John Moore III: [00:00:14] Welcome back to ChilCast: Healthcare Tech Talks, the podcast from Chilmark Research. Today we will be tackling a bit more of a somber topic than what we normally cover. Approximately two weeks ago, from the date of recording, I lost my father to cancer. He had been battling neuroendocrine pancreatic cancer for close to 14 years before he finally succumbed to the illness. He passed in peace in hospice care at home, you know, basking in the sunlight, looking out over his garden with surrounded by family. Actually my stepmother was counting his breaths towards the end because the hospice nurse had informed us that keeping track of the breathing was the best way to know whether or not the patient is comfortable. And so she had been counting his breaths. It seemed like he was breathing a bit rapidly. And in that moment between, you know, where she was counting and when she stopped, she looked up at him and he happened to wink at her and then stopped breathing. So I have to say, as far as these things go, it was probably one of the best ways to to pass. Obviously, end stage cancer is pretty traumatic and pretty awful for everyone around the patient. So that part was quite unpleasant. And I'm sure that there are many people listening to this right now that can relate to that experience. But thankfully it was short lived.

John Moore III: [00:01:40] He was only bedridden and in really critical kind of need of ongoing care for three days, which is exactly how he would have wanted to live and how he would have wanted to go. He was able to live, you know, being active up until pretty much the very end, which is something that he had always, always instilled in me as one of his real big goals around how he would pass on from this world. In fact, when I was a kid, he used to tell me that if he ever got dementia to the point where he could no longer recognize his loved ones, to just take him out in the woods and let them wander around until he passed away. And I was just like, "Dude, you can't put that on me!" But it was very indicative of just kind of how he was and how stoic he was about his, you know, how he wanted to go in his final days. So I'm going to start off today reading what I read at his interment, which happened a few days after his passing. He had a green burial, so he had to rush to get him in the ground because they don't use any preservatives or other chemicals for a green burial. They just keep the body as natural as possible and then put it in the ground.

John Moore III: [00:02:36] My dad was very much into gardening and nature, and he's going to have a shadbush tree planted over his cemetery site so that he can have, you know, a fruiting plant that feeds the local ecology and contributes to the local ecosystem, which is just perfect for him. So I'm going to start off today reading what I read at the interment, and then we'll all kind of share different thoughts around the impact that he had on us and, you know, some of our favorite things that he wrote, as well as the brief discussion about how we will be continuing his legacy going forward.

Dad wanted to have someone provide a reading from Marcus Aurelius’ classic collection of stoic philosophy, Meditations. Instead of a single reading, I will be sharing a few of the passages that I found marked in the copy he kept on his desk. I’ll start with one I believe encompasses much of how he went through life:

“If, at some point in your life, you should come across anything better than justice, honesty, self-control, courage – than a mind satisfied that it has succeeded in enabling you to act rationally, and satisfied to accept what’s beyond its control – if you find anything better than that, embrace it without reservations – it must be an extraordinary thing indeed – and enjoy it to the full.”

As you all know, dad had a passion for living life to the fullest. 

John Moore III: [00:03:53] When he found something that lit his heart up, he went all in. His first love, to my knowledge, was bike riding. Even going over his handlebars in high school and knocking out his front teeth wasn’t enough to turn him away from the sport he loved – and continued enjoying up until his body could no longer handle the strain. One of my all time greatest accomplishments was doing the Pan-Mass Challenge with him in 2019, raising over $5000 for cancer research – each – and biking 196 miles over two days. And now one of my final memories with him from last week is when his face lit up seeing me geared up and ready to take his bike out for a ride. Despite the amount of discomfort and pain he was in at that point, he was still so happy to see me enjoying this sport he loved so much he could come out of the haze long enough to give me a huge smile paired with his sparkling, joyful eyes.

He was an avid fan of music and art, and I owe so much of my appreciation for both to the environment I was raised in and how he shared those interests with me over the years. My first concerts were with him, and I will look back fondly on the music pop quizzes he would give me during car rides to test my growing knowledge of classic and alternative rock. 

John Moore III: [00:04:56] My first trip to the Louvre and Musee D’Orsay was with him, a truly mind-blowing experience. We both agreed the Musee D’Orsay, was the more interesting, though the sheer grandness of the Louvre is unrefutable. Growing up we attended numerous exhibits locally at the MFA, galleries, and other events like First Night here in Boston. In fact, our last outing together was with Mayali to the Hokusai exhibit currently at the MFA, the Saturday before he passed away, and I will be forever grateful that was the final activity we shared. The tattoo on my arm is actually based on a Hokusai print, so now this permanent art on my body from 14 years ago claims even more personal significance. So the same year that he was diagnosed, I actually got the tattoo before he was diagnosed, but same amount of time from 14 years ago. Claims even more personal significance. I've been working with him for over a decade now on the firm he started named after where We stand today, Chilmark Research and being his son, this wasn't always easy.

