care and Medicare. But for them to come our direction, they're going to have to figure out how to shed, you know, how to get lean ten, ten basis points of operating cost.
00;13;25;10 - 00;13;50;08
That's not easy to do. So. So it's not something that people can come rushing into. I do think we'll have more competition and time, but and for the most part, it's, it's just the the inertia of status quo. That's the biggest. I mean, you become an acquisition target by one of these folks at some point. Yeah. But, you know, like, we've already had that, based on where I'm at in my life right now, and I sold companies way too soon in the past.
00;13;50;08 - 00;14;09;13
Like, this is not a company for sale. I mean, we are, you know, we may have additional capital, but the goal is to stay independent and keep growing because the need is huge. And as soon as we go to a competitor, we get sold. But there's no guarantee that things carry on. Right? So. Yeah. Right. I mean, this is your mission and you don't want to have it.
00;14;09;14 - 00;14;35;20
Yeah. It's a screwed up. Why would you do that? I mean, a lot of our a lot of the people in the industry are telling me the same thing. They're like you, you know, really want to see this guy stay independent. Yeah. That's cool. So we're sitting in this amazing new building in the boardroom. Talk a little bit about your real estate journey and how you know, how much effort you put in, trying to figure out what you wanted to do.
00;14;35;20 - 00;15;04;10
And then how we got to this amazing place was funny. We we were, we were just talking about that before we got here. The, you know, I got known in town, I think, as a professional shopper. Lots of lots of, kicked a lot of tires. And I would tell you, it's been a journey in the sense that, we started in the downtown warehouse district, and we had the old Cooperstown new.
00;15;04;10 - 00;15;26;29
Remember that? That was one of our buildings. And we had a cool building. Yeah. Cool building. We had another building that was, you know, they were great when we started because they were kind of edgy and entrepreneurial and a lot of fun. And being urban presence was really important to us. And, but, you know, we just outgrew, and, when you start the growing pains of and the parking, there was just a lot of challenges.
00;15;27;02 - 00;15;46;11
We were running into security. And so as we started getting, pressure and I started seeing really early, like, we're going probably outgrow these things, we're going to need to start thinking about what's next. And I could just never see, Medicaid business like ours in a marble lobby, like, you know, it's got, you know, high rise.
00;15;46;11 - 00;16;15;20
So, so it was a it was a challenging time to try to figure out what do we need? How do we do it? And we had some false starts with some other groups that just, you know, well-intended, but, you know, some of the reasons I think Keyser is so successful is the true focus on the independent, part of independent broker, like, you know, we we were kind of being put into buildings that there was some kind of relationship, you know, those were the priority ones.
00;16;15;20 - 00;16;32;15
We had to go to first as spring. I didn't I don't have a lot of time trying to build this business. I spent a lot of time going into buildings that had no make no sense to, why we even considered because it was in the best interests of the broker showing you. Yes. Right, right. This is your first versus my best interest.
00;16;32;15 - 00;16;45;11
And I didn't know that at the time. I just thought, well, why don't we here and, you know, here's a list, here's a list, here's a list. And, you know, I look at the list, I see a building. I don't know what it means until I get out there. And it just wasn't done. Right. And so I'm going.
00;16;45;11 - 00;17;07;03
Wait a minute. We got this leading company in this country that is like doing this amazing mission. It's getting huge visibility all over the country. We need a headquarters that represents that. I'm going to be hiring people that need to come and feel like, hey, this is a substantial company I'm going to work for. Not one that's, you know, looks like an edgy, like, do I need to see your financial statements?
00;17;07;03 - 00;17;30;14
For sure. You know, a start up? Yeah, exactly. So what do we do? And so, you know, that's when you and I start talking and I'm like, you know, I need we need like it. We need a strategic. We need someone to understand our business, understand we're trying to get done strategically, and we need someone to help us, like, engage with our employee population about how do we think about this collectively mean we're very tight group.
