Can This Service Solve the Problem of Information Overload in Healthcare?


  • Share on LinkedIn

Information overload is an issue that all of us face. Finding a decent signal in the midst of a very noisy world is a difficult challenge. Few are able to master it on a consistent basis. And that includes doctors.

Check out some of these stats:

  • 100,000 scientific journals are now in circulation.
  • 30,000 new clinical trials are funded annually.
  • 1,500 new articles are published every single day.

In fact, if a general practitioner were to spend just five minutes reading each new article published on primary care, it would take 600 hours each month!

Yes, that is information overload at its finest. But the end results are even more staggering:

  • Misdiagnosis is the leading cause of medical error in outpatient facilities.
  • 40 million patients experience delayed or poor care as a result of missing information, including historical examinations, tests, and medication reports.

In this interview with Zvi Mowshowitz, CEO of MetaMed, we learn more about their second-opinion service that is taking on the information overload challenge within healthcare by enhancing medical diagnoses through a robust team of researchers and data analysts.

And if you’re in the medtech space, as you listen to this conversation, think about how you could potenitally partner with services like MetaMed as we enter a new era of healthcare in which patients will be more empowered than ever before.

Interview Highlights with Zvi Mowshowitz

  • What is MetaMed and why does personalized medicine matter?
  • Specific examples of how MetaMed has helped patients with both common and rare diseases.
  • From initial consultation to end product, what does the MetaMed process entail?
  • How much does the MetaMed service cost and will health insurance companies pay for it?
  • Two ways in which the MetaMed “personal health consultancy” can scale.
  • Will MetaMed face increased competition in the future?
  • Why Zvi transitioned from the gaming space to healthcare.

This Is What You Can Do Next

1) You can listen to the interview with Zvi Mowshowitz right now:

2) You can also download the mp3 file of the interview by clicking here.

Don’t forget – you can listen to this interview and all of the other Medsider interviews via iTunes.  And if you get a chance, leave us an honest rating and review.

3) Read the following transcript from my interview with Zvi Mowshowitz.

4) Or, click here to download a copy of the transcript from my interview with Zvi.

Read the Interview with Zvi Mowshowitz

Scott Nelson:             Hello, hello, everyone.  It’s Scott Nelson, and welcome to another edition of Medsider, the place where you can learn from experienced med tech and medical device thought leaders, and on today’s program we’ve got Zvi Mowshowitz. He is the CEO of MetaMed. Zvi was a world-class strategist and gamer, and was a Magic: The Gathering World Champion, member of its Hall of Fame. After retiring from that, he founded a profitable startup that was eventually acquired by Pinnacle Sports. Zvi holds a degree in mathematics from Columbia University. Obviously, that was a more formal intro, but without further ado, welcome to the program, Zvi. Really appreciate you coming on.

Zvi Mowshowitz:       Sure, happy to be here.

Scott Nelson:             Okay, so I’m going to start out our conversation with a quote from, I’m not sure if it’s the founder or a founder, of MetaMed, Michael Vassar. Let me quote him first. He states, “We used to rely on doctors to be experts and we’ve gradually crowded them into being something like factory workers working in a constrained system where their job is to see one patient every 8 to 11 minutes and implement a by-the-book solution. What I’m talking about is creating a new expert profession where doctors evolve in a more patient-focused and more caretaking profession, and then scientists to evolve into a more argument and critical analysis and management of technology profession.”

                                    And so that was kind of a long-winded quote, but it really stood out to me and really piqued my interest. That’s why I decided to reach out to you guys. 00:01:26 But with that quote in mind, can you give us sort of the thesis of MetaMed? And then we’ll maybe dig in to where this idea was hatched and how you got involved.

Zvi Mowshowitz:       Right, and that very much speaks to the core of what MetaMed is all about, which is there is no way that one person, one doctor, can be all of the things that we need from the system, can process all of the information, can master all of the different domains. It’s impossible, right? I have the greatest respect for doctors, but most of the time they have a minimal amount of time to spend on the patients, they have to master lots and lots of specific domain knowledge in the areas where they are true masters and experts, and there’s no way that one person could also master all of the complementary skills that could allow you to understand all of the scientific problems involved in finding the best possible care, and the system just doesn’t allow them to spend the kind of time required to do that.

                                    So, MetaMed was founded with the idea that we’re going to bring together all of the complementary skills that allow you to combine what the doctors are masters of with all the other ways in which people process and understand information, figure out what’s going to result in what, and make better decisions that result in better outcomes, together with collaborating with physicians and the existing system.

Scott Nelson:             Got it. So we’re surely going to get into more detail in regard to kind of the processes and services that you have in place within MetaMed, but correct me if I’m wrong, but the idea there is that you’ve got a team of researchers that basically research certain diagnoses or disease states on behalf of patients and/or I guess physicians, and you put together almost like an individualized report for that particular customer, in this case it would be most likely a patient. 00:03:33 Am I understanding that correctly?

Zvi Mowshowitz:       That’s exactly right. So far, it’s usually been the patient.

Scott Nelson:             Yup.

