Frank Jaskulke 0:06
I think about many years ago when the 35 W bridge collapsed, and rapidly a lot of patients have to go to now Hennepin Health Care at the time HCMC just down the street. That health system has to be prepared every minute of every day for an event like that to happen so that people don't die. What could you imagine if your business was run staffed at 100% capacity for the busiest clients you ever would have 365 days a year, no time off Saturday or Sunday, 24 hours a day? What would that do to your margins? Right? It doesn't work as a business.
Matt O'Leary 0:53
This is Matt O'Leary, and you're listening to the Influence Hacker Podcast. Let's face it, marketing doesn't have a great reputation. While cynicism about the field grows, making people care about products, services, platforms and good ideas isn't going away anytime soon. That's why we need to chart a path forward to learn how marketing can be both growth oriented and good to humanity.
This podcast is an unlikely collaboration between marketing expert John Lenker, academic philosopher Kevin deLaplante, and myself, a counselor by training, through fascinating interviews and in depth analysis. Our purpose is to educate everyday consumers, such as myself to be more critically minded and discerning about marketing messaging, while educating marketers to be more ethical and effective as they strive to influence consumers. We affectionately call this process influence hacking.
Frank Jaskulke 2:07
Well, my name is Frank Jaskulke. I'm the VP of intelligence for the Medical Alley Association.
Matt O'Leary 2:23
Our guest today is Frank Jaskulke, a fellow Minnesotan with John and I and an absolute world beater in the art and science of medical industry innovation. In this conversation, we first get to know Frank's work and his perspective on what makes the US medical industry so difficult to solve, both for medical startups trying to make it and for the rest of us on the other end, consumers of medical products and healthcare services. Then Frank hands over a few ingredients of a secret sauce. We'll gain key insights into why some medical startups make it, while others fizzle.
Maybe your in medicine yourself or the healthcare industry, or maybe you're like me, I only think about healthcare when I'm forced to compare insurance rates or when I'm watching presidential debates every four years. If you're that person, then why should you care about Frank Jaskulke? Well, if you're in business or marketing, it follows that you should be soaking in business wisdom from experts. It's really that simple. And frankly, Frank knows better than anyone how a new company and an endlessly complicated and regulated industry like healthcare, can manage to grow like crazy, that is to grow while keeping the end user, in this case the patient first, John asked Frank about the history of the Medical Alley Association.
John Lenker 3:55
This would be a great moment for you to talk about why Medical Alley exists because, you know, ostensibly, it's here to create an ecosystem where nurturing and cross pollenization of ideas and helping people get access to people different perspective, different talents, you know, there's a whole point of what you guys are doing is to in fact, make this easier, so maybe a little pitch for this.
Frank Jaskulke 4:20
Yeah. Back in 1984, Earl Bach and founder Medtronic, Danny Lieber Lin, who is an entrepreneur as well, and the governor at the time, Rudy Perpich. And the planning commissioner, the future Governor Mark Dayton got together and said, Minnesota's got this incredible healthcare ecosystem. So Earl and Lee had this idea that we need to protect and promote healthcare innovation and we should create an environment in which no place on earth is better at bringing people together to solve problems in healthcare that improve quality and lower costs. And make sure the world knows it is the best place on earth. So that if someone's in Berlin, or Beijing or Mumbai or wherever, and they go, I want to solve a problem in healthcare. Their second thought is I need to get on a plane and get to Medical Alley, because that's where I'll find a welcoming community, the best infrastructure, the smartest people, the most capabilities to take an idea and turn it into an actual product that benefits humankind.
Matt O'Leary 5:29
Frank's focus is on medical startups with the initiative, Medical Alley Starts. Meant to lower the cost of starting scaling and pivoting new business ventures.
Frank Jaskulke 5:39
Imagine you're doing your work. And you go, Oh, my gosh, I need help with marketing, like, I don't know what I'm doing. And I got to figure this out, because we have a milestone to hit or we don't get funded. And they could call a bunch of people they could Google they can look around to try to find someone who knows their space, and it's trustworthy, or they shoot us an email, they tell us what they're looking for. And in 90% of the cases in under an hour, we send them back a couple of options that we know, do work in their area, have references from trusted parties, and then get back on with their work.
Matt O'Leary 6:17
Like Silicon Valley, Minnesota's Medical Alley is littered with hot young stars trying to make a big, well, sort of, there are plenty of entrepreneurs and startups trying to bring their products to market to help more patients. And it's exactly this goal, bringing good ideas out of heads and into the real world that connects what John, Kevin and I are doing with influence hacker to Frank's passion.