00;17;30;14 - 00;17;46;14
We call ourselves healthcare rebels, where we we do things very unique and very different and very aggressive. So like, we all want to be in on the solution. And I remember, you know, we sat down and we talked about you and I and you said like, you know, put me in. Let me show you what I can do.
00;17;46;14 - 00;18;06;14
I know you've been burned on some of these things here in the past, but I promise you we'll do the work. And from there it was really pretty. Pretty amazing what you guys did in terms of stepping in with first, a complete strategy review and what when I say strategy review, Jonathan, what sticks out the most to me is it wasn't a all right, let's just get that done so I can get on to showing you some buildings.
00;18;06;14 - 00;18;24;07
It was like literally like trying to understand exactly what we're trying to. Was our business mean? What does it mean to the community? It doesn't mean the people coming to our facility. You know, we went through a lot on perceptions and what what we what my goals were. You know, I told you about some of the goals I had in the building.
00;18;24;09 - 00;18;52;04
And, you know, from there, that journey became much more focused around that. And then I'll say we can talk a little bit more about, like how the we did all the assessments and all the other kind of things. But I can just tell you strategically, us connecting strategically on where this business is, where it's going and what the headquarters needed to represent to me and to my executive team was, you know, job one, you guys killed it there.
00;18;52;06 - 00;19;24;29
Thank you. Yeah. We, I remember a lot of those discussions. Right? And they weren't always easy, right. Because you had a lot of different, a lot of different factors to consider. Some of them seemed inherently challenging, right? Like when you're trying to be very mindful of cost, yet you needed to have something that displayed success and that you were a real company.
00;19;25;01 - 00;19;43;11
Talk to us about about how you felt about this building. I remember I remember texting you and saying, man, there's, you gotta see this one. Yeah. Well, I remember we were looking there was another one that was the pretty good building, but really struggling with the location. You know, it was like they just, just could not see us there.
00;19;43;11 - 00;20;05;10
A lot of industrial type traffic and stuff. And it was one of those things where, you know, it was it was just kismet. We knew, like as soon as, you told me it was on the, you know, was on the software peanut reservation, I was like, okay, that was one of the big requirements we have was that there's has to be some cultural high ground here.
00;20;05;10 - 00;20;23;14
Yes, there has to be a connection. There's plenty of office buildings that are out there. Like we need it to tie to the kind of communities that we serve. Right? So being on the reservation was a huge benefit to us in terms of how we thought about it. The other thing, what I would say is, you know, it's a good market, right?
00;20;23;14 - 00;20;42;20
I mean, you guys did a great job negotiating, but we were also kind of stepping into a time where, you know, they might be willing to give things they wouldn't have given before. Right. So it made it financially more feasible for us to say, well, we can sublease these buildings, we can step into this new facility without it, you know, being a crushing blow.
00;20;42;23 - 00;21;06;22
And then also in terms of how you structured a deal, in terms of how much of the building we can use now versus how much we'll use in the future. Those were all like huge prereqs to us being able to successfully do this. But when I got to the building, it was game over. I mean, just when you pull up the the view, the grandeur, the, you know, even though I think this is a high class B, is it I think, I consider the name.
00;21;06;22 - 00;21;40;01
Yeah. It looks like an I feels like straight A's completely from, from people that come in and so, you know, gorgeous lobby, gorgeous entry. And, you know, you and I talked a lot about, like, I had this vision at the time for a diversity museum in the base of whatever building we found, which turned out to be like and really not feasible to do, and a security challenges, but, but what we did come up with was kind of a community hub, or we could put in a community art and do art as representative of the communities that we serve.
00;21;40;04 - 00;22;06;11
So downstairs in our lobby, one of the coolest things we've got about this building is we have people, you know, we have, people of color that have, you know, sell their art in that in this area. But it also provides when we, we, we we, we let, community organizations use our, boardroom. There's that beautiful granite boardroom down there that we were allowed, that we let them use that, then they can mingle.