John Moore III: [00:06:00] Surprise surprise - I’ve since learned, as I transitioned into the leadership role, that just about everyone who has ever been in a similar situation with a parent, experiences the same thing. My over-familiarity with him though, at times allowed me to take for granted just what he was accomplishing with the work we were doing. As analysts, we don’t always see the direct impact of the work we do, but in these final months I saw such an outpouring of adoration and love, it drove home the genuineness of the connections he had made as well as the influence it had on our very problematic healthcare industry. Here are some quotes from that part of his life:

Quotes about the impact of his work:

Former employee: “Your father made me believe in myself during a really really bad period in my life. He will always be very important to me and never forgotten.”

Dale Sanders: “My friend, this feels surreal to me, as well. For whatever reason, the Universe gave us an easy and fun chemistry from day one of our friendship. I could go anywhere in a conversation with you—from oceanography to interoperability, and our favorite topic, skiing-- and a laugh was always right there on our shoulders, no matter how serious the conversation, a moment before.”

Dan Burton: “John, we at Health Catalyst love and respect you, and are so grateful for your multi-decade contributions to making healthcare better, by telling the truth, asking tough questions, and encouraging others to become better and stronger. I'm so grateful I met you more than a decade ago, and for many, many conversations since then.” I'm so grateful I met you more than a decade ago and for many, many conversations since then. 

John Moore III: [00:07:15] Suzanne Cogan: “You have made a mark on so many of us and helped so many people grow in their understanding, far more people than you will know.”

Dave Watson: “I've enjoyed our friendship over these many years and have been so pleased to see how you've nurtured Chilmark into the success it has become. You've always had a North Star built on integrity and making a difference in all that you do which puts you in rare company. I will miss your smile and your cynicism. Until we meet again...”

And these were all posts and comments that were left in response to the post that my father had put up prior to him this year, talking about what he was going through and sharing his, you know, his end of life thoughts. So now, after passing, people directly reached out to me and shared some anecdotes and some commentary as well. 

So Jeff Clapp wrote “Of the good people I had the privilege of getting to know all these years, your dad ranks with the very top. He did what we all hope - he made a difference. He will be missed.”

John Moore III: [00:08:14] Hans Boerma: “John, my deepest sympathies to you and you family. I had many debates with your dad and was always blown away by the depth of his insights, his healthy questioning of  the next big thing, but above all his friendship. I will miss him greatly.” 

Larry Yuhasz: “Your father was a bright light in the world. His energy, curiosity, and thought process will be greatly missed. Chilmark is so much more than a company…it is a manifestation of his human spirit. Godspeed to you, your family, and your colleagues as you carry forth as he would want.”

I don’t think the irony of him deciding to work in the healthcare industry 2 years before his own terminal diagnosis is lost on any of us here. His zest for life is apparent in the ways he dealt with the news and knowledge that his time with us was going to be cut short. While it definitely dragged on him at times, particularly when the symptoms were more acute, he made sure he did whatever he could to use it instead as motivation, not something that would slow him down. 

John Moore III: [00:09:21] There are very few people I know that could have dealt with the sadness and trauma of receiving that diagnosis with as much stoicism and strength as he did. I think the following passages sum up how he tried to live his final days without giving in to morbid apathy:

“Bear in mind that everything that exists is already fraying at the edges, and in transition, subject to fragmentation and to rot. Or that everything was born to die.”

“And how long your body will contain the soul that inhabits it will cause you not a moment’s worry. If it’s time for you to go, leave willingly – as you would to accomplish anything that can be done with grace and honor.”

He always saw himself as an educator, and I like to think he was successful in that spiritual calling. He certainly taught me so much of what I know today and I can’t wait to see how he continues to show me the way in the coming years. He’s exited his mortal self, but I know he’s still here with us, enjoying the sea breeze and the sound of the waves on the Vineyard.

“If all the rest is common coin, then what is unique to the good man?

To welcome with affection what is sent by fate. Not to stain or disturb the spirit within him with a mess of false beliefs. Instead to preserve it faithfully – saying nothing untrue, doing nothing unjust. And if others don’t acknowledge it – this life lived with simplicity, humility, cheerfulness – he doesn’t resent them for it, and isn’t deterred from following the road where it leads: to the end of life. An end to be approached in purity, in serenity, in acceptance, in peaceful unity with what must be.”

He was a good man, and I take comfort that he will be remembered for his many good deeds and the numerous positive ways he touched people’s lives. 

