 For those who don't know me, my name is Joe Matarisi and I'm the founder of a New Hampshire based staffing and consulting company by the name of Medicis Healthcare Solutions. Medicis has become one of the largest companies of its kind in the country. The company covers 10 specialties with anesthesia and radiology being the oldest and the largest. At the heart of the company's success is our innovative ways that we approach solving complex customer problems relating to staffing. The past 20 years, the number one concern in healthcare beyond patient safety and cost has been trying to find qualified healthcare professionals, more specifically physicians. The company was created in the basement of my home here in Wyndham with two other very close friends of mine to capitalize on this very important problem. We knew in order to improve physician staffing we had to develop innovative solutions and align our customers and our physicians. To that end, the company has pioneered revolutionary solutions such as Medicis One MSP, transitional management services and consulting services and an interactive client portal to name a few. I've been fortunate to have the pleasure of being the company's founder and CEO of this company and basically one of the things that I thought was amazing is the front row view that I had of not only looking at the inner workings of healthcare but as a CEO I've worked with hundreds of CEOs, hospital CEOs, thousands of doctors and all these interactions had given me this perspective that was quite different than when I came into the business 20 years ago. I'd like to share a couple of these perspectives. What I've learned is healthcare is expensive, high premiums. I would ask the people in the audience and the people at home listening how much premium is taken out of their checks every payroll period. If you stopped and looked carefully, most likely you'd be shocked. And that in many cases the company's paying half of that number. High deductibles, high proportional co-pays. It's not only unsustainable for the employer but it's unsustainable for the family as well. We are heading down a very, very dangerous path. Healthcare costs have risen to the point where it's going to bankrupt the country. I've learned also that healthcare is inaccessible in many ways. Wait times to see a physician could be literally months. Jeff just outlined his story. It may be okay to wait two months for a dining room table from restoration hardware but it's not okay to wait two months to see a doctor, particularly if it's a real urgent matter. We also found narrowing of networks. The one thing that President Obama said in 2012 and you may remember maybe it was 2011, if you like your plan you can keep your plan. Well guess what? I think he got the Pinocchio of the Year Award the following year is the biggest lie because you couldn't keep your plan. The plans were very narrow, it left you without the proper care. The other thing that I learned about healthcare is it's notoriously inefficient. Third-party billing is not uncommon. If you look at a simple ER visit you'll get bombarded with multiple bills that you can't decipher and the cost usually in the thousands. Three-hour office visits are unnecessary. A lot of those visits can be replaced. Jeff mentioned this also about telemedicine. You have people running across town fighting traffic to sit in a doctor's office for three hours when that could have been a 15-minute interaction and much safer for society, not only from the traffic perspective and being on the road but from a health perspective sitting in some crowded waiting room with other sick patients. And finally I realized that there's a misalignment between the patient and the system. Very few people in the room would describe a hospital or their interaction or relationship with their physician as being customer-centric. I think we would all agree about that. Several years ago I started to think about healthcare from a free market perspective and how the patient would benefit from competitive markets. I wholeheartedly agree with Jeff and a lot of what he said I am as optimistic as he is, because in the end, even as the government pushes down bad policies, the one thing that's going to stop them is they're not going to be able to afford them. And there is going to be plenty of opportunity for markets to rise and we're going to talk to a lot of great entrepreneurs today about that very thing. When I thought about healthcare from a free market perspective, there's a lot of forces against that. You've probably heard politicians, you've probably heard economists. Recently I heard in New York Times columnist Paul Krugman. I heard Bernie Sanders in the past also, just to name a few, mentioned that healthcare was too critical. It's too important to be left to the market. Of course, having studied the great Austrians of the past and present, I knew this was not to be correct. Healthcare is like any other economic good and it will behave as such. In fact, I've noticed that there's three areas of medicine that do function with market principles. Lasik surgery, Lasik surgery and medical tourism. What do all of those have in common? Well, looking over the last 10 years and comparing it to healthcare in general, you would find that the cost declining and the quality improving, which is not surprising, the massive innovation that's made in technology in those areas. Just the kind of outcome you would expect from a competitive market. Today you will hear from some great entrepreneurs who have demonstrated the power of those markets and innovation and how the companies are changing healthcare. In my remaining time today, I'm going to cover some of the drivers that have propelled healthcare staffing and some of the industry's innovative approaches to solving some of these problems. But before I do, it would be impossible not to mention the impact of COVID on healthcare staffing and more importantly on its effects of patient care. For the purposes of illustrating just how important medical freedom is now and will be in the future. One of the main tragedies of COVID is the failure of public health and the disastrous government mandates. However, the medical community's response also left many more questions than answers. Centralized control with technocrats advising and crafting unprecedented recommendations that by and large did enormous damage to the extent that it may have impacted deaths that could have been avoided by simply treating COVID in an outpatient setting with protocol treatments that many physicians knew were very effective but instead let people sit at home until it was too late to reverse the damage. Sadly, doctors who were compassionately helping their patients were ridiculed, censored or even worse, fired. There are too many of these types of stories. Dr. Peter McCullough, some of you may have heard of him, has been the world's most prominent and vocal advocate for early outpatient treatment of SARS-CoV-2 infection in order to prevent