00;22;06;14 - 00;22;25;21
And we've had a number of events already just in that art area where it's just and have the artisan and have them talk about it. It's really, really cool. So, you know, just that alone on the esthetics was really powerful. But then, you know, a lot of character in the building, a lot of unique, breakout spaces. We're looking for hotel spaces.
00;22;25;21 - 00;22;48;28
And you guys had some really great ideas on how to reconfigure a hot kitchen that we didn't need to make it the space more amenable to employee lunches and kind of, group get togethers down there. And, you know, pickleball court, weight room, fitness facilities, I mean, all that, was in this and, you know, was it was just a no brainer.
00;22;48;28 - 00;23;10;14
But now we got to do a deal. Cut. Right. And this wasn't the cleanest thing to do, right? I mean, there's a lot had reasons to have, you know, a lot to. Yeah. Yeah, I think a lot of a lot of, a lot of times companies don't really see what's possible if you don't take the time on the front end to do that.
00;23;10;17 - 00;23;39;17
I like to call it strategic, right. The strategic thinking on the front end to then kind of come up with solutions that may not be inherently obvious. Yeah. And I think this is a perfect example of it, right. That like you said, the grow into the space, the fact that you're in a class A building paying, you know, class B minus rates and those are those are just real special opportunities that, may not always be in the broker's best interests.
00;23;39;20 - 00;24;01;09
Right. But they're certainly in your best interest. We'll give you I'll give you props even on the this room, this boardroom. So boardroom being the most important to me is where I spend a lot of my time as chairman. And we have a lot of outside investors or a handful of outside investors that come in and, you know, there were not we had one oversize went downstairs.
00;24;01;09 - 00;24;23;19
It didn't make sense. We wanted to reconfigure for the community boardroom, but we wanted one that was accessible to the to my office, accessible to, the restrooms accessible to the, elevators. And you guys helped brainstorm this this area we reconfigured completely. And, that it turned even down to the table. Yeah. It's just really, fantastic.
00;24;23;22 - 00;24;44;02
Set up can be can be happier. It was going to be hard to beat your last one. Remember your old circle table? That thing was awesome. That was cool. And it fit with your logo and all of that, because this really did turn out turn out awesome. So, you know, obviously I'm in a commercial real estate is a very competitive industry.
00;24;44;04 - 00;25;06;24
Right. And then and I'm sure your phone still rings off the hook with everybody calling with every pitch. I would love for just, if you're willing to share a little bit more about, you know, kind of what the, what the experience was like, working with, with us versus maybe more of the traditional firm, like, what was that?
00;25;07;00 - 00;25;29;13
What was that experientially like for you? Yeah, it was it was, you know, it's the way it's supposed to work. I mean, I guess maybe the easiest way to say it, you know, you'd think this would be easy and be consistent, but you're a rare, you know, diamond in this that just it's hard to find. So not just the strategy, which was critical, right?
00;25;29;13 - 00;25;58;06
How do we end up in a cultural place? You listened to our cultural needs and how important this was to us. It really came down to, you know. The team that you assembled, that we're part and obviously you're great and we know that. But like the team that was you brought to work with us from project leads and project management through the interior design firm that, you know, really lined up with the vision we had for the place.
00;25;58;08 - 00;26;22;29
Your, your, your talent and assessment, team that helped us get the employee surveys and identify what was most important to them, working with our HRA. I mean, again, something that this, this, these sometimes are bulleted on your competitors things, but it doesn't happen. Okay. Right. It tends to be sometimes just a okay, we hear kind of what you're looking for.
00;26;22;29 - 00;26;46;13
You look for this much square foot, you know how many plates? You know, a few qualifying questions, and and here's the list. Let's go. You know, and then a lot of pressure to get to at least always like, come on. Well, it's always there's always a scenario, right? There's always, that, you know, peloton is looking at the space, you know, whatever.
00;26;46;13 - 00;27;11;05
You're like, okay, you know, like we have to also not do a knee jerk, you know, emotional purchase of office space experience for the next ten years. And this is not going to happen. So, so just, you know, you guys were patient. I would say that was probably the most, unusual attribute for this line of work, from my experience from where I sit and it not being that close to it.