John Moore III: [00:10:33] So that's what I read to the family during the interment. It was a really nice ceremony. We did it on the vineyard in Chilmark, the town that was obviously the basis for the company name. Chilmark is where he was always most comfortable. He grew up as an Air Force brat, as they refer to them. So he I think he said he moved to ten different places by the time he was eight years old. So he didn't have a whole lot of stability in life. And Chilmark was always one of those places where he always did feel at home. And that is what became the basis for the naming of the company that he founded and the work that we do now for Chilmark. So next, we will chat a little bit about some of the impact that he's had on each of us.

Jody Ranck: [00:11:40] So I'll want to begin with when I first came to Chilmark in 2016, and John, you might remember, there was a one evening when suddenly there was a newsflash that GigaOm was going bankrupt. In the very next morning, you tracked me down and called me and asked if GigaOm's demise could be Chilmark's gain. And being an analyst was really a side hustle for me at the time, and I had focused on mobile. So when you brought you asked me to come into Chilmark with you and your dad and the others help. It was rather new to me, surprisingly, and it was really pretty amazing and quite an educational experience to have your dad's tutelage into a broader set of health IT areas that I now focus on or I integrated with some things I just dabbled in, such as AI and data analytics and, and just having that deep historical knowledge of it just felt like every company in the ecosystem, which now it just seems rather impossible almost for someone to capture that that amount of depth about an ecosystem this large and to help guide a new analyst in the in the firm to get some grounding and think critically. And what I always loved was this passion for truth and cutting through the marketing hype and getting to what's real and what's not, and then thinking what's going to have the impact, but always trying to as best as he could, instilling in all of us to think about the patient end users of these technologies has grown up to have a very unique, mature, analytical voice in this space.

Jody Ranck: [00:13:34] And it is a very unique take on things that I think we all, as you come in, as you come into Chilmark, your dad's voice gets kind of instilled in all of us in that those analytical frameworks and lenses. And the other thing is, is just it's quite a renaissance man. We could be talking about AI one minute and mushroom foraging the next. And I'm a cyclist as well, so we always had the cycling in common. And then, you know, history of the Habsburg Empire, you know, and a single call, it was really it's quite precious to have work colleagues that you can talk about that range of things subject areas and enjoy it and learn from one another. And I think it's really one of the things that animates the team to this day and his voice carries on in all of us.

John Moore III: [00:14:27] I would concur. I definitely think that he did his best to try to train all of us to think critically. You know, follow the money was always something that he would say, see where the money's going to get to the truth. What's really driving things? And yeah, like you said, Jodi and a couple of other people called out his passion for getting to the truth is very much kind of the core of what we do here is really trying to understand what's really going on, weeding through all the hype, all the crap that's being pushed out there and getting to the heart of the matter.

Jody Ranck: [00:14:59] And what was cool also was, you know, you could disagree with your dad and we duke it out on a topic and how to look at it. But it was always pedagogical for all parties involved. Even if we disagreed, we could learn something from a disagreement that made us better after the differing points of view. And that's not an easy thing to accomplish often. I mean, I come from academia and you you often are out to annihilate the one that you disagree with. And here, you know, having a more pedagogical way of talking about these things until we find the right way to, you know, analyze something. It was that was very, very good, very constructive.

John Moore III: [00:15:43] I definitely know that I saw the value of that over the years of having, you know, those debates and those discussions to really understand the nuances and different perspectives of what was going on.

Elena Iakovleva: [00:15:52] You know, for me, it's a very special podcast, without a doubt. And John was one of the best people I've ever known. And obviously the impact of my communication with him and the privilege of working with him for the past year and a half definitely made a huge, huge footprint on the way I'm thinking and the way I am seeing health care in the United States. After being in the United States revenue cycle for over 12 years, I realized that I grew so cynical. And even though I saw many, many good doctors, excellent providers, many good and kind people, I felt like it was a black hole we all were falling into. And John became that lighthouse for me, showing that through critical assessment of what was going on, you can actually help the industry to see the true light, to set some frames to actually really shake the industry and remind them of some ideals that we all should follow. Without a doubt, he was always a most pleasant human to talk to. We could discuss mushroom hunting since it's like my favorite outdoor activity as well. Gardening, tons of things, books, music and so many other things. And one of the points that I took from those discussions is your horizon never can be too broad.

Elena Iakovleva: [00:17:38] And I think the broader your horizon is, the more you can contribute to the particular industry you're working in. And hopefully through that we can enrich Chilmark research as well by taking those principles and applying them to health care. So that's what I'm hoping to do. Obviously, it was a totally different role for me. I became an analyst a year and a half ago and I learned so much in those year and a half through him that I think it was much more than I could learn in ten years somewhere else. Even now, when I reach out on behalf of Chilmark research to a certain company, people saying like, Oh my God, hi, hello, let's talk. And I just know that I get that positive response through him, through John, because they had a chance to talk to him and through him. We all share this very positive response from the industry. Somehow he became that one of a kind who was seen as being capable of making a very serious impact. So I am so thankful for this amazing opportunity to meet this man and have this unique opportunity to work with him. And without any doubt, we will try to do our best to carry on whatever he built. Chilmark on.