Zvi Mowshowitz:       And so what they’ll do is they’ll come to us and they’ll say, “This is my situation, this is the decision I have to make or this is the medical problem that I have, and the existing system has either failed me and the solutions people have offered me aren’t working,” or, alternatively, “The system is providing me with more than one solution, I don’t know what to choose,” or, “Help me optimize the implementation of what the system wants to do. Find me the best place to go. Find me the best dosage, the best routine, the best sequence, the best plans that I can do to maximize what’s likely to happen to me.”

And then, we’d assemble a research team. So, every time we have a medical person to do the intake, to provide initial information, another medical person to review what we found and approve it and make sure that the things that we found check out and make sense and will benefit the patient. And then we have a research team to complement them, which can also include more doctors, but also includes people who have been trained in complementary skills, especially statistics, and we think of the ways to analyze research and read papers and evaluate that kind of information.

Scott Nelson:             Got it.

Zvi Mowshowitz:       And so I’m one of those team leaders in addition to being CEO. At first, I did all the cases, now I do about a third of them. And I will then [00:05:11] a research team, generally between one and four other people, and then I will assign them areas [00:05:20] we go locate the research. If we have enough budget, we go for primary literature, if not we go for secondary literature. We read it, we extract the information. We actually analyze their procedures. We figure out whether or not what they’re doing provides strong evidence for what they’re claiming, and then them provide a picture of what we believe the different options would actually do.

Scott Nelson:             Got it.

Zvi Mowshowitz:       Right? What the risks are, what the benefits are. Then we provide all that information to the patient and their doctors, and they can then make the decision. We can’t, nor do we want to, tell them what to do. It’s not our place to say, “You should do this,” or “We recommend doing this.” It’s our place to say, “This is what would happen.”

Scott Nelson:             Got it, okay. And there are a couple of other questions I want to ask around that particular process, but before we get there, this idea is fascinating, and I mentioned earlier that quote from Michael really piqued my interest in what you guys are doing at MetaMed, primarily because when I talk to friends or family members about what I do in the trenches within kind of the med tech space, I often call it sort of the unhidden benefit of being involved in healthcare, sort of the behind-the-curtain look, and I get to work with physicians, especially specialist physicians on a daily basis, and even within a relatively small geography, they all practice and treat a disease state completely different, or what I would consider completely different. And most of the patients just think the doctor’s word is golden, but they don’t realize that those are humans too, they suffer just like all of us, they suffer from information overload.

And I think there are some really interesting stats on your website, let me just name a few of them. “The National Library of Medicine adds 34,000 new references every month. There are 560,000 new articles published annually. A hundred thousand scientific journals are now in circulation,” etc., etc. And so this is a really interesting concept because I think healthcare would really, really benefit from taking a step back and realizing that physicians, they too suffer from information overload, and so there’s got to be a different way to sort of solve that problem. 00:07:33 And that’s what you guys are doing in essence, correct?

Zvi Mowshowitz:       Yes, that’s what we’re doing, not information overload but requirement skill overload. I thought about, you know, like many kids do, right? Whether or not I should look to be a doctor.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       And then I realized, “But I just can’t hold this many facts in my head. My memorization skills just aren’t good enough. I can’t do that job, and I have so much respect for people who can.” But at the same time we’re asking them to do an impossible job, which is to have at their fingertips all the information when everything could possibly go wrong with a human being…

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       …even if only in the specialty area. And so what ends up happening is, of necessity, they learn what to do, is through practical interaction, through experience, through conversations with other doctors. And so what we find is that different doctors will think different procedures are the correct procedure for a given situation and won’t even necessarily even know about the alternatives. It varies a lot by region. You’ll see like people in one area of the country will do things completely differently from another area of the country, and the people in other countries will do different things still, even when they all potential have access to the same resources.

Scott Nelson:             Got it.

Zvi Mowshowitz:       And so, at the same time, it’s not just the bare knowledge of the situation, it’s that what doctors will learn in this huge array of skills that eats away their entire young adult lives…

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       You know, I was studying a completely different set of skills that would not allow me to do their job but do allow me to do a much better job than their set of skills enables them to do at evaluating this physical strength of a claim, for example.

Scott Nelson:             Okay.

Zvi Mowshowitz:       Right? Or forming a [00:09:27] distribution over the possible [00:09:31] of the world of what might happen based on a given set of information if certain options were taken.

Scott Nelson:             Right.

Zvi Mowshowitz:       Right? So you need to complement them in time and complement them in skill and complement them in knowledge.

Scott Nelson:             Got it. So let’s get into like the actual process that you folks follow there at MetaMed in your team, which I want to do ask about sort of the team that you’ve built there, because it’s incredibly impressive. 00:09:57] But before we go there, is it possible to maybe walk me through a case study or an example of a patient that you’ve helped? And I certainly don’t expect you to name names, but maybe just an example of a patient that’s come to MetaMed and said, “I’ve got this problem,” or “I’m dealing with this,” maybe how specifically you helped them with their challenge.