Kevin deLaplante 6:43
My name is Kevin deLaplante, I'm Chief Knowledge Officer at Lenker. My background is actually in academic philosophy, and taught philosophy at Iowa State University for 16 years before leaving, and I left partly because I was interested in making a public impact in a way that it's hard to do when you're behind the classroom, and within the confines of academia. So I was interested in you know, great ideas. I talk about them a lot. But then the question about how you turn a great idea into realities is the thing. Right, right. And I know that this is you're in the business of helping to do that. And we as a marketing company are in the business of helping to do that.
Frank Jaskulke 7:24
I say, No, it's it's a great topic. It's right at the heart of what we do. And even earlier today, I was reading an article about doing code, like in software engineering, and this idea of like, it can't be good code if it doesn't make a good product. Right? Like if you get obsessed with the code, and the product actually stinks. It's not good code.
Kevin deLaplante 7:48
Right, right. Because no one codes for its own sake. Although although I should say there are people who code for its own sake, who would who have find that intrinsically valuable, right. But the but that practice will not translate into impact and influence that one might want to have if that's the only thing that you're thinking about, right? You have to run the football all the way down the field, and score, right. If all you do is like football plays, you know, executing football plays, that's fine, but if they don't translate into yardage, right, and touchdowns, something's missing.
Matt O'Leary 8:27
In football yardage for one team means more yardage that the opposing team has to gain to score. Unlike this zero sum game with a clear winner and loser. Business presents an opportunity for Win Win relationships where one company's extreme riches can mean 1000s or millions of customers happily served. Both better off because of the others contributions. Examples of exploitative capitalism and marketing aside, this is at least the concept of benevolent business. In the medical industry, John brings TelaDoc to the forefront, the leading innovator around virtual healthcare. This is an obvious win win situation right? Frank helps us understand how it isn't that clear cut.
John Lenker 9:20
But Michael Gordon was the guy who invented TelaDoc or founded TelaDoc. So the reason that I think that's a nice little kind of anchoring case is that it really does seem to be a situation where every single stakeholder, every audience, everybody who is involved in TelaDoc benefited and had their lives elevated when mothers had to choose between going to work and taking their kid to the doctor to see why they've got a sore throat today and into the barrier of either make money or I go there and then oh my gosh, I have this huge deductible and now there's all this out of pocket, you know until it comes up, I pay $25 a month. And suddenly for the, you know, 90% of all illness that a child will get in a 15 minute phone call without missing work without the kid missing school, you know, you've got a prescription that's going to CVS, the family wins, on multiple levels, the doctors win because it can be more efficient, and they can see more patients and the investors in TelaDoc, won, like everybody won, the founders won, I mean, those are the kinds of stories that inspire me.
Frank Jaskulke 10:35
Very cool. Well, I'll tell you on TelaDoc, the the direction I go is, all of that is great, except that we've built a health system in which emergency rooms are funded only because hospital systems have access to the primary care patients, which leads to secondary and tertiary care, which is what pays the bills, right? You have a kid at Allina, which means your kids still to care there as you get older, you need a knee surgery and you did it at Abbott Northwestern. If that front end goes to some other organization, how do we pay for the ER, when there's a polytrauma event because ERs don't make money, they can't really make money just by their very nature. They need to be staffed to serve a terrorist event 365 days a year. That doesn't work. So the the telemedicine piece right in healthcare is a balloon filled with water, you squeeze one and and it bursts on the other end. And the the fun practical business and political implications of those sorts of things or telemedicine making healthcare more accessible. Now, the rural hospital is even less profitable goes under, that's the major employer. It's the factory of today. And all of a sudden, it's you know, the rust belt all over again. And so these like threads that connect all the different pieces of healthcare. For me, that's the part that gets me very excited about this work that we have a multivariate equation to solve for that are, they'd be like NP problems, right? Like you can't solve them in a linear fashion.
