Marcus Osborne 0:28
Hello, my name is Marcus Osborne, I’m with Walmart Health and Wellness. And it is my great pleasure to be able to chat with Ryan Wells today. And Ryan is one of my very favorite, when we think about the word entrepreneur, he’s one of my very favorite entrepreneurs. And so in the course of this discussion, what I’m going to, hopefully, we’ll get into is have everybody else figure out why he’s one of my favorites. I think it’ll become obvious to everyone. So Ryan, thank you for agreeing to join today and be willing to talk to me.

Ryan Wells 1:01
Thanks for having me. It’s gonna be fun.

Marcus Osborne 1:03
Yeah, gladly. Before we get into anything specific, I have a first question that I’m asking everybody that I talk to. If you’re trying to get somebody to do something or you want to understand why somebody is doing something, doing what they’re doing, either way, you need to understand what fundamentally is motivating that individual. What gets him up in the morning, what keeps him up late in the night, what is it that sort of, you know, rings your bell? This is not so much a comment about why you got into healthcare or why you’re an entrepreneur. I’m just interested in general, what is it that motivates you and why?

Ryan Wells 1:39
Oh, that’s good. I think I’m as much a creator as I am, you know, when I look at what bucket you put yourself in, compared to a business leader. I really like unwinding a complicated problem. And I like applying multiple pieces, you know, and weaving those pieces together to create a solution. So that process, for me, is the biggest motivator. You know, that’s the beauty of being in healthcare. You’re not short on problems, right? And the bulk of those problems are layered, and they’re, you know, we’ve always got to dub them as these wicked problems. That’s, to me, a creative process, to kind of find the root cause, kind of try to see the layers, and understand the stakeholders. And then weave. Either you’re applying technologies or you may be actually inventing new ones. And I’ve never looked at that situation, and kind of paused. That’s when I actually lean in. And it’s fun, right? It’s just, for me, it’s energizing. It’s very uncomfortable. Because a lot of times, if you’re doing something new, there isn’t really a playbook. And I just constantly say it around here, you know, you just got to be comfortable with being uncomfortable. You just have to, you know, take it one step at a time and, you know, go through the process like that. But I think it’s the creative process, be honest with, you know. I think, if that wasn’t part of this journey, then I would probably have trouble.

Marcus Osborne 3:05
Your comments there were kind of interesting to me because, in some ways, it throws me back to this concept of human archetypes and the kind of view that there are a number, but at some point, there’s this, kind of, always a desire to like put people in fewer and fewer buckets. And there was this one that, you know, there was a claim by, I don’t know who the individual was, that you have builders and you have farmers. And if you want to have your society be successful, you need both. You need to have the people who can build cities, and build buildings, and build roads and build, you know, build the things that occur that allow us to engage and progress. But, you also need farmers who can produce and go out every single day and often sort of do the same thing over and over, but look for small ways to kind of improve. And I think what I heard from you is that leaning to being a builder. And we’re gonna come I’m gonna come back to that one because I think that’s actually interesting. I have this fundamental belief in theses and the thesis, and this idea that, when we see something, when we see a problem, when we see a challenge, when we see an opportunity, we actually see that challenge or opportunity. And we inherently kind of develop a thesis around it. That thesis often explains or describes why that is an opportunity or why it’s a challenge. And so what I’m interested in is, as you think about what you’re doing today and what you’ve worked on in healthcare as an entrepreneur, I’m interested what is that thesis or theses that you have about health or the healthcare system, or whatever it might be, that have influenced you, that continue to influence you as you think about what you as a builder have focused on building?

Ryan Wells 4:47
If I look back and, you know, kind of started out right out of college in the medical device industry, which threw me into, you know, I was a medical device rep starting out, right? So, I was in surgeries. I was really seeing it on the frontlines, right? And it really drove this deep respect and appreciation for, you know, what these searches do, what the specialists do, like, you know, there’s not a lot of padding. You know, it’s really where healthcare, where the rubber hits the road, right? Snd I think that’s, you know, in trying to create, you know, a retrospective on the building blocks of, why do I think the way I think and why I would go to some thesis. In short, the patient/provider relationship is the bedrock of healthcare. I firmly believe that now. I’ve seen healthcare from multiple lenses over the years. And, you know, it’s just a complicated environment. But that relationship is a pure relationship rooted in trust between that patient and provider. And I think the noise around healthcare is what disrupts that, right? So for me, I just thought it was a very interesting challenge to make that relationship as pure as possible and get the noise away. And I think the best technologies can do that. You really may not even really think of the technology. But if it connects people, and builds trust, and makes events frictionless, that to me is very exciting. And making things simple is a great challenge. And I think that’s about as clear as I can, you know, piece that together.