Zvi Mowshowitz:       Okay. I mean, obviously, one of the big problems in medicine is confidentiality.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       So it’s always tough to use specific examples. So let’s think about the most recent case that I just finished, which was a mother came to me and their child had an unknown condition, and she had spent a long time going through the system, didn’t know what it was, was trying a lot of different treatments, going through a lot of different tests, examining a lot of very long shots, and things were still progressively getting worse. And so I looked at the situation and I said, “Well, there’s so much…there’s this giant keep of medical records and it’s not something that I understand all of,” but we looked through it and we came to the conclusion—first, I had my wife Laura Baur talk to this person and we did an intake, and found out the situation, what had gone before, what attempts had been made, what had been found.

Scott Nelson:             Okay.

Zvi Mowshowitz:       And then, we looked at the record and we said, “Okay, there’s a lot of potential things that we know about.” We [00:11:32] what had been found already, but there was this unique aspect to the situation that isn’t…you know, this thing that’s unique about this person that looks like it’s the most efficient place for us to look because there’s a good chance that this is what it is. There’s a good chance this is what it is because what’s the chance this would happen coincidentally? You know, without getting into too much detail…

Scott Nelson:             Yup.

Zvi Mowshowitz:       So our researcher looked at it, found that when the same thing—there have actually been for other reasons animal studies of the same thing, and they found that when this happens, very similar symptoms to what this child was reporting occur.

Scott Nelson:             Okay.

Zvi Mowshowitz:       So we said, “Okay, this obviously makes it vastly more likely.” So we looked into this in more detail. It all seems to make sense. Actually, in this case, it had never been seen before.

Scott Nelson:             Okay.

Zvi Mowshowitz:       So it was not a hypothesis that hadn’t been mentioned before, but it was more a case of like people thought it might be as opposed to it probably is, or [00:12:45] illustrated to her exactly how this would be demonstrated, why this would be something to presume, and then was able to find a potential treatment that while a relatively long shot due to the nature of the situation…

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       …was worth exploring in more detail, and was able to recommend…not recommend, but was able to note that there were certain things that were being done that if it’s sort of the case wouldn’t do anything. They would only involve additional costs and additional inconvenience…

Scott Nelson:             Okay.

Zvi Mowshowitz:       …and additional side effects. So the only reason to continue them would be if this potential cost was incorrect. So this is one of the different situations that we do.

Scott Nelson:             Yeah.

Zvi Mowshowitz:       Another recent case was the client came to me and said, “I potentially have this…I have cancer. They’re attempting to deal with it, but it turns out that they haven’t been able to remove it and it’s now stage III. What should I do?” There are a lot of different drugs out there. There are a lot of different chemotherapies. And then, I went through and I examined the literature and the evidence behind each of these different possibilities, and I gave a likely effective survival benefit to each of the different [00:14:06] treatments and treatments in combination, and explained the potential side effects, and gave a basis by which to make a decision depending on what was found. I [00:14:17] between them.

Scott Nelson:             Got it. Okay. So taking a step back, so most of the time…and I like the fact that you brought it to sort of different spectrums in that you helped a patient and a family with a really rare, extremely rare sort of…

Zvi Mowshowitz:       Yes.

Scott Nelson:             …disease, and then the other patient had cancer and dealt with probably quite a few different oncologists, which is, you know, quite common in our world today. So, two different ends of the spectrum. But in terms of the process, so usually it’s a patient that comes to you with a certain medical record. [00:14:51] Do they submit it via email? Is it via phone? And then what happens after you…is that where it usually starts, with the medical record? And then talk to me a little bit about like the research part. Are you looking at journals? Give me at least a little bit of an overview in regard to the actual research that goes on typically.

Zvi Mowshowitz:       Sure. So there are kind of two different parts to consider. So the first part, we can say the process for us starts with the conversation that leads to the contract and the agreement to do things, which leads directly to the intake where we will have one of our medical people talk to them, preferably in person. If not possible in person due to location, we’ll do it over Skype.

Scott Nelson:             Okay.

Zvi Mowshowitz:       And this will generally take at least an hour, often will take several hours. We’ll talk to them, gather all the information. And a lot of what we’re looking for in that conversation is not only what is the situation medically, what are the facts of your case, but also, what does the patient really need from us? What do they want to know? What do they value? What are they looking for?

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       Because it’s all too often that the medical system is forced by its nature to make presumptions that everyone wants what instinctively they maybe “should want,” and to focus primarily on the same measures of health for everyone, and some people have very different preferences.

Scott Nelson:             That’s a great point, yeah.

Zvi Mowshowitz:       Yeah. And so we say—one thing we have to push back [00:16:24] with our medical people all the time is they will always try to go after instinctively whatever the big glaring health threat is with the patient, the big concern, and we have to sometimes say, “No, that’s not where our comparative advantage is. That’s not what the patient came to us for.”

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       Right? That’s something that the patient has to deal with, but that’s not our task here. And maybe they want something else, we have to give them that. That’s what’s going to help them.

Scott Nelson:             Got it.

Zvi Mowshowitz:       We let the patient run the show, in that sense. So then, once that happens, once that’s done, they’ll brief me, generally. Sometimes they’ll brief Sarah Constantin, who is our other active case manager who does a lot of cases. We are branching out to add So-Han Fan and Adam Widmer, as we scale up, as additional managers. And then often I’ll learn with the cases, and then based on what the cases are, I’ll choose even a manager that’s appropriate that has more area and background knowledge of the case, that’s more specialty. I’ll choose the team based on the specialty area. So you want like one person to handle a lot of different cases of cancer, even one particular type of cancer, because all the research they’ve done before they already have at their fingertips.