John Moore III: [00:19:09] Thanks, Elena. Yeah, I know that he really enjoyed your guys conversations. He always really liked your perspective on things and, you know, some of your crazy travel stories. I know he really enjoyed those because he was always such a traveler himself. And you've done a fair amount of that I wanted to bring up since the mushroom foraging has actually been mentioned twice, I actually happened to find a Chicken of the Woods mushroom the day before everything kind of went south on him. So on Father's Day, his final Father's Day, which was the last good day he had, I found a nice big chicken mushroom that I went and harvested and he was super excited for me. And, you know, we were all excited to eat it the next day. Sadly, he didn't get to, but the rest of the family did and it was delicious. So got to complete, you know, one of his last things with me going out foraging mushrooms just like him.

Colin Kingfisher: [00:19:56] I'm not typically on the podcast. My expertise isn't necessarily in the subject matter at hand, but that actually is what my fond memory or I guess the first thing that I think of when I think about your father is, is that when I came into this work, I have a sales and marketing background and, and not a health care or a tech background at all. It was pretty intimidating to start learning about some of the technology and reading press releases from various companies and even saying to myself like, "My God, what does interoperability even mean?" And I talked to your father about it and I was kind of; I told him that I was intimidated and that I wasn't understanding a lot of what was being written about the space. And he kind of just very matter of factly said something along the lines of like, "well, everybody's kind of making it up anyways." Or, you know, they're they're not really they're not really saying anything anyways or something like that. Just kind of a very like, you know, the emperor has no clothes kind of situation. And it was just I don't think he was actually trying to make me feel better or anything. I think he was just really being himself and. Acknowledging that so much of of what people love to do, especially with the kind of massive amounts of money that have poured into the health care tech space is to just say, hey, what are you guys actually doing? Yeah, that's great.

Colin Kingfisher: [00:21:37] I love your press release with the flowery language, but what's underneath it? And when you had a conversation with him, it really became evident that that was his approach to life as well, is what is it really all about? What are we really doing here? You can dress it up and make it look as fancy as you want, but. At the end of the day, let's get out into the woods and get into the dirt, you know? So that coupled with his ability to just be interested in seemingly everything was really inspiring. It's something that I think about from my own life is how how big and wonderful and wide is the world and how how can I experience as much of it as possible before I go? And getting to talk to John about his life was pretty thrilling. I mean, he he had a number of careers. He didn't even get into health care until he was, I think, 50 or something. And to imagine getting to that point in your life and then deciding, hey, I'm going to just totally take a left turn, do something completely different and also make a huge impact. I mean, that's kind of amazing. You know, you think that I'm 36 and it's hard not to think like, Oh man, my best years are behind me. But, you know, to just fearlessly at 50 years old think like, yeah, I'm going to I'm going to take on this whole sector, this really complicated world. I'm going to learn all about it.

Colin Kingfisher: [00:23:10] I'm going to call it like it is. I'm going to make an impact in it. It really speaks to a what he was capable of as a person and be just a mindset of I can apply myself to anything. I can understand anything that exists here in the world, and I can talk to people about it. And just facing facing the world with such determination and gusto is truly inspiring. And I hope that I can bring some of that energy to my own interactions with health care IT and the world at large in the same way. And I definitely will will fondly remember the way that he talked to me about my own niche interests. You know, even in my first interview with Chilmark, I told him I was an avid bird watcher and he just instantly was throwing down bird species names and just I'm kind of amazed. You know, most people are going to say something like, Yeah, I saw a blue jay in my yard one time or something, and he's like, Oh yeah, there's a family of red shouldered hawks out here. And, you know, just right away made me feel at ease. And also, like I was talking to somebody who was, yeah, just interested in what was going on around him. So I have fond memories of him and I'll carry them with me always. And I hope that we can honor his legacy by continuing the work that he started here.

John Moore III: [00:24:30] Thanks, Colin. Yeah, I definitely sometimes forget about how big of a switch that was for him to make from going from, you know, manufacturing and ERP software as an analyst to jumping into health care. Like, I remember when he did it and every now and then it would come back to mind just how crazy of a jump that was because of how complex health care is. But he you know, he started in 2007, started going to events, really launched Chilmark in 2008 after he'd been doing it for a bit. He was debating between doing an ed tech analyst firm because he saw a lot of potential around the education and technology space, but he just saw that health care was really much more in need at the moment. And, you know, obviously education budgets are always so tight there. Just the amount of innovation that could happen there was going to be limited until that changed. So health care, there's money coming in. And he timed it perfectly, obviously, because the whole high tech act got passed just a couple of years after he started the firm. And that obviously became, you know, bread and butter for all the analysts and consulting firms in the industry as everybody tried to navigate what it meant. Um. Yeah. And the varied interests. One of his the hospice company, they, you know, have five wishes that you answer. They've got this document where they talk about different things when you're planning for end of life. And one of his final five wishes was making sure that the bird feeder stayed topped off in his yard.