hospitalization and death. Dr. McCullough is an internist, a cardiologist, epidemiologist and professor of medicine at Texas A&M College of Medicine in Dallas. He has 40 peer-reviewed publications on the infection and has commented extensively on the medical response to COVID-19 crisis on many popular news outlets. Last November, Dr. McCullough testified in the U.S. Senate Committee on Homeland Security and Governmental Affairs and throughout 2021 in the Texas State Committee on Health and Human Services, the Colorado General Assembly and here in New Hampshire, the New Hampshire Senate concerning many of the aspects of the pandemic response. From his unique vantage point, he has observed and documented a profoundly disturbing policy response to the pandemic, a policy response that may have proved to be the greatest malpractice and malfeasance in the history of medicine and public health. I highly recommend his one hour 45-minute interview that could be seen online and can be simply found by using Dr. McCullough's name in a search engine. The last thing I'll say about this is that there's no better time for the emergence of the free market medical options as there is today. Okay, let's switch gears now and get into staffing and let me talk a little bit about something a little bit less controversial. I'll start with the key drivers of healthcare. When medical was started, the genesis of looking at the market and why we thought we can help was that the supply demand was off. It was significantly off. There was more and more demand and less and less supply. The supply actually for physicians was relatively stable but it appeared almost to be an imbalance because the shortage was greater and greater because the demand was growing and growing and we'll talk about why that was the case. We'll start with the demand. The US population is going to grow almost 11% from 330 million to 363 million by 2034. The implication is plain. As the country grows, so does the need for healthcare. As you can see from this particular slide, you can see the line sloping upward pretty consistently, pretty dramatically. The reason why it's so dramatic is because the 65 and older population has grown more rapidly since 2010. The US Census Bureau released estimates showing that the nation's 65 and older population is growing and continues to grow and it's driven by primarily the baby boomers between 1946 and 1964 as they become in their latter years. But the population of American aging, the increase of primary care, the increase of doctor visits is significant. In fact, people 65 and over visit the hospital 80% more than the rest of the population. 80%. So we know we have a system that is already overtaxed. We saw that with COVID and now we're going to continue to add more and more volume Another driver of that was the ACA, the Affordable Care Act, Obamacare if you will. And what that has done is it has increased the insurance rate of people in the country and it's added more volume to the hospitals. The one thing that Obamacare did, although it gave insurance, it didn't necessarily give healthcare and the distinction is I may have insurance, but if I can't see a doctor, then I'm not sure how good the insurance is. So what we've done is we added the insurance without which was essentially the demand side of it, without the corresponding supply side of it. We didn't magically create more doctors. So these forces have been dramatic over the last decade or so. And we've really seen Medicare's growth in this regard. Hospitals are tragically looking to find doctors, ERs are on demand. Really at all specialties. Anesthesia happens to be our busiest, but really hospitals are overtaxed in all the areas. The other thing that's driving it is life expectancy. People are living longer and the longer they live, the more medical treatments that they're going to require. Now let's switch gears and talk a little bit about talent and physician supply. What you can see from this graph here is it's very clear that if you look at the bottom line, the checkered line at the bottom, it's pretty flat. And so that's the matriculants over the last period of time here. And as you can see that it really isn't growing at the rate necessary. Jeff also pointed this out that very smart people who are in high school may be picking medicine as a passion and they may be doing it altruistically. They're certainly not doing it for the money. And some of the greatest minds are being lost in medicine and they're heading to finance and other sectors of the economy. And we all lose because of that. Another interesting phenomena is physicians are working less. So whatever the underlining causes, the decreased mean of hours worked among U.S. physicians during the last decade raises the implications for physician workforce supply and overall health care policy in general. Hours have declined 5.7% by non-resident physicians. If you think about that and you really put pen to paper, that's approximately 600,000, well, it's a loss of about 36,000 physicians when you look at the inefficiency of that lost hours worked. So it is actually pretty significant. Physicians, Jeff mentioned this also, physicians are also very frustrated. They don't have as much autonomy. They're working for the insurance companies. They're working for the hospitals. They may not be as passionately committed as if a physician was to set up shop here locally and be a community-based doctor where he knew the names of his patients. Now the whole system is so much more anonymous. Traditional physician practices are also on the decline. Doctors are now employees. This may explain to some extent why physicians are working less hours. One interesting fact, the number of physicians over the last 30 years has doubled, but the output hasn't, and that speaks to the inefficiency of the system. A lot of people attribute to the bureaucracy of medicine and the amount of paperwork that the patients have to do in an eight-hour day. And every minute they spend doing paperwork, it's one less minute they're spending with a patient. Are patients happy? 46% of physicians are worse off than they were a year ago financially, contributing factors are low reimbursements. But what makes physicians most unhappy is the drivers of the ACA, Obamacare. It has created less patient interaction and less medical care and more burdensome paperwork. To sum it up, the demand has gone up dramatically. Patients are getting older, they need more medical services, 65 and over, visit the doctor 80% more than average, patients are living longer. Also, better and easy access to telemedicine also drives up demand because it's easier to do. I don't have to wait three hours to get an appointment. Number four, more people are insured, which when the marginal cost of insurance is zero, you demand more of it. So you see people going out to see physicians to the extent that they can. So again, driving that volume up, Obamacare has brought in millions to the system and not necessarily in a good