Scott Nelson:             Got it.

Zvi Mowshowitz:       Right? Everything they’ve done before. Like specialists are important to the medical system for a reason. We’re creating our own specialists as we go as well.

Scott Nelson:             Sure. Okay.

Zvi Mowshowitz:       So I’ll assemble a team with the specialists for the particular situation, and then… So then we’ll scour the literature, and generally this involves packing on [00:18:02] as the primary way to do that/use [00:18:09] them references to and from the initial things that you find, and from the initial things that experts who you ask questions about refer to as, “These things are important. These are the key things that people are talking about. These are the key things that reflect the developments in the field very recently.”

                                    And then, the great thing about the literature is that if something is important, people will reference it all the time…

Scott Nelson:             Okay.

Zvi Mowshowitz:       …unless it’s very recent. So you know that even if your initial searches don’t turn up everything, if it’s not very, very new, it will be found because it will be referenced by any reasonable set of things that you find. You use that to find the rest of them. As long as you do a careful search of the things that are recent, you also, if you have sufficient time and budget for this, you find an expert in the field and you ask them, you know, you’re trying to keep up with this particular…you know, this area you are keeping up, you know…

Scott Nelson:             Yeah.

Zvi Mowshowitz:       …as best you can. Well, what’s going on? What’s the new hotness here? What are the recent developments that we should be sure to cover? And then we have our literature, and then we’ll look through that literature. If we have a lot of time, we’ll be looking for primary stuff only and we’ll read it all cover to cover and we’ll extrapolate based on everything. If we have a limited time, we’ll try to use [00:19:28] value of information. We’ll say, “What—” It’s very important during the intake to figure out exactly what matters to this client and this patient, this situation. And then you say, “Okay, this patient’s situation says we need to find out the effectiveness of the various treatment options, so we’re only going to look at things that bear on these treatment options…”

Scott Nelson:             Sure.

Zvi Mowshowitz:       Or offer alternate treatment options that show enough promise quickly to be worth examining. And then we will look at those things, and then one by one gather up information to either rule them out or make it clear that it should be part of the decision tree, right? Something that we should look into in more detail. Those we would narrow in.

And then, when you’re reading the literature, the two things that are most important in the evaluation are you’re watching out for the [00:20:26] methodology of what’s being done in any study, because the different [00:20:33] methodologies that are done sometimes because people intentionally choose very robust systems and sometimes less robust systems, because either it will cost too much money to do it the other way or be too dangerous it would put too many people at risk. They can’t do it in a more robust fashion. They have to use very small sample sizes or they can’t do double blind or anything like that.

So you have to look at the [00:20:55] design, which can be better or worse, not affecting those things, and then figure out, “Okay, how likely is this to give the right results? How much evidence does this result signify?” And you also have to look out for bias.

Scott Nelson:             Got it.

Zvi Mowshowitz:       Because there’s a huge problem in medicine that, you know studies don’t happen at random. Studies happen because someone decided to do them, and that person often, or that corporation especially, is looking to give off a certain impression…

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       …is looking for a certain finding. You have to keep that in mind as well, right? You have to say, “Well, there are no negative results from studies like [00:21:34] would there be? Would they have been published even if they had happened? Are these engineered to find that? Would they have tried various different things of similar type until they found one that succeeded?”

Scott Nelson:             00:21:44 And you make room in your research to allow for that sort of bias?

Zvi Mowshowitz:       Absolutely.

Scott Nelson:             Wow.

Zvi Mowshowitz:       You would never… It’s inherently what you do when you read a research paper.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       Right? Whatever you’re looking at, any source of information, in fact, in the back of your mind should always be, “Who’s telling me this? Why are they telling me this? How did they go about getting this information? Does this actually reflect on what’s going on?” [00:22:19] if someone is telling you something at all, that choosing to tell you that thing is often as interesting as the content of the message.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       And this is sort of, you know, a lot of the people involved in this company came from the community that we’ve grown out of the less wrong and [00:22:37] biased websites, and we dedicated a lot of our study to the questions of, as it says in the [00:22:43], overcoming bias…

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       …how to locate these types of biases and how to account for them, how to adjust such that we’re not making the cognitive mistakes that humans always, always make, because that’s how we’re wired. One great source for this is Thinking Fast and Slow [00:23:02] recently, which is a great illustration of how the human brain just doesn’t work properly in these senses because it has to use heuristics and shortcuts and biases in order to make the decisions in general, but those decisions fail you in situations the human brain wasn’t evolved to deal with, which are things like scientific double-blind studies.

Scott Nelson:             Right.

Zvi Mowshowitz:       Right? That would never have happened.

Scott Nelson:             So I’m going to stop you right now and ask you questions. I can imagine there’s a clinician or a physician that’s listening to this and is going to ask… I like the idea that you guys try to eliminate the bias. 00:23:41 But how would you respond to two issues, and they’re kind of on two different sides of the coin in that, one, the overwhelming majority studies would never actually be published if they weren’t funded by industry, so that’s one side, and the other side of the coin is the specialist physician that practices in his or her particular area and says, “I know that there are a lot of studies that point to this, but in my experience, with my base of patients over the course of treating a thousand different patients, my algorithm is actually quite different than what most of the studies would point to.” How do you respond to those two sort of statements?