00;27;11;07 - 00;27;29;12
Very patient with us, making sure that we front end of this thing with our needs first and what we were looking for and then it made. I mean, honestly, I don't know if you think, but like it made the buying. We didn't look at like 30 buildings. We looked at like a handful. And this one you knew was special and bam, we got it done.
00;27;29;12 - 00;27;47;13
So but the team was, you know, full, I would say, fully functional, fully representative of all the different components we needed to be successful, including all the way in to move in. I mean, just just fully supportive of of of the team we had we assembled our own team and they worked great together. And it's the way it's supposed to work.
00;27;47;14 - 00;28;11;16
Honestly, I love that you had you had a used a term. I can't remember exactly what it was, but in describing some of the experience you had, I think it was like space. I don't remember what the term was, space pushers or space something. And I think that that is most people's experience, right? Most people's experiences brokers are just trying to hurry up and get them to do a deal so they can get paid and move on.
00;28;11;16 - 00;28;47;13
Yeah. And really, you know, from my perspective, what you needed was someone to care about your organization and try to help you find both short and longer term solutions. And I would tell you this, I would expect that out of any broker firm, okay, I expect that. I wouldn't expect that I would tenant broker. But even your competitors two years that are tenant brokers or space who have alignments and and or entanglements and aren't always, I don't want him, I don't are always as,
00;28;47;15 - 00;29;09;04
I guess, embattled and not non-biased as maybe they, they could be or should be. So that was maybe one of the hardest things. I kept wondering why I find myself in those situations and then start looking thing, well, maybe it's me. Maybe we're not explaining this or doing this right. There was just no voice to listen to it because it seemed highly transactional and not like something I'm going to invest my time in.
00;29;09;05 - 00;29;26;11
I thought, well, maybe we're just wrong. Maybe we got to do this ourselves until you and I sat down. So yeah, but definitely a huge. And this is why. It's why I sing Keyser Song. And wherever I go is that there's just not. It's just such a huge. And this isn't my first company. So I've had this in other companies as well.
00;29;26;13 - 00;29;49;16
And, you know, usually I'm working with my CFO in that case, and it's just the same dynamic. It's just finance and space, at least that. But, you know, an office is your home. It is a, it is an emotional place. It's a place that we go during our days when we're not with our families and we want it.
00;29;49;18 - 00;30;16;23
We want to break down some of that, you know, coldness that exists in that world. And it takes, you know, I think we're not the norm. I don't think we're the exception in that anymore. I think people really want, a place they can identify with and be proud of and, you know, just I can't say enough about the comprehensive approach you guys took in the team and everything to get us where we are today.
00;30;16;24 - 00;30;44;00
Now, I appreciate the kind words. You know, we're often probably very similar to you. We're often in a very thankless industry, right? Where you hear all about the things that aren't perfect, but you don't get a lot of accolades. So that's very appreciated. Talk, talk about, as you look forward. How do you see how do you see the, your needs changing, if at all, when it comes to how you occupy space?
00;30;44;00 - 00;31;00;26
Do you feel like everybody's gone through this pandemic transition? Maybe talk a little about how you're doing it? I know we did a ton of work getting here. I think we did probably a lot more than other companies do. And there's still a lot of companies I work with today are still trying to figure it out. And like, I talk talk a little bit about that piece of it.
00;31;00;29 - 00;31;18;04
Well, yeah, I think there's a lot of this comes down to leadership. And, you know, I'm, I'm, I'm old school. So I believe people need to be at work like I'm not big on the hybrid thing. I, I, I understand it. I mean, there's always been positions in any organization that are field based, and that's a good third of any business anyways of not half.
00;31;18;06 - 00;31;37;15
So but when you get into a building a growth business, okay, if you're at a widget manufacturer and you guys are growing 10% a year or less and okay, great, I get it. But if you're in a high growth 3040, 50, 60% kegger business, you got to be there. You got to be part of the blood that's flowing in those veins of the hallways.