Colin Kingfisher: [00:25:55] A noble wish.

John Moore III: [00:25:57] Exactly. Exactly. That was definitely like one of the final things that he called out that he wanted to make sure kept kept going after his departure. So actually, speaking of which, I need to fill the bird feed because the rest of the family's out on the vineyard, so they're not maintaining it right now.

Fatma Niang: [00:26:15] My fondest memory of John was when I first interacted with him. I already shared this with the team. But my favorite memory is I'm preparing to go into this interview. I'm super nervous. Like my heart is racing, beating really fast. And immediately we get on the camera. He looks at me and he goes, Wow, your glasses are just really huge. And immediately it just made me laugh because it's something that my mom complains about all the time. But I just feel like if I'm constantly staring at my screen, why not get like glasses? It's a whole thing. But I explained to him that my mom complains about it all the time and she just thinks that it's like my generation's style kind of thing. And he was like, Yeah, they are, you know, huge. But immediately I just felt my guard go down. I didn't feel as nervous. And that just shows how personable he was. But in that interview as well, he also told me that he wasn't looking for me to just dedicate my life and career to Chilmark, but he also wanted me to build my own brand and develop myself as an analyst. And I thought that was very telling to his character and the type of person that he was, because not only he wasn't thinking with a business mindset like, Oh, I'm bringing this person into my business to do X, Y and Z, But he also wanted me to have a career that was fulfilling at the end of the day. So I really value that and I carry those lessons in a lot of times. He held me to it like he saw a lot of things that I didn't see in myself, and I'm very grateful for all our conversations, the lessons and just how personable he was. I didn't view him as a boss, but more so as a mentor. So I cherish those memories very.

John Moore III: [00:27:57] Thank you, Fatma. Yeah, I know that he he enjoyed having you on the team. He thought you were fantastic. Obviously you guys didn't get nearly enough time to work together, but you had almost you had about a year, so you know, a enough time to get to know each other. But it would have been nice if you guys could have gone to hims together, you know, and you could have seen him in his prime, just wrecking hims and, you know, just all the meetings you would have, all the conversations and parties he would attend. I just I'm much younger than him and I have no idea how he had the stamina to do it. When he was in his mid to late 50s and dealing with cancer, he was still going harder than me. At one of the dinner parties. He actually got to win a guitar from Keith Urban, who was playing at the Serner party in Vegas one year. I was so sad that I missed that because, I mean, I didn't know that there was a big concert going on in general, and I'm not super into like pop country, but I mean at a thing like hymns, that would have been fun. But yeah, that was just one of the random things that would happen to him because he was kind of everywhere and talking to everyone and just things fell into place because of that.

John Moore III: [00:28:58] Um, one of the things that he really tried to instill in me when I first came to Chilmark and started working under him was the important of importance of relationships. And I do think that one of the things that's become clear from everything you guys shared, as well as what the rest of the industry has kind of reminisced about him, is how much he actually did fulfill that kind of obligation or that that part of his role. Like he genuinely was very interested in other people and that really helped him form valuable, meaningful relationships with other influencers in the space and the people that are getting things done in health care. So, you know, one of my goals as I think about the future of this company is how do I do something similar? How do I make sure I am as connected to the people that can get things done? And share with me how the industry is really going to change as opposed to, you know, everybody just kind of talking and thinking and putting ideas out there, networking with the people that will get shit done. So, you know, personally, I've been reaching out to some people for advisory board and that's how I'm thinking about who I'm recruiting for.

John Moore III: [00:30:02] The advisory board is who are the people going to be that can either introduce me to the people that can get things done or are the ones that know how to get shit done. So I do think that he had a really good head for that and a good knack for kind of teasing that out himself. And while I think I do have the skill set, I'm just not confident enough in myself yet to, you know, do it all on my own. And I think that's one of the biggest things right now for me is I've been really focused on the backside of the company for so long that I haven't been doing the analyst work for a number of years. I've been overseeing it. I know how it gets done and all that. But if I'm going to be leading this company, I do need to really fill those shoes that he had before where, you know, he was a thought leader. He was someone that people listened to. And so that's one of the things that I'm really focused on for myself right now while I'm working on running the company and, you know, trying to fulfill my role as a mentor to the rest of you as well.