Zvi Mowshowitz:       Those are two very different objections, obviously.

Scott Nelson:             Uh-huh.

Zvi Mowshowitz:       So you have to deal with them on their own terms separately. So the first objection is a very good point, right?

Scott Nelson:             Uh-huh.

Zvi Mowshowitz:       Which is that you need to get the money from somewhere. You know, a scientist or a doctor who comes up with some novel idea doesn’t just have a hundred million dollars lying around. They have to go to a corporation. And the answer is, you don’t throw out information because it’s coming from someone who has a motivation, but you do give special care to whether or not they have done things in the proper fashion, whether or not they have provided a structure that protects you from the facts that they want you to find a certain result.

And sometimes the study is not being done by someone who has a financial interest in the situation or a bigger outcome, and in those cases you even give it a lot more weight than you would normally give it. When a corporation is funding a trial on their own drug, you don’t discount it entirely, you just keep that in mind that these choices were made with an eye towards sending the message that they want you to hear and that the message was written in a way to give off the impression that they want you to have.

Scott Nelson:             Got it.

Zvi Mowshowitz:       Right?

Scott Nelson:             So you’re not saying, “Don’t throw the baby out with the bathwater,” you’re saying, “Perhaps there’s a little bit more skepticism warranted with some of these maybe well-known studies and the biases that kind of come along with those.”

Zvi Mowshowitz:       You have to be much more careful, right? To watch out for these problems. And you have to assume that, you know, all the choices that were made were made such that they were the best choices they could have made given their motivations.

Scott Nelson:             Got it.

Zvi Mowshowitz:       And you look at these studies, you have to like [00:26:07] make sure to even undo the framings that they make. You know, people will use different ways of stating the same statistical fact because they give off different impressions, and this can fool even the most advanced statistical minds…

Scott Nelson:             Got it.

Zvi Mowshowitz:       …and the best doctors, because, unless they’ve specifically been trained to avoid it, they don’t even know it’s happening. Even if you have, it still happens. You have to fight it.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       Now, in terms of in my experience, so this is obviously the difference between anecdotal evidence built up over time and statistical evidence that comes from studies. So a doctor’s anecdotal evidence is still valuable, but it’s very easy to get caught by that [00:26:55] information because we don’t naturally process it properly into getting the wrong idea.

Scott Nelson:             Okay.

Zvi Mowshowitz:       It’s also very possible for a doctor to have a situation that because of who they are and what they’re dealing with differs greatly from the cases being described in their studies. So, often the quality of implementation of a given type of care or the attention to the details of the situation and the ability to make the right decision based on exactly who the patient is and manage all these problems matters greatly.

Scott Nelson:             Got it.

Zvi Mowshowitz:       So some procedures are relatively easy and carry very little risk, and you can do them pretty much anywhere and you’ll see more or less the same results. Others are highly sensitive to the skills of especially the surgeon performing the procedure. And so sometimes someone will in fact just be that good…

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       …and will have the ability to get results that can’t otherwise be gotten. And so you do need to keep that in mind that, you know, any pilot program, anything where you pay a lot of close attention to one specific thing, you get better results and you can make things work that then you aren’t able to replicate. This is true across the board. This is not just medicine. And we also know for example that the more times a given surgeon had done the same procedure, the better the results are.

Scott Nelson:             Right.

Zvi Mowshowitz:       Right?

Scott Nelson:             Absolutely. It’s a skill set.

Zvi Mowshowitz:       Absolutely.

Scott Nelson:             Yeah.

Zvi Mowshowitz:       Yeah. So you would give a different set of possible outcomes for someone who is capable of going to the best, you know, who can step outside of, you know, doesn’t have to worry about their insurance network, who doesn’t have to worry about where they are and how much time they can allocate and so on, and can search out the very best, the special of the special in this particular thing. And we can and do help with that. We identify, okay, here’s the person who is the best, who’s expectations would be different than if you just went to someone else, and that can change what the best action is for someone. You know, often that will change the outcome when it’s otherwise going to be close.

So I would say, you know, sometimes, he says, “Well, I’ve done a thousand of these,” and I do something different, and my response if I was talking to him would be, “Yes, but it doesn’t necessarily mean that someone else should do it too, especially if they haven’t been tested and replicated.”

Scott Nelson:             Yeah, that’s a fantastic point. Yeah. Even though it may be a very valid treatment algorithm, that physician that’s in a different part of the country, or world for that matter, may not have that particular skill set that…

Zvi Mowshowitz:       Yeah.

Scott Nelson:             Yeah.

Zvi Mowshowitz:       These rely so much on tacit knowledge, right?

Scott Nelson:             Sure. Right.

Zvi Mowshowitz:       Seeing as that the doctor doesn’t necessarily know…they know them, but they don’t necessarily know how to articulate them properly or they just have it [00:29:48].