00;31;37;15 - 00;32;01;12
You can't be dialing in and waving from a zoom call. So, so we've got but we are. That being said, we are tolerant. We are understanding of the impact that Covid had on people. We are understanding of a changing paradigm in the workforce, on, on, on. But as I often say, and my chief of staff, Sharla there laughs because she gets to hear this too many times.
00;32;01;12 - 00;32;17;28
But you know, I will take a be player who's willing to work their butt off and come in the office any day over any player that's a prima donna and can't seem to make it in. And, that is, I think, the recipe for success. And so we want to give em a killer virus. They need to come to a place that kicks ass when they're here.
00;32;17;28 - 00;32;34;22
Like. And we've had tremendous results. There's tremendous feedback on on the building itself, but we're still like anybody, we're still having to. And I'll get to the like. All right. How many of your employees didn't make it a day? We're starting to check badges. We're starting to like make sure that we're getting the activity, but we want to make sure it's productive activity, the activity just to be.
00;32;34;22 - 00;32;47;28
I showed up at the office it needs. How were you engaged? How were you engaging when you were there? So we spent, you know, a lot of energy on that. I think as we go forward, we'll continue to press for that. We'll probably end up getting to a four day workweek at some point. And currently we're three, three.
00;32;47;28 - 00;33;09;12
And, and then we'll always probably have a virtual Friday because, it's a good flex. Somehow you get more work done when you don't have to do the work, you know? But now we're when we think about when I think what future office space needs and how we build, a lot of this right now is focus on how do we build our culture out.
00;33;09;14 - 00;33;29;28
In nontraditional ways. So I don't know if it's right or not, but we're trying to figure out ways to create, like, executive pods that go to different markets and work out of that office for a week or two, like trying to start to rotate so that we can keep people sometimes are slave to the corporate office, you know what I mean?
00;33;29;28 - 00;33;46;16
It's like back in Phoenix, this is how they do what they think. Our Texas business is already bigger than our Arizona business. So and just few years of contract, it'll be million lives on its own at some point. So so we need to start thinking about what are the other Phoenix type, you know, offices. What are they look like?
00;33;46;16 - 00;34;09;13
How large are they? So right now, like, for example, we're thinking it's either Houston or Dallas. Probably Houston is our next big MSA that we would build, you know, a larger office. And so that people have a HQ to go to, maybe Nashville as well, maybe not as big, but, based on the, the market size and opportunity.
00;34;09;15 - 00;34;31;03
But what is that third major MSA going to be? And I think as we scale up, which we think we can be, 10 to 20 billion to our company in the next, you know, five, 5 to 7 years, I did ten years, as we do that, we're going to need to have skilled, you know, facility operations.
00;34;31;03 - 00;34;56;10
They can't just be, you know, outpost depots of, you know, place for people to plug in computers and, you know, 2 or 3 exacts to work, it's going to have to be more robust of, of an office environment. So we're going to try to figure out how do we carry over culture here to there. Commonality looks and feels everything, so that you feel like you're operating in a single.
00;34;56;12 - 00;35;14;17
Physical plant. Right. Even though you're not, you're not. Yeah. What do you what was the word you used again for the the executives going around. Yeah. I just call like it's like going to pods. But basically I think it's really I'm just trying to think we're trying to think creatively of how do we just to have someone fly in for a day, it's no big deal.
00;35;14;17 - 00;35;31;18
But like, how could you how could we figure out a way to work for a week out of the different mixture of exacts so that people are in the office? You're building a thriving, you know, you're showing you're showing your commitment, which hopefully they show their commitment by by being there. But you know, and experiment some other ideas.
00;35;31;18 - 00;35;51;25
But I think the the main thing is though is it's how do you impart culture into the organization? So that it's not all about headquarters, that everybody feels like they're part of equality, health, no matter where they're at? I think that's wonderful. Could you touch just quickly on your culture and how you describe it? Yeah, I like I said, we were healthcare rebels.