Elena Iakovleva: [00:30:57] John You know, it's interesting you mentioned it about people who actually change health care. You know, I was thinking on a few occasions. You find your answers in the most unpredictable places. And I remember John was sharing with me one day his trip to Stanford. So he went there to talk to some professor of population health and she was sharing studies with him. It was on Medicaid population and precisely on diabetes, because like we all know that diabetes is super high in Medicaid population. And she was saying that, amazingly enough. But research shown during interviews that Medicaid people are so willing to use all the high tech apps, they are willing to engage with health care and they are willing to do everything that depend on them to make sure that they stay as healthy as they possibly can. And he was sharing one particular interview with an older gentleman with diabetes, and he was using the gadget he was given by his PC. And he was saying that diabetes probably is the only thing in my life that I can't control myself right now. And I just still remember those words. And every single time, like whether I'm working on my hospital at home or any other projects, I am thinking about that end receiver who's going to be using the technology and how it impacts their lives. So I think that definitely he he just implanted this concept in my brain.

John Moore III: [00:32:42] Yeah, and that's the other thing. You know, just talk to people. You never know what kind of juicy nuggets you'll get around understanding the industry better. You know, as analysts, it's already part of our role to be at events and hear the get the pulse of the market and hear what people are talking about. But he was great at just talking to people on the floor, talking to people in the halls and, you know, the different events. I mean, some of the best memories that people shared with me were meeting him at the airport before or after the event and just riffing on things that had happened or things going on in the industry. Some of the tightest relationships I know he had was from meeting people in the airport after the events that he would attend. So I guess as I think about the future of Chilmark research and how we build upon the legacy that he began, I think about the company, you know, we got our. We cut our teeth around the patient health record space. That was really the first area that we dug into and that exposed to my father that really the big area was the space. The interoperability problem was the biggest issue that we were going to face as an industry. And so we really got deep on the interoperability issues and helped define honestly the space and what he's really needed to provide in order to truly enable the functionality that the government was trying to encourage and push. So as I think about where we take the company, I'm looking back to its foundations and seeing where we are today relative to that, looking through a bunch of his posts as part of the thinking about what to talk about on this podcast and how to remember him.

John Moore III: [00:34:20] I saw a few patterns emerge around the big topics that he would write about over the years beyond just a specific type of technology or specific technology category. And so a couple of these were how do we turn some of these into platforms? How do you actually develop a platform in health care that is going to enable more cohesive. Uh, integration of different applications and services that can provide better care can actually change the care delivery process. So the platforms piece is something that he wrote a number of blog posts about, but we never actually did a research report on because the market maturity was never quite there for there to be true platforms. So Jody and I are actually right now working on scoping out some research with Vince Kritis to really start looking at that platform space and see if these platforms are mature enough to really be considered an enabling platform that health care organizations can then build on top of. Another big area was data rights and who owns the data. So I actually when I was going through his post, I saw that he actually had two post titled Whose Data Is It Anyway? And they were almost a year and a half apart and they were doing completely different takes on who owns the data. They both had the same premise, which was that we really need to work this out as a society and come up with some new regulations or some new guidance around data ownership.

John Moore III: [00:35:38] But we still haven't done that. And you know, when it all boils down to it, it's really the patient's data and we all know this, but how do you actually activate patients to then take control of it and own it and, you know, know how their data will be used or not used in the future? So one of the areas that I am going to be kind of focusing on long term for the company as we go is I really want to get us involved in the policy conversation around data rights and in health care. I think that we're coming to an inflection point where the government is going to have to step in because of all the current issues with big tech abusing privacy. And I think that that will trickle into health care. So I want to be sure that we are part of that conversation when it does finally happen and, you know, advising people around that data rights issue. And that brings me back to Jody again for another area. We were one of the first firms to really take a crack at what's going on in AI, in health care, specifically in health care, as opposed to just AI writ large. And so Jody is currently working on getting some certifications around responsible AI development practices. He's been studying this area for a long time and I'm really excited to be able to have that be something that we can offer from Chilmark is what our best practices around governance and the management of data and privacy rights. Jody, I don't know if you want to add anything to that.

Jody Ranck: [00:36:59] Yeah, I think this is one of the most in my mind, one of the most important issues of our day and creating the guardrails and beyond and safe practices around the development of AI. Since AI is playing a bigger and bigger role across our economy, from access to education, health financing, health care, all of that, that we need to really dig deeply into it. And it's more than just validating algorithms, although that's that's an important part of it. But I think we need to start looking at I'm calling the algorithmic determinants of health because we know there's a lot of bias and so forth, but these things creep across the whole economy. So tracking algorithms, who's made them, how they've been validated and where they're being deployed is a major task. And it's not this existential crisis nonsense that Silicon Valley peddles. And I'm not buying that dog don't hunt, as they say, that that's a dog they've put out there to enhance their own power over these discussions. And we need to fight that and come up with what we think are democratically developed practices for responsible AI and automation as well.