Scott Nelson:             Okay. 00:29:49 Before we move on to some other ideas outside of the typical process that you folks follow, what does the end product typically look like for most of your patient customers? Is it a report or do you go beyond that and direct them to certain physicians? What is that?

Zvi Mowshowitz:       One second.

[Side conversation]

Zvi Mowshowitz:       She works with the company as well. So…

Scott Nelson:             The end product. 00:30:43 What does that typically look like?

Zvi Mowshowitz:       Right, the end product. So the end product, at its core, the end product that you’re buying, is a report where we write down, we say, “Here are the sources that we used. Here is the reasoning behind what we found. Here is what we found,” and then we organize it in a way designed to give you the information you need to make your decision. The question I’m always asking when looking after the researcher comes back with an alpha version is, I put myself in the mind of the patient, I need to make a decision, does this information help me? Does this tell me what I need to know? What’s left? Am I actually being given the necessary information to make the decision and know how to implement it? You know, often people will give advice and won’t provide the necessary steps and there will still be mysterious portions of the implementation.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       Right? Because the person saying it will know how to do it, but the person hearing it won’t know, and often the details, especially in medicine, can be very important. So the first thing we do is [00:31:55] the report. But it isn’t the report, especially for larger cases, more complex situations, bigger budgets, you also speak to them. You will do an interview with the manager of the case or the medical of the case as appropriate, and this person will sit down with you and will explain the contents of the report and their practical implications to you, answer your questions, and make it clear how this carries forward.

If you need more from us, we talk about whether or not we might want to continue if there are things that the addition would still be helpful to you. We explain that there’s something that doesn’t make sense to the client, the patient doesn’t know. Sometimes they’re two different people. You know, often you’ll get a family member who comes to us, right? And they’re not the patient.

Scott Nelson:             Yeah.

Zvi Mowshowitz:       And so it’s important to keep that separate. And often they have different concerns and somewhat different needs – keep that in mind too. And you know, you sit down, and they’ll often grill you and they’ll through for the report sentence by sentence, and they’ll say, “What does that mean? Are you sure about that? Like how do you know that?”

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       And then you’ll explain it. And then, in some cases it’s relatively straightforward because we’ve been asked a relatively simple question. You don’t need to talk to them that much or some quick email will suffice to explain what’s happening. Other times, you can sit down for hours.

Scott Nelson:             Got it.

Zvi Mowshowitz:       [00:33:23] Both of these things have happened to me.

Scott Nelson:             So I imagine those listening to this would think, you know, this idea of a very robust second opinion is what healthcare really should be, right? Right now, it’s usually very difficult to have a candid sit-down sort of conversation with a specialist physician, but this is ideal. However, it seems like it would be really expensive. And I know if you go to MetaMed.com, your website, there’s the free consultation. Certainly, this process isn’t free. 00:33:56 But can you explain sort of what the costs typically entail? And obviously, I presume insurance companies are not paying for this right now. Is there a typical cost that you allow or is it all over the board?

Zvi Mowshowitz:       So you are correct that insurance companies do not cover this, and we do not deal in any way, shape and form with insurance companies, and that has allowed us to provide our service at all. So the range of costs, we have had cases as big as 250,000 dollars; we have had cases as small as 5000 dollars, which is the minimum that we accept.

Scott Nelson:             Okay.

Zvi Mowshowitz:       Due to the cost of doing the intake process, [00:34:37] ourselves [00:34:38] the situation, acquiring [00:34:40] medical records, briefing everybody and so on, [00:34:44] makes sense to do… You know, the intake process itself essentially costs 5000 dollars, plus [00:34:50] with the case, initial lookover [00:34:52] to do less. Most cases that come to us [00:34:57] the majority are worthy of, yeah, sort of have enough problems involved in them for 10,000-15,000.

Scott Nelson:             Okay.

Zvi Mowshowitz:       And, you know, this process is obviously not cheap, that’s a lot of money for a lot of people, but for some people it’s not that much money, certainly relative to their health, and also relative to their healthcare and their healthcare costs. So if you’re deciding between very expensive procedures or the procedures that could potentially cause major effects on your life, you end up saving money rather than spending money…

Scott Nelson:             Right.

Zvi Mowshowitz:       …when you make sure you get it right. Getting these things wrong is ridiculously expensive.

Scott Nelson:             Right. And I think that that’s such a unique aspect of healthcare in that if the physician or the hospital where you go or whatever setting it is, if they do something wrong or if something goes bad and it’s potentially their fault, well, yeah, maybe there’s a lawsuit down the road, but in the immediate term, the patient is responsible for paying for that. You know, if it means multiple days in a hospital, etc., it’s not the hospital or the physician that pays for it. It’s the patient. And so you bring up a very good point that maybe there’s a higher upfront expense, but it could potentially be rewarding down the road for sure. 00:36:18 So in a typical-case example, do you give a quote upfront or is it as the case unfolds then you bill out a certain hourly rate, or how does that work?

Zvi Mowshowitz:       So we do charge for our time, right? The resource that we are spending is people’s time primarily.

Scott Nelson:             Got it.