00;35;51;25 - 00;36;13;17
We break glass. We are we've always been critical thinkers in our space. I'm most proud of the fact sometimes I say the entrepreneur is the, you know, is the spark, but the eternal flame is that management team. And, you know, they they're the ones that get it done. They're the ones that do all the amazing work.
00;36;13;20 - 00;36;43;05
And we have an unbelievable team. We have one of the most talented team in the country and what we do. And so, you know, when I think about culture, I think about high IQ, high IQ teams that think treat each other respect. Have passion. And as the underlying thing and what they're doing, there has to be some egalitarian component of what works if you're going to do well in our company, it's our company.
00;36;43;05 - 00;36;57;29
You go to where you might just be super smart and do you'll make a lot of money, plenty of them out there, play them out there. But if you don't have that kind of currency, that current level that runs inside of you that says, I'm here to do good, you're going to not fit in as well because we do some things.
00;36;57;29 - 00;37;32;19
Sometimes it just don't make sense because we care about our clients and our and our patients and our doctors. So, so I think that's part of it. I think we also have a business that is, highly fragmented because the Medicaid system fragments, you've got all these different pockets of, of skill set. So I think we've been able to figure out how to harness all that and the work like what we call mission moments, but kind of ways where we can tell a story about how our entire model health really improves someone's life at the highest level, sometimes even speak how it improve their life at our company town halls.
00;37;32;26 - 00;37;46;20
But I think those kind of thing, I think that's key, right? Because otherwise what's my understand? What's my contribution? I'm in it. Right. How did I help this happen. Yeah. Yeah. Right. Well here's how you here's how you draw the line on how I just came from a meeting. We said we have a lunch. Huddle with you.
00;37;46;20 - 00;38;17;14
Huddle lunches we do with, our leaders just to make sure, like, what am I out doing? They don't see me as much. I'm traveling. What? We're here. What are you doing here? And then I ask them, what do you want to ask me? And we get tremendous, like, a tremendous feedback. And that was one of the things we talked about just recently was one of our leaders has said the greatest value I've been able to do within the company is showing how your one function ties to that patient not going back into the skilled nursing facility because they were dehydrated or had, you know, some other issue arise because we engaged, right?
00;38;17;14 - 00;38;43;00
Right. And so they wouldn't have had the data they would have had, because you provide that data, that data wouldn't have been, accurate and therefore this wouldn't have happened. Right. Be able to draw those lines back means a lot. Then then you can get into your personal mission and the work you do. So those are just some examples, but I would just definitely call our culture, one that, is valued on entrepreneurism.
00;38;43;00 - 00;39;04;28
It's valued on independent critical thinking, it's valued on creativity and innovation. And to a lesser degree, on corporate stuff. Right. Less corporate stuff I like. That's a good tagline. Yeah, less corporate stuff. The bigger the bigger we get, the harder it is to fight from that. But, man, it's it can be the stranglehold of a of a great company.
00;39;04;29 - 00;39;32;11
Man. I think, you know, it's it's, it's it's exciting for me. I just got back from Chicago, where I was at for a conference this weekend, and and I'm pulling in there, going down the, the airport to the Skytrain. And, you know, there's a really cool equality health sign, right. And, and and I think, I think your messaging is so dialed in.
00;39;32;13 - 00;39;54;20
Right. Like, it really does convey the heart of the founder. Yeah, right. It's something that we've tried to do a lot at Keyser is convey the passion, the mission. So why don't you tell me about alternative one? You tell me about your culture. You built an amazing culture is why you guys are so differentiated. Yeah. You know, our our culture is we're we're in an industry, as you know, that is very cutthroat.
00;39;54;22 - 00;40;19;13
Doggy Dogg it's all about that deal. It doesn't matter how you get to the top. You want to have your picture as the top guy. And it is usually guys. And so we've, we've really created this culture of, of care of selfless service of, of really trying to help ensure that we're delivering on the brand promise that you just described.