John Lenker 12:29
It's amazing. Is there any way that you could just sort of take a step back and tell us a story of this case, telemedicine in a way that kind of frames this broader set of issues and interdependencies
Frank Jaskulke 12:43
Imagine, you had like just an open field and you wanted to build a home. It's pretty darn easy. There's no trees in the way no buildings, no existing infrastructure, there's work to do. When you kind of get to make all the choices. Then imagine you're in a dense city that's fully developed and you want to replace a home with an apartment building. And so you've got to demo the home and build the new apartment building. But you've also got to put in bigger electrical equipment and probably bigger sewer pipes. And you've got to do that without disturbing the neighbors too much, right? You don't want the house to tip over on the neighboring house. So there's all these things you got to work around that are much more complex, more costly, more time consuming than if you were, you know, building out an open field.
Matt O'Leary 13:37
Much like in aging building in a popular city. Telemedicine is embedded in the particularities of the medical context in which it came about decades ago. rural families can always drive for hours to see a doctor for their kids stuffy nose or sore throat. So the phone calls are reimbursed for city folk regulations cut out the possibility of insurance coverage.
Frank Jaskulke 14:01
So the clinics, the docks, they preferred you to come in. Pandemic comes along, and all of a sudden we don't want people going in. So we turned to this decades old technology, telemedicine, and say, well, heck, maybe we can use this and we saw that incredibly rapid adoption. And there was this mind shift, I would argue, that patients, doctors, hospital administrators realized it's not as complicated as we thought. Once the mental barriers were removed and the regulations were set aside for the emergency. We were able to move very quickly to do things that delivered effective care in 70, 80, 90% of the situations and really took pressure off of bringing people in and risking infection.
Matt O'Leary 14:53
Frank explains how this one domino in increased reliance on telemedicine has shifted the landscape significantly. You've got IT systems that need to be modified, you know, payment policies updated. And then there are new businesses coming into the market.
Frank Jaskulke 15:09
I mean, imagine if your Prime subscription included telemedicine, like, I'm going to watch the latest Jack Ryan series, and I'm going to go get a doctor's visit at the same time, maybe literally at the same time. So now I'm getting my care through an Amazon or whoever. And if I need something specialty, you know, the doc says, hey, you need to go talk to a specialist about your condition. Okay, how do I get a referral? Amazon probably starts thinking like, ah, there could be opportunity in delivering referrals, which in healthcare is a big part of the business. On the whole other end of that are emergency rooms that are managed by our health systems that handle emergencies, right, you get in a car accident, and you need care right now, they also have to be prepared for large emergencies. What would that do to your margins? Right, it doesn't work as a business. So we've had a model of, we provide subsidies from the federal government, we subsidize it with the cost of the procedures that are done, you know, surgeries that get done, and through the primary care facilities. And healthcare is not this disaggregated set of services, but instead is a very integrated set of activities where the money made in one area helps to keep the service levels and another area up, so that if an emergency happens, we're able to respond. Now, maybe that isn't the right model, but it is the one we have today. And if telemedicine takes off, if it sustains if it really starts hurting patients out, eventually, we can get to a point where the revenue is no longer there to subsidize those emergency rooms. And we have to start making really hard political decisions about how to provide that care and how to be prepared in the case of an emergency. So telemedicine, if we were starting from scratch today, knowing what we know now we probably would make very different decisions about how we pay for health care how we deliver it, the regulations around it, all of the things. But we don't get to do that we have the existing world and we modify it.
Kevin deLaplante 17:33
So you have situational awareness of this ecosystem in a way that few other people do. You can see when a proposal for what seems like a good idea from a certain frame of view, has downstream implications for the rest of the ecosystem. And part of your job, as you see it right is to help solve that strategic problem for people. So that their solution can find a home that actually works for everybody.
Frank Jaskulke 17:58
Yeah, fundamentally, right? What we're doing is trying to have enough knowledge of enough different parts of healthcare to see those connections. Because we know they're things that they need to change, right? What we're doing today is not working for really anyone that's involved in it. But each thread you pull, right has another end. And there's some downstream consequence. I think it's part of why you know, healthcare has been such a challenging nut to crack like aside from it's gigantic, but it's also so interdependent and intertwined. That you know, short of starting over every piece we move also moves every other piece of the puzzle at the same time, and sometimes those are working at cross purposes to each other.
Matt O'Leary 18:48
All this rigmarole adds up to the 12 sided Rubik's cube that we're stuck with today. Hearing Frank's inside baseball and the topic definitely gave me more empathy for everyone trying to make the best of health care the providers for sure, consumers and even don't quote me on this politicians.
John Lenker 19:26
Think there a lot of people, especially consumers, you know, the health care system, they're out to get us their filthy rich, they don't care about the everyday people. And what you're telling me is, it's a fight to stay alive.