Zvi Mowshowitz:       There are some minor expenses that we charge whatever we pay, but beyond that it’s mostly our time. However, we do work on the contract, you know, choose-the-amount-upfront basis, because that is what people are comfortable with. Different people have different budgets they can afford to spend on their care where they’re comfortable with, so we talk to you first about what you’d like from us. We tell you what we believe this will cost, and then we do the best shot we can with that amount available. Because one of the problems in healthcare is that these problems, you can always dig deeper.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       Right? You can always say, “I’m going to leave no stone unturned.” In theory, you could even fund your own labs, do your own experiments, you know, advance the cause of science.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       But you have to stop somewhere. So the way that people are almost always most comfortable is this is the problem at hand, and then we say, “Okay, in order to give you the type of health that you want, we think this is the appropriate budget for that,” and then we’ll agree on that budget, and then we’ll work to that budget.

Scott Nelson:             Got it.

Zvi Mowshowitz:       And then, in general, if it costs somewhat more than that in terms of what we would otherwise bill, we will do what we can to make sure that we go the extra mile.

Scott Nelson:             Okay.

Zvi Mowshowitz:       And if we had extra, then we’ll look in more detail at places that we would otherwise have looked in less detail and/or we’ll examine more issues that you have with the remainder of the budget.

Scott Nelson:             Got it.

Zvi Mowshowitz:       Because there’s always more to do.

Scott Nelson:             Okay. So almost like a personal health consultancy, I guess, to a certain extent. 00:38:25 With that said, this current model, do you see it evolving over time? And maybe the better question is, can you scale this up where maybe that price can begin to lower a little bit? Maybe speak to that.

Zvi Mowshowitz:       Right. So there are two types of scaling that can and need to be done. The first type of scaling is simply 10 [00:38:50] enough other people do what we are able to do. And this is very hard. To be able to properly evaluate the medical literature in this fashion and to work with all these problems requires a large number of skills that are rare, and so we have been slowly attempting to find the people who have what it takes to do that and we’ve been instructing them. And this is our biggest going forward in my opinion, is that we need to prove that we can scale in this sense.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       And so far, you know, we have myself and Sarah, who has handled most of the cases. We have several people I’m confident have been trained and can and will in the process of taking on cases themselves. Can we keep doing that as we need to reach out farther and farther into the world [00:39:45] and with people we’ve had less and less contact with and who share less and less of our mean space? And I am confident that we can do this, but it is the most likely problem that will ensue for us.

                                    The other type of scaling is, can we make this process faster through the fact that we’ve done it enough times and we’ve systematized it and we’ve created automated assistance and preexisting knowledge such that we can bring the price down?

Scott Nelson:             Got it.

Zvi Mowshowitz:       And the answer to that is absolutely yes. Not right away, you know, but every case we do, we bring the knowledge of every case we’ve already done, and [00:40:26] that means we can start at a farther-off point, we get to have better, more efficient procedures. We are innovating in this realm as we go. So every time we do a new case, we’re learning about the best way to do these cases…

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       …the best way to track down the right studies quickly and efficiently and not miss anything, that rightly differentiate where the highest value of information is and the right way to do all of these things.

Scott Nelson:             Got it.

Zvi Mowshowitz:       So we’ll get better at it, and we’ll also be able to design systems and have preexisting findings.

Scott Nelson:             Okay. 00:40:59 And so with that said, I mean, I can almost potentially see this becoming almost like a human-powered sort of Google for health, maybe similar to what Ben Heywood and their team is doing with PatientsLikeMe, but could you somewhat pull all of this data and knowledge from the case studies that you’re doing at MetaMed where someone could potentially pay for a service and almost do the research within MetaMed themselves? Do you see where I’m going with that?

Zvi Mowshowitz:       Yeah.

Scott Nelson:             00:41:31 Is that viable? Is that a viable option [00:41:32]?

Zvi Mowshowitz:       Well, so in my experience, right? With my family and my community, whenever anybody has had their own medical problems and they do the work themselves…

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       They will do what MetaMed does, but they will do it on their own behalf, or if they’re too sick to do it, their friends will do it, their family will do it on their own behalf, because it’s so important to consider this information and to get it right.

Scott Nelson:             Right.

Zvi Mowshowitz:       And then, so this is one of the inspirations for it, is people who have more training at this, who have more practice, more experience, can obviously do it better or can supplement, but it’s absolutely true that even now without MetaMed’s help you are very much incentivized by the system to do this yourself, and if you are capable of it, then you’ll be better off if you do it than if you don’t do it. It’s well worth your time.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       You know, because it’s your health you’re dealing with. You need to do this. It’ll make you better informed and you’ll often get information that you can pass along. So we can almost certainly provide both advice on how to do this, you know, guidelines for how to go about doing this yourself, and provide some part of a process for people who otherwise couldn’t afford the depth of attention that their case deserves.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       So I say absolutely, and I want to encourage everyone out there to do this themselves to the extent that their case is something they can handle or something that they can’t afford to have handled by someone like us when there’s enough high value, right? When you have to make a decision about your health, you have to make a decision about your health, you should gather as much information as you can.

Scott Nelson:             Mm-hmm. Got it. 00:43:18 We’re running short on time here, but before I ask you a little bit about your background, what do you see the competition looking like in another couple of years? Do you see MetaMed competing against another similar service?