John Moore III: [00:38:17] Yeah, that also completely agree. But you know, things that also won't inhibit the innovation piece and threading that needle, threading that line, it's very difficult.

Jody Ranck: [00:38:25] But I think the important way to think about it is to before we jump down that particular framing is to think that good governance enables good innovations that move fast, break things doesn't it's a failed a failed model. So I think you've got to be careful to say, oh, your your regulations and safety guardrails will impact innovation. Well, you know, good solid regulations and and best practices around responsible AI, implementing responsible AI at the mundane, everyday level that will drive innovation not not not buy into the blackmail that all these practices that will make better algorithms and so forth work for more people. That gets in the way of innovation. It doesn't. Who are you innovating for?

John Moore III: [00:39:20] Yeah, completely agree with all of that. One of the last kind of decisions or policies that he kind of enacted internally was the fact that in all of our research going forward, we will talk to the AI element of what's going on in that technology area. So I think that, you know, he's a big believer in the future of AI, but also in the inherent problems and risks with it as well. So I think that us really leaning into that will be a great way to build upon the Chilmark legacy. And then another thing that we've been working on for a couple of years that that we're finally about to release and, you know, really be pushing is this future of health care map that we had developed. And this was something that actually Jody and my father had really worked on together with contributions from the rest of the team as well as, you know, some industry experts that helped us really think through how we position this this new graphic or framework that we're introducing. So, Jody, do you want to talk about the health map as well?

Jody Ranck: [00:40:23] Sure. In a previous life, I worked as a kind of social science futurist forecasting and so forth. In these types of maps are really, I found can be quite valuable in helping people wrap their head around a lot of different you know, we have some major drivers from value based care and consumerization and so forth, but then lots of sort of micro trends as well as some potentially disruptive events or constellations of things that can come together and sometimes change an industry. So going through the like a very disciplined research approach to map all of these trends and drivers and some of these potentially change making, I hate to use the word disruptors, but you know, we'll use that for the time being. Big stories that can sort of make a big dent in established practices, mapping this out so you can see as much as you can on like one map, but also understand that there are holes in a map. No map is the entire territory, but you can use this to help you find in your own niche that your company is in to sort of go through an exercise to think about where where is the uncertainty and then narrow that cone of uncertainty, as Paul Saffo calls it, and and start generating forecasts and develop scenarios and understand the different impacts these could have on different types of patients, for example.

Jody Ranck: [00:42:02] So we we mocked up a few personas and these are not rigid kind of fetishized personas, but just a tool to help you ask questions about what could be the impact of the impact of consumerization with AI, with, you know, the public health crisis and so forth, on a particular type of product or service you're offering, and then map that out and see like, Oh, could there be an innovation here? Could there be something that could disrupt our our company's business? So it's a we think it will be a really effective tool for companies to do their own scenario planning, forecasting, even risk mitigation and so forth that we can help your company with and use this as a tool and then take your own custom data and insights and overlay that on top of this map and work with you to through an exercise as such to plan your innovation strategy or, you know, forecasting for the next year or two and so forth, not necessarily predict the future, but plan for potential futures and then maybe work towards alternative futures that you desire.

John Moore III: [00:43:13] Yeah, I'm really excited to see how people receive this map and see some of the conversations that hopefully will start. I'm definitely curious to get people's hot takes on where they think some of some interesting inflection points may happen in the industry at the intersection of these different trends and stakeholders or I guess care delivery sites. Something else that I'll be working on personally that I'm kind of taking on is looking at the impact of health care. It over the last 15 years, roughly since high tech went into effect. I know that impact and value has been assessed for many years now from a number of different experts in the space. And so we're going to look at what frameworks have been developed, how this has been approached previously, and start having conversations with folks to understand, especially buyers, to understand how they assess value, whether that's purely ROI or if there are other upstream or downstream effects that they're looking for from the implementation of these tools as well as secondary effects. Basically, what are some of these downstream effects? What are some of the secondary effects of the implementation of health care? It and if anybody has any thoughts on that or have done these evaluations, I'd love to hear from you because like I said, we know that this has been a problem for a number of years, trying to figure out how you actually effectively assess the impact of these technologies.

John Moore III: [00:44:35] And I also want to in this impact effort, I also want to take on kind of the sociological aspect of what's going on in the industry and be like, okay, some of these problems that people are developing for, they're not really technology problems per se. They are social problems that require social engineering before any kind of technology can actually come in and have an impact. And I think there are definitely many things in health care right now that we're trying to fix with technology that is not necessarily a technology first issue. We're also. So something else that we just started getting into in the last couple of years was looking at the revenue side of health care. Historically, we focused more on the actual care delivery enabling technologies. But in the last five or so years, we shifted to incorporate a little bit more of the administrative work going on because of how that affects the patient and the provider experience of care delivery. And so one of the reasons why we hired Elena specifically was because we were getting into this space. And so, Elena, do you want to share a little bit about kind of your expectations and interests and how we'll be covering the finance side of health care going forward?