00;40;19;13 - 00;40;47;14
And in very good terms, and I'm grateful for that. So and don't you think, I mean, when you say that the like. What I said about patients. Yeah, that is a great indicator of your different approach. Right. Because the patients was one thing I can tell you after I tried a couple of different firms over the last before I came with you guys that did not exist, it was, let's just go, let's go, let's go.
00;40;47;14 - 00;41;11;18
It was not like, let let's take the time to understand what the real needs are. And then when it was done, it was an easy exercise. You know? Okay, I appreciate that and I agree I think from my perspective as I think about it, what what what we do as a culture is something that we all inherently, as humans know how to do at some level, right?
00;41;11;18 - 00;41;35;16
It's take care of people. And what does take care of people being that means you put their interests ahead of your own. I think that's the fundamental flaw with not only commercial real estate brokerage, but business in general, right? As people are putting their own personal interests ahead of the people that are supposed to be serving. And I believe fundamentally that if you love and serve other people, it comes back.
00;41;35;19 - 00;41;56;13
And and I think of it in a very practical sense. Right. Like if my focus is on helping you get what you want in a deal that's structured the way you want it, so that you and I are able to have this experience where we're we're talking about it and it's been a very positive outcome that's good in the long run for me.
00;41;56;15 - 00;42;16;03
Right. Because that means you trust me. That means you're going to work with me in the future. Yeah. Right. But so to me it seems so inherently simple here. It's like take ridiculously good care of people. Love on them. We all make mistakes when we make a mistake. Admit it. Right. Screwed that one up, man. I'm going to do better next time and so hide it or whatever.
00;42;16;03 - 00;42;41;11
You hit the nail on the head there. It's it's you've got longevity or longitude nowadays versus transactional, right? I mean like when we start to talk about, you know what like let's say is our next hair. Hey, get Jonathan on the phone. We're going to be like, it's not even a question, right? Yeah. If you were transactional with the sense of space, we had a bunch of things that we found out later that, you know, came out.
00;42;41;13 - 00;43;07;09
Then we're going to go, Yeah. That wasn't a great experience. What are we going to do? Like, we start now again. Right. And some some firms are willing to take that I think. But like that's not the long term thinking. It is short term think that. Yeah, I think that's really good luck. But I'm going to ask you for, for something, what I think would be really cool and apologies to all of our podcast guests.
00;43;07;09 - 00;43;46;24
We are going to use this in a, in a forward facing, function, but would you just talk to the camera as if, as if I'm interviewing for another big potential client and they asked me for a reference and I say, hey, which which camera? This camera right here. Would you just look at that camera and give them like a 32nd, 62nd on, on your, you know, kind of boiling all the stuff we've said down to what your words would be to that CEO, CFO so had a real estate, whoever that may be.
00;43;46;26 - 00;44;18;24
Hi a few little I'm the founder and CEO of Equality Health and and choosing to work with Jonathan Keyser and the Keyser organization. Probably the single most important thing is that I thought about the fact that you're not going to make any almost larger purchase decision in your company's experience. Since then, your lease requirements for and or your purchase of your office space, that is a, very expensive, proposition.
00;44;18;27 - 00;44;56;15
And it's one that ultimately reflects all the components of your business. It inflects your how you feel about your employees, how you look in the community, what you believe in the, the power of your business, the conviction of your business. And this is something that in working with Keyser, I found, was incredibly rewarding. And the fact that I was able to get, tremendous support, strategically, tremendous support on execution, tremendous support in negotiation, and most importantly, at the end of the day, I trust them.
00;44;56;18 - 00;45;24;24
You know, I think that Jonathan participates in an industry where that's a really hard thing to come by, and it made the total difference for us. And we're incredibly happy at our new headquarters here. And, on Dobson Road. So I know we're running out of time here. I look at my non watch. I know we're running out of time here, but, I also I also want to talk about the quality of foundation.