Zvi Mowshowitz:       So there are similar [00:43:37] services that offer similar services that are out there today, but as far as I can tell, they are vastly weaker. They charge more money at the bottom end and offer much less. But I certainly expect as MetaMed grows, as MetaMed succeeds and paves the way for this, that others will attempt to follow us.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       And some of them will succeed. And I think that’s great. I think that competition is good for all involved.

Scott Nelson:             Yeah.

Zvi Mowshowitz:       And we will make them better and they will make us better, and they will show us new things and we will show them new things, and together we’ll [00:44:19] improvements and we’ll look into the results. You know, the patients that get our reports are free to share them, and we encourage them to share them with whoever they want.

Scott Nelson:             Mm-hmm.

Zvi Mowshowitz:       It’s their choice. It’s their information. They don’t have to if they don’t want to for privacy reasons or any other reason, but we hope that more people benefit from what we’ve found.

Scott Nelson:             Right.

Zvi Mowshowitz:       And if someone else is out there doing the right thing, benefitting people, we think that’s great. We think that we bring a lot of unique human capital and skills to the table that will be remarkably as hard to duplicate.

Scott Nelson:             Sure.

Zvi Mowshowitz:       And so we do think that we can maintain our edge over the course of a long time, and not just because we’re first movers, effectively.

Scott Nelson:             Yeah.

Zvi Mowshowitz:       Yeah. If someone beats us, that’s great.

Scott Nelson:             I can almost see some of the larger health systems, at least across United States anyway, almost either setting up their own MetaMeds or requiring a MetaMed-like shop within their own health system to really add more value to the patients that they could potentially reach. But anyway, that’s a whole other conversation. 00:45:35 Last question before we conclude here, because like I mentioned we’re running short on time. I gave a little bit of an intro, or I should say I provided a short bio when we first started this conversation, but you went from sort of the gaming space, and then your startup that sold to Pinnacle Sports, to healthcare. Why? Why that transition?

Zvi Mowshowitz:       Because, so I started out, you know, as a gamer, I majored in mathematics. I love solving interesting problems. I love figuring things out, figuring out proper procedures, optimizing [00:46:11] rule sets. That stuff really appeals to me, and the people who it appeals to are people that appeal to me as well. So I’m drawn to those communities, I’m drawn to those activities, and I excelled at those activities.

But there’s a problem with those activities, which is at the end of the day, when you develop a great strategy for playing a game and you prove it in competition against other people, everyone’s had a great time, but what have you done? What have you accomplished, right? You haven’t saved lives. You haven’t changed the world. And so at some point you have to take the skills that you’ve created and the connections that you made and all of the knowledge that you have out of the realm of a game, right? Or a sport, and into a realm where you can really make a difference.

Scott Nelson:             Got it.

Zvi Mowshowitz:       And in a realm where you can play on a larger stage where you have a chance to work on problems that matter. And so Vassar and I, especially he, came up with the idea for the company himself, and then brought me in as a cofounder, he asked the question, where can people with our types of skill sets—he comes from the Singularity Institute and a rationality-style background, which has a lot of the same problems—where can we really take our skills and make a difference and impact the world? And he said, well, you know, medicine is a place where people can see the value that we can provide and where we can provide a lot of value so that we can get people to agree to give us the equipment, the ability to go out there and do our work.

Scott Nelson:             Yup.

Zvi Mowshowitz:       And then where we can, you know, make a huge impact and save lives and help a lot of people. And so that’s why I’m here.

Scott Nelson:             Okay. Well, I’m going to leave at that, because I think that’s fantastic, the idea that—it sounds cliché, especially in the startup community, that, you know, go after something where you can make a dent in the universe or make a dent in the world, but you guys are certainly doing it with a very unique set of skills and applying it to a space that desperately needs it, at least in my opinion. So thanks a ton for doing this interview. I’m going to leave it at that. Can you hold on the line real quick?

Zvi Mowshowitz:       Absolutely.

Scott Nelson:             Yeah, and for those listening that have made it all the way through, thanks for your listening intention. Remember, you can subscribe to all these podcasts for free. Just go to iTunes or Stitcher Radio or whatever podcast app you have, type in “med tech” or Medsider, and the podcast will come up for free. Download it, and you’ll find that way, with every new episode that’s published, it’ll be downloaded to your smartphone with ease. So, anyway, that’s it for now. Until the next episode of Medsider everyone, take care.

[End of Recording]

More About Zvi Mowshowitz

Zvi Mowshowitz Solves Healthcare Information Overload

Zvi Mowshowitz is the CEO of MetaMed. He is a world class strategist and gamer, and was a Magic: The Gathering World Champion and member of its Hall of Fame. After retiring from the game, he founded a highly profitable startup that was acquired by Pinnacle Sports, the world’s leading sportsbook for American-facing events, where algorithms and strategies he developed have been responsible for over ten billion dollars in transactions. He holds a degree in mathematics from Columbia University.

Learn From the Best

The best stories from the world's brightest medtech and healthtech thought leaders. Subscribe for free and never miss an issue.

100% privacy guaranteed. Your information will not be shared.