Elena Iakovleva: [00:45:43] Yes. John. So working in a revenue cycle for over 12 years, I've seen so many glitches and slips of the system in terms of proper billing, proper reimbursement policies, just the enormous amount of manual labor that's involved in this whole process. In the next report on payer provider convergence, hopefully Chilmark can analyze deeply this whole space because without a doubt, it's pretty much clear that the future of RCM is in convergence. So the more we build trust between providers and payers, the more we can proceed with this utilization costs, with providing care quickly and making everybody's life so easier. And with that, I'm thinking primarily about patients in my career. I've seen improper billing practices way too often in my own billing history, and all the bill bills from hospitals that I've received during my lifetime in the United States, at least in 60% of them, I've seen errors, whether it was billing or coding or something else. And that is really unfortunate. And one of the ways to actually make it all tight and make sure that we're doing the right thing at the right time for the right person. It really takes a village and the convergence will probably going to be the answer to most of those questions. So that's how I see that evolving over time. And I do see a lot of technologies popping on the market. They might not be the newest technologies, but I think that they are developing pretty quickly, serving multiple stakeholders and actually showing quite an interesting effect on the market and a very impactful result on provider side and payer side likewise. So I am extremely curious and what the revenue cycle in the United States is going to be in 2025. So that's going to be the next goal for Chilmark research to make sure we communicate it properly back to our audience.

John Moore III: [00:48:09] Thanks for sharing that, Elena. I'm excited about getting into the space. For years people were asking what we were going to do in that area around, you know, different aspects of the payment and finance side of this world. So I'm excited to finally be getting into that. We did our first report a couple years back on revenue integrity and yeah, we'll be doing this new one over the next few months. And obviously convergence is a topic that we have been talking about from the Chilmark side for many years. We host our first conference in 2017 on the topic of convergence. So we've really been trying to build this concept in people's minds as we see it building in the industry on its own. You know, the growth of providers, the growth of IDNs and, you know, other assorted fully aligned systems. And then finally, we're going to keep sticking with our interoperability work, of course, and as well as population health management. But on the interoperability side, I wanted to bring Fatma in to just talk a little bit about what she'll be covering in that space over the next year or so. As far as, you know, current plans.

Fatma Niang: [00:49:10] I anticipate watching Tefca really closely to see how that pans out as things get established as well as info blocking, just seeing what happens in the aftermath. And I'll also be working on an API report that's slated to release later this year.

John Moore III: [00:49:27] Thank you Fatma. I'm definitely looking forward to seeing what's new in the API space. Obviously Brian Murphy, who is our original interoperability guy, other than my dad, wrote a lot on APIs over the years, so I'm definitely curious to see where we've come today and how both new technology as well as new approaches to deploying APIs and cleaning and normalizing data due to new standards. How all of that is expected to shape up in the industry over the next few years and how that might affect both technology adoption as well as, you know, the ability for patients to use their own third party apps to manage their health better. I mean, who knows if they'll actually take it up? Because as any way that's been in this industry for a while knows, getting patients activated is hard. But maybe part of that's just because of how complex the system is. And as some of these new tools come out and simplify it, you know, maybe people will take more responsibility and ownership of their own health and not just of their child or their parent or, you know, the external person that their caregiver for. So with that, we're going to wrap up this episode. I really appreciate everyone sharing their kind of anecdotes and personal experiences with my father. I'm definitely going to enjoy looking back on this podcast in the months to come, as well as obviously going back and looking at his post and some of the other things that people have been saying about him. Like I wrote in my follow up post, hearing all of these personal stories from everyone has been really touching and a really great way to get to know my father a little differently than I knew him, because I always had my own relationship with him.

John Moore III: [00:50:56] But this has shown me just, you know, all these other relationships he had that I didn't know were as deep as they were. And it's been really fun to get to know him a little bit better that way. So I guess to close, I will share one of these poems that I actually so I just drove up to Boston from Texas. I'm going to be going out to the Vineyard, which was originally our plan. We were supposed to kind of meet up on Martha's Vineyard and we thought he might end up going there, But I'm still going to be going out there with my stepmother and sisters. And I actually when I got to the house, I found one of his old notebooks, had some poetry in it. It addresses my step mom. So it starts, my gracious Andrea so fully of giving, so radiant with love. I have no idea how through struggles and trials, a time when everything was thrown at me, I was able to come through the other side to find her waiting. My trials are not over yet. Knowing she stands next to me, none. See them? The doom they once presented. I find there are times when thoughts get away. Thoughts of the future. What will it be? How long do I have? But upon reflection, these are meaningless. No one has these answers yet. Everyone has today. And today is a good day.