Matt O'Leary 19:45
While the health care industry in our country is in a perpetual, uphill battle to sustain itself, it's not all doom and gloom. med tech shows great promise. The Advanced Medical Technology Association reports that from 2000 14 the 2019 US medtech employment grew by 4.1%. Compared to a 3.3% increase in overall manufacturing employment. Minnesota's Medical Alley is an especially shiny beacon, producing a whopping sum of state revenues and jobs. And then there's a life saving medical technology itself. No example greater than the 1958 battery powered pacemaker, which lies at the heart of the medical allied community.
Frank Jaskulke 20:31
Dr. Walt Lillehei at the University of Minnesota had a problem. They were doing heart surgeries on children and they often would need temporary pacing of the heart post surgery. At the time, they would put the lead wires on the heart and they had a system plugged into the wall. The electrical system was not as reliable in the 50s as it is today. And power would go out from time to time and the system would stop pacing the heart. And occasionally you would get people who would die as a result. Dr. Lillehei needed something better had asked a number of engineers to work on it. Then there was a biomedical technician by the name of Earl Bakken, who had a contract to service equipment at the University of Minnesota, and Dr. Lillehei asked Earl if he could work on it. And in the literal proverbial garage in Northeast Minneapolis, Earl and a few others worked on this idea of a battery powered transistorized wearable pacemaker. Wasn't yet implanted. But it wasn't dependent on being plugged into the wall. Earl supposedly brought it over to Dr. Lillehei. And he came back 24 hours later to see what did he think of it, maybe we do some testing and boom, it was on a patient already in work.
Matt O'Leary 21:47
The battery powered pacemaker offers some general principles for application today. But the 50s were a very different time. So an apples to apples comparison of the medical landscape then and now is very difficult. Considering the complexity that we already laid out. John asked the obvious next question,
John Lenker 22:07
How is it that an entrepreneur and med tech should proceed knowing that they likely have many, many variables they don't have access to when they have to make the decision to take the risk? Does that make sense?
Frank Jaskulke 22:21
It's a great question. And it's one that we see the consequence of it not being asked all the time. And my answer is the same to everyone on it, which is go backwards. Far too often, particularly with technical founders, we see this with academic spin outs. They're starting with a technology that solves some problem, but they haven't articulated or identified if the problem is one that's real and meaningful.
John Lenker 22:48
So you're advocating for much of what we advocate for, which is think of the audience and think of the benefits. You're basically saying, think of the public benefit, and work backwards from that?
Frank Jaskulke 22:59
Right on, you know, if there's a thing you can do, but no one needs it. I would argue in healthcare, then it's not a thing you should do. I won't name names of specific companies. But I can give you two types of technologies that I see 25 to 50 times a year, every year for the last decade that I've yet to see, turn into a successful business that's impacting patients. And these are very broad strokes. There are businesses in these areas, but we routinely see startups that fail in them. So one is in wound care, diabetic wounds and ulcers are a massive clinical problem. It's painful, it costs a lot of money. It can lead to amputations, death and comorbidities. It's a bad thing. And it's not well managed in many cases. I see every year, dozens and dozens of startups that have some sort of technology that they want to apply to the management of wounds. Often they're from academic founders who have seen the unmet clinical need, have access to great technologies, but they haven't tapped into the broader knowledge base of well, how are these diseases treated today? How are they paid for? What are the incentives or disincentives that are in place? And what are the problems that the patients want to solve and the clinicians want to solve? We just haven't put that puzzle together. They often get interesting technologies that likely would help the patient but structured in a way that they're just not viable to be a business. The other one that I see 25 to 50 times a year is neuro-rehab robots for patients who have had a stroke. Usually, it's a robotic assist device, often on a hand or arm that after you've had a stroke you may have lost the use of your arm. But we know, if we help you move the arm around, you can retrain your brain to move your arm. That's a lot of work for therapists to do by hand. So the ideas are automated, have a robot that can do it more consistently and tracked the data. The concept is there, it works. There have been some sales. But there's yet to be really a breakout in that space. Despite every year, bunches of companies coming out doing functionally the same thing. In both cases, there's probably opportunity in a real business, but they haven't put the puzzle together in a way that they can actually go from this works to it's actually being used on lots of patients for their benefit.
John Lenker 25:51
It's likely I'm going to guess that what happens is that the founder, who has all this technical knowledge, isn't very open to bringing in partners or others into the business to round out his or her knowledge, such that they could have a more robust approach to the market opportunity analysis.