00;45;24;27 - 00;45;45;26
I have such a amazing, organization. And you're doing such work. Could you just talk a little bit about that? Yeah. I'm really proud of our quality Health Foundation. And the leader, Tomas Leone, who's just done tremendous work with. He's a man of the community. I call him our chief art officer. He's got a big.
00;45;45;28 - 00;46;10;06
He's a good man, a good guy. But, it's also was very strategic for us. So when I, when I created the foundation, it was because you can go back to our business mission. We're here to help underserved communities achieve the highest individuals, to achieve the highest, most optimum level of health that they can. And we do it through this whole person care model.
00;46;10;06 - 00;46;29;27
And what I came to realize is that, that's awesome for who we're doing this for, for people were contracted to do it for it's not everybody. And some point, you know, this is a missionary in business and you start going and but what about the people who can't get access to quality health? I mean, that's the kind of sucks, right?
00;46;29;27 - 00;46;53;01
So, so we came up with this idea of wrapping around our LLC, a not for profit organization that could become a, we call it convener, an opportunity to go out and raise funds from various groups, that want to support equality health but have the same issue, like we're only touching so many members, and now it allows us to go so much further.
00;46;53;01 - 00;47;23;28
Now we can go beyond just our membership and deeper into the community. Right. We can go. Let me give you an example. Examples. After the shooting in Uvalde, Texas. Right. That was one of the most devastating things ever. Community was in Healing Equality, Health Foundation, along with one of our clients, Centene Corporation. And Walmart, went in and put together a Christmas program to reach out to the community to allow them to, to heal, you know, to come in.
00;47;23;28 - 00;47;44;25
Yeah, to give away gifts to kids, to allow them a safe place to come. And, you know, we gave away, food items, as we always do. We gave away, you know, Christmas turkeys and Thanksgiving turkeys as well. And we do. We do this in a way that, like, allows our mission to extend, allows people to have access to it who wouldn't have otherwise.
00;47;44;28 - 00;48;10;25
And one of the cool things about this new space we have is that we're able to put it together in the same building now, right? So, one of the neat things that we have is in that, in our lobby where we have, community artists display people of color that paint, in our local community. We also have a community facility that they can use for meetings and other types of, you know, gatherings and, and programs.
00;48;10;25 - 00;48;31;01
And so we've had all kinds of people come through. And it's a great way to showcase not only, for them to meet other people in the community and showcase the art, but also showcase that high quality health as an organization, as a social responsibility, and as living up to that social responsibility by, bringing everybody together. And it makes me really proud.
00;48;31;03 - 00;48;55;02
I must just say, I think we are so grateful. I know you're a humble man here. I know we are grateful for your leadership in this community and for what you're doing to help the health outcomes of so many people that have been historically underserved. I get the chills even saying it. Like, I'm really grateful for your vision and your willingness to take the risk to to make that a reality.
00;48;55;02 - 00;49;21;15
And I'm really just I'm really excited for the organization, for the benefits that all the all your million plus and growing members are receiving. And also, that I get to play a small role in it. So thanks for your leadership and thanks for being, you know, just again, for for just to say it, I know you get a lot of accolades, but, I find you to be one of the most authentically genuine people that I know.
00;49;21;18 - 00;49;49;07
And you don't say what you don't mean. And you're also very gracious with people, even when they don't necessarily do what you need them to do. I watched you throughout the process when when you know different folks didn't necessarily give their best in that second. And the way that you handle it is you're a class act. And, and I'm grateful to know you as a friend and as a, and as a business associate.
00;49;49;07 - 00;50;12;06
And I also, I also look forward to seeing how the impact of your leadership in this community, trickles out and affects others, right? Because you're you're kind of become this beacon of what, what a leader can be that I know a lot of younger people are aspiring to become. I want to thank you, Jonathan, I appreciate it.
00;50;12;06 - 00;50;29;13
And back at you, authenticity is, to me, one of the leading characteristics in leadership. No one follows someone. I believe in a trust. And you do a great job with it as well at Keyser. So, honored to be your friend. And thank you so much for the amazing work you did in this project. It's my pleasure.