Marcus Osborne 6:31
And so let me kind of just for fun here, I’m going to then challenge you on that, on that thesis, then. I’m going to say, what we see now the emergence of real AI, not fake AI. I say fake AI is just this stuff that I can do, which is create a very simplistic, I’ll call it an algorithm or equation, that sort of analyzes data, that sort of even, like, not even machine learning. It’s like slightly smart Excel spreadsheets. But, real AI. And your comment about the role of technology in that patient/provider relationship, I’m interested in, to what extent do you sort of see advancing AI solutions in healthcare? Do they sort of have a displacement effect on that relationship, meaning, is it now between the patient and tech directly? Or does it create more of what you were describing as an enabling effect where it enables that sort of relationship to sustain, grow stronger, be deeper? Or both? I’m kind of just interested where you see it going?

Ryan Wells 7:29
It’s a great question, I think. A loaded question too, I think, the best-

Marcus Osborne 7:35
You’re welcome.

Ryan Wells 7:36
Yeah. I think where we are today, you know, we’ve got to remember that we’re seeing these huge advantages in 12 to 18 month periods, right? And so I’ve been tracking this space for the past three, four years, really, pretty diligently. And there’s these different buckets, right, of what, you know, AI has just sort of been this catch all, you know. I look at it from either machine vision to machine learnings, you know. You kind of put that natural language processing, taking all the big data and mashing it up. And so all these different buckets are there. So I think the way I see it is this: for the foreseeable future, I see is a great augmentive technology and/or enabling technology. I think it’s safest for it to be applied in processes that are non-clinical at this stage. It’s not because of the technology. I think it’s the source of the data, and how clean is the data, right? And we haven’t really got our heads around that, right? So I’ve seen a lot of different great talks on this, from Eric Schmidt and on down. I’m a big fan. You know, I had this turning point about how I thought about it when I watched the Netflix Go documentary, the deep mind thing. You know, it was kind of, to me, this was the existential turning point of what AI could do. The way I see it is, no, I don’t see it displacing that relationship between caregiver and patient. Could you onboard or navigate to find the right caregiver? In other words, again, I view that as an augment or an enabling tool, but not to displace the actual care delivery model. I don’t see that. I even get nervous when we make claims around just triaging sort of the diagnostic process, right? I’ll tell you this, this is a good little quote from one of the operators I was working with, one of the physician groups, and we were starting to build out our platform. at this point, it was just, you know, a glorified slide deck, right? And there are a lot of moving pieces that haven’t been done yet and he’s just really doubtful. And I’m like, this is right around the time when, you know, SpaceX just had the rockets landing in synchronicity onto the pads, which I just thought was the coolest visual I’ve seen a long time. And I would say something like, you know, surely, if SpaceX can autonomously land two rockets at the same time, we can onboard a patient and go through this process. He goes, there’s not a patient on that rocket. It’s like you’re adding this new variable and you can really have this great technology. And then when you apply the human variable and all the complexities around what that might mean, that’s a humbling piece, right? So that’s kind of how I view it. I’m a tech junkie when it comes to something like that, right? I really want to apply it. But you can’t be a technology looking for a problem. It just has to slap you in the face. And like, oh, yes, there’s that. We’ve applied several layers, more on the machine vision and machine learning piece. But like, we tried to train up sort of a chat bot in doing mechanical turks and getting utterances and I’m like, man, we’re just years away from that. I don’t know if we’re ready for that culturally.

Marcus Osborne 10:54
It’s funny, you unintentionally hit on one of the things that, when people ask me, what advice do I give to entrepreneurs, there’s a few things that I have. And one of them is, stay away from the temptation to build the thing that really excites you, the “build it and they will come” mentality. What I will honestly tell you is I’ve never seen “build it and they will come” work, right? Ever. Even Walmart, sometimes I see us build things that I’m not certain we ever really assess whether people wanted them and, guess what, we do. We put them on a shelf and they don’t sell, right? So there is kind of this reality of the tension between, you know, pushing progress and meeting people where they are. So one of the things that I’ve always found frustrating in entrepreneurship is the mythology of the entrepreneur. And the mythology goes something like this: of two people getting together in Starbucks and grabbing one of the napkins with a pen and writing down some business plan, and they walk out of there. And then with just deep vim and vigor, they go about executing that business plan, and they don’t let anybody get in their way, and they don’t let anybody tell them no, and they don’t let anybody kind of stop or sway them, or those kinds of things. The greatest entrepreneurs are the most pragmatic, are the most flexible, are about learning and taking that learning and having it transform what they do. But I’m interested, when you think about entrepreneurship and being successful as an entrepreneur, how much of it is kind of the doggedness, the kind of stick-to-itiveness that I’ve heard people use that term, versus the sort of being pragmatic, being open to evolution, being open to change. Where do you kind of stand on it and how has your experience in your current business and what you’ve done entrepreneurially overall, how’s that kind of informed your view on entrepreneurship?

Ryan Wells 12:43
I’m sure there are so many different sort of amalgams of personality types that drive successful entrepreneurs, founders. I actually rarely use the word entrepreneur. Outside of something like this, I don’t even really think of the word. I kind of like just thinking of myself as a founder, just in the sense that, okay, I’m going to take this thing that I think is meaningful as a theme, and start peeling back the layers to it. The characteristics that I think are relevant, for me. Not only is every founder different, every deal is different. I am a different CEO, founder, CEO than I was in my first company. You know, my core, my wiring, is the same. But, you know, the circumstances and the model are different. I don’t know how much my leadership style has changed or whatnot, but I’m sure it has. But the things that I think are essential for me, it’s hard for me to kind of think about universal characteristics. Observation, you know, observation is key, right? And it’s key because you got to have pattern recognition, you’ve got to kind of see, what’s repeating here? And is this, you know, something that, once I see the pattern, I can get to the root cause? And is that root cause fixable to yield this result? And is that result something that people really want? You can fall in love with the result, then realize the key stakeholders don’t want that change to happen, for whatever reasons. And so, you know, that’s what’s so fun about it, because you think about all those layers. And you know, you’ve got checkers, you’ve got chess, you’ve got Go. And when you get to the Go level, you’re thinking about all these dimensions, it’s hard to calculate. So I think that’s what’s interesting, and maybe why people are so fascinated by the entrepreneur as a definition, because you’re going into a place that’s unknown. There’s not a playbook. I do believe you just have to be decisive and the timing of your decision can be as important as how good your decision is. I’m pretty comfortable with making decisions quickly because I think it’s very rare that you can’t unwind a bad decision. Now, there’s some critical stages and, you know, you’re like, I look back like, oh, wow, blew that one. But there are also things that led up to it. It gets back to my whole “be comfortable with being uncomfortable”. You have to just sort of be willing to sit on the fringe there. I recently met Jim McKelvey, co-founder of Square. We’d just closed a round and he’s the GP. And he just written this book, “The Innovation Stack”. And, you know, he really does a great job of talking about the genesis of Square. They didn’t know it at the time, but he’s kind of dubbed this process the innovation stack, and it’s problem, solution, problem, solution, problem. It’s not like, once you solve one problem and you have the solution, that nothing else is gonna follow. And so I think there are some folks that are going to be really frustrated once they solve the first problem and realize there’s five more. You’ve got the solution in place, and then all it does is really unveil five more problems, you know, but that’s the stack, right? So if you can go and continue to build out to where, effectively, you’re building a platform and/or ecosystem, he references that story as compared to, you know, Amazon basically copied, you know, the Square, and could have crushed them on every level with financial power. But, they didn’t have the stack, right? They were just going for the one slice of how someone interacts with a credit card transaction from a small business perspective. It’s stuff like that I find so interesting that I don’t really spend time thinking about but, you know, if you ask the question, what does that really mean and what characteristics drive that process? I’ve just been sort of doing things project oriented, building things, since I was young as I can remember, right? I wouldn’t have self described myself like that, outside of, I wanted to be an architect when I was in sixth grade and somehow I veered from that at some point. My wife still tells me that she thinks that I will go back to doing that, at some point.

Marcus Osborne 16:47
I was talking to somebody, an individual that I’m friends with, about a founder that we both know, and I won’t name this founder, but I will tell you that our interaction with this founder is, this individual has founded a startup and that I think the startup is going reasonably well, you know, it’s moving along. And it looks like their own personal health has, they struggled with it for a number of reasons. And some of it is, you know, this belief that “I took this money from these venture capitalists, and I’m afraid I’m gonna screw up their investment” or “I’ve hired all these people and I’m afraid that I’m gonna screw up the company.” And this is a bit of a paradox, that need to have that level of ownership in what you’re doing, to be that sort of committed. But at the same time, you describe some of that, you used the word, I think maybe you used it at least three times. Maybe you said it four times there: fun.

Ryan Wells 17:40
Yeah.

Marcus Osborne 17:41
So help me understand, why is it fun to you? How has it become fun and not something that causes you to only sleep three hours a night and have your hair fall out?

Ryan Wells 17:50
First of all, I’ll say, it’s not always fun. It is a high stress journey, and it’s long, and I always frame it out as like an NFL running back career. You get past three to five years, there’s some wear and tear that’s kicking in from those nights and your processing things. And I think it takes a village of support too. I think you have to have people around you that really honor that journey. And you have to also honor the fact all these folks are supporting you. So I think that’s important to be said for anybody that’s thinking about taking that journey. I think what really resonates with me when you start thinking about, when you take on outside capital. And this is for me personally. I burden that weight tremendously. Taking other people’s money has always been this weird dynamic for me, right? It’s great because it’s a catalyst for growth and, you know, you can do so many things. On this one, I actually held off quite a long time. And I was fortunate to have the resources to do that. The genesis of doing that was, I kind of had this idea of like, it’s kind of like I’m buying this artistic freedom, right, because I’m not really beholden to any vantage point other than my own for X amount of time, outside of a couple I’ll kind of call super angels that just really knew me, like, really, they were betting on me, versus where we were at that time, 100%, right? There’s got to be a lot of humility in that early journey because there’s got to be very few deals that really crushed it, nailed that whole model early. They went out and they ran into some brick walls and they’re bumping around in the dark on some topics. And you just have to recognize, again, there’s your pattern recognition. If it happens once, okay. If it happens twice, now it’s three, four, wait, Something’s just not right. It’s not because we aren’t working hard enough. We’re not working smart enough. There’s something wrong here. But then you have to shift gears because you might have the right solution. But the market may not recognize it as such yet. So that’s a sales-there’s this ship, right, of converting mindset on thinking new versus the old way we did things. So I think there’s a really complicated relationship there from building out a solution that’s scalable, that solves these problems, and then making sure the market understands the solution in a new paradigm, especially in healthcare because healthcare providers specifically are entrenched in their workflows not because they choose it, but because that’s what’s been dictated to them by the ecosystem, right? Whether it be the EMR workflow, regulatory, FDA, you know, all these outside pressures really define workflows. And so, for you to come in, you might have this whiz bang technology that really will change their flow and make a better world, but it breaks the ecosystem, you know, ruleset, let’s say. You kind of recognize that and so what you have to understand is that, can that be broken? Should it be broken? And did we do the right things to fix it? It’s an interesting balance between being humble and then also seeing a vision that like, okay, there is a new world, that looks so different. Can we shift the mindset to get there?

Marcus Osborne 21:13
There was an individual, Greg Foran, who was the CEO of Walmart US a few years ago. He always had this quote, it sounds a little hokey, but I absolutely love it, which is you get one point for talking about it, and nine points for doing it. But embedded in that is also a commentary about what’s hard, meaning the reason why you get more points for doing it is because the doing it is hard. And in some ways, the doing it is where you’re more likely to fail. And, you know, if you talk about, you really can’t fail. So that’s the upside. What was the sort of moment that you said, I’m gonna go from just simply being happy with talking about it, and being happy banking that one point, to saying, no, I’m going to actually go do it and try to earn the nine points? Maybe it’s the sort of advice you would give to somebody else who’s considering founding their own company and start trying to start something up.

Ryan Wells 22:02
Like I mentioned earlier, I started out with Johnson & Johnson on the med device side. And when they acquired DePuy, I think in ’99, I was at our national sales meeting. And I should mention that journey was a great precursor, because I think, out of the 25 years I’ve been working, I’ve been a salaried employee for eight months. And that’s when after acquisition of our last company, right? And I didn’t stay a year. So, you know, even with Johnson & Johnson, it was a commission-based sort of 1099 negotiation. That’s my normal, right, so I guess I’ve built up tolerance on that front. But I will say, you know, in the role that I was in, we built up a really good business in the market we were in, I was doing pretty well at this time that I’m getting ready to mention. But we were at a national sales meeting. And Dean Kamen was speaking and Dean came and doesn’t really do a lot of public speaking. So Dean Kamen, DEKA, Segway, the iBOT, and I think the only reason he actually spoke is because J&J had put like $50 million into the iBOT, so it was basically like, Dean, can you go speak to these guys? So this was definitely a moment of clarity for me, right? So, you know, he comes out on the Segway and he’s telling these great, you know, this is a brilliant engineer, great stories about the innovation cycle, kind of, you know, just like, how does he get to this point, and what does it do? And I literally can still remember this. And this is, you know, again, I think in ’99. I don’t know if I have my year right or not. But I’m literally like looking around the table of my peers. These are folks that I’ve worked with, you know, 8, 10 years, at least, at that time, I think. And I really just asked myself, like, am I more like, these guys or am I more like him? Or do I want to be like him? And it was just like, no going back. It was sort of ingrained in me, it’s like imprinted, that this isn’t my journey anymore, right? It just wouldn’t go away. I basically scripted out this whole business model in 2001, but did not act on it until 2007. So you can see there that, while it was imprinted, I did have to really coach myself up, like, can I do this? I mean, why do I deserve the right to go try to build a technology? I’ve got a degree in anthropology. I mean, where’s my, you know, credential to go build this new thing that’s not there yet in a complicated space. But I couldn’t help it, like I literally couldn’t walk that back. So it was almost like begrudgingly going, making that stuff. Not like this, you know, woohoo we’re gonna do it. But it had to be done. Also, I think on the duality of that, the energy was so high. So it was fun, right? I mean, it’s just like the thinking of that, okay, there’s a sense of a got to do it. And so, to get to the root of your question, you know, what would I tell you? I would say, what’s the why? I mean, why do you want to do it? That can be kind of existential, I think. Is there something, that part of you, that’s just itching for this? And I have folks call me, you know, either friends or, you know, someone that’s different stage of career and wants to switch. And you can almost hear it in the person that the why’s there, and they may not even recognize it yet, or they’re not comfortable with it. And then there’s others I talk to that feel like they’re still searching and they don’t really know the why. And that’s probably not a, that may not have a happy ending. Rob Morris is one of my mentors, and has said this, that he doesn’t believe companies fail, he feels like founders give up. And I think there’s a lot to be said about that.

Marcus Osborne 25:42
Well, maybe that’s a good place to end it. Let me first, Ryan, thank you for what you’re doing. And I think, the story you just shared, it’s through conversations like this, that I hope that you maybe your story acts in the same way on somebody else that Dean’s story acted on you, right, that convinces somebody. Because here’s what I do believe, and this is part of the reason I agreed to do this. We’ve got real problems. We’ve got problems in healthcare, we’ve got problems broadly, we’ve got climate change issues, we’ve got any number of challenges that we’re facing as a planet, as a species, as a society. And probably the biggest thing that gives me hope is innovators and people willing to take risks to go out and do the crazy things to build companies and build institutions that are intended to kind of solve these challenges that we face. That’s the thing that gives me hope and optimism. And so, thanks to what you’re doing. Hopefully, people will be inspired to step up in the way that you stepped up and I appreciate you sharing your story today. Thank you.

Ryan Wells 26:42
Thanks for having me. This was fun.