Frank Jaskulke 26:14
Sometimes it is, we call it founders syndrome, where a person just has an elevated view of what they've developed and are, you know, reluctant to refuse outside help. And when we find that we just like, hey, not our thing. We can't help that. When you find ones who are coachable, who want to learn who recognize their strengths and their weaknesses, who have you know, humbleness and humility, then you can do magic.
Matt O'Leary 26:44
Frank draws attention to some of the individual factors that contribute to success or failure. For the former, it's essential to start with the consumers needs and then work backwards to the product design part, a fairly generic but all important point. On the other end, it can really stultify a startup for an entrepreneur to get myopia or tunnel vision, where a lack of openness and too much ego can grind the best ideas to a halt. He also brought up that the founder can be so ensconced in their own world of like minded people and technical jargon that they fail to see anything beyond it.
John Lenker 27:25
It would seem that fundamental to the idea of being a visionary is the ability to see, right, to have your eyes open, and know how to scout for, to know how to perceive what is going on in the landscape, you know, a visionary has to be able to see before they can guide other people. Otherwise, it's the blind leading the blind.
Kevin deLaplante 27:57
My thought in your description and earlier on was that it's likely impossible for an academic founder, as smart as they are as open as they are to know enough to learn enough about the pitfalls and the common problems without someone like yourself or some other professional party who can advise them in order to avoid making some recurring mistakes. Now, in your view, is that too pessimistic? Or is that closer to the truth?
Frank Jaskulke 28:32
I'd say it's closer to the truth. And I always give the caveat when I meet with startups or with any company that, you know, I don't do this, I observe I interact with lots of these companies. If someone wants to start a nonprofit or a trade association, I got to all day, the actual work of starting and building a medical device company incredibly complex fraught with risk. And no one person can truly understand the totality of it. Advice for the entrepreneur that we give all the time, is build a community. You know, no one is an island that is not done alone. There's so much more out in the world than any one person to ever know. And in doing that, trust that most people are not trying to hose Yeah. Especially in this field. And especially in Medical Alley in the Minnesota community. People do this work, not because it's the way they're going to make the most money because it's not like the amount of time and effort you spend you could make a lot more money doing a lot of other things. People get into this they self select into it because they want to do good things for people. And that includes regularly helping out that new entrepreneur even helping competitors out. So build the community and build it early. I see far too often companies wait until they've gone really far along, they've spent a lot of money, they want to have it right. Find good people early on, so that you don't spend money on the wrong things and find out too late.
Matt O'Leary 30:13
There's no surefire way for a company to inoculate themselves against the vicissitudes of a market like medicine. But working with someone like Frank and Medical Alley Association is a good place to start. We'll call it a booster.
Kevin deLaplante 30:28
I was struck by I mean, the primary insight from the conversation with him is the role of this broader 360 degree ecosystem level perspective on the task of market opportunity analysis. And this is a particular case study where the need for a very intentional, systematic, rigorous, open process for coming to the proper understanding of the market need is absolutely essential to success in this field.
John Lenker 31:03
We need to figure out what kind of lens do we need to bring into our endeavor that will bring things into focus properly, and not to just live with a blurry vision for their idea or for their enterprise. And, you know, market opportunity analysis really becomes that lens, right. That brings things into focus, so the people can endeavor to do the things that will lead to the destination of benefiting the most people.
Kevin deLaplante 31:31
Mm hmm. That process that initial process has to be a discovery phase, and genuinely open to learning new things. Otherwise, it's, you're going to just rediscover things you already expect to see.
Matt O'Leary 31:48
Thanks again to Frank for joining us on the influence hacker. It was a joy to speak with him, and I'm sure we'll be back for part two at some point. Before we go, I should mention that in the first three episodes, I said I was working as a school counselor. That's my training, but I decided last year to join forces with John and Kevin at Lenker Consulting. This made sense on so many levels for me for my family on a personal level, and among other things, it gives me the chance to produce this podcast on a more full time basis. For a little deeper dive into the influence hacker mindset. You can read our first three companion journal articles now by following the influence hacker journal on medium and can help us get this off the ground with a five star review and by sharing with coworkers, friends and family. The influence hacker podcast is executive produced by John Lenker. And Kevin Dell upon our mixing and mastering engineer is Patrick O'Brien, the producer of this podcast as well as the writer of the narrative and original music is yours truly, Matt O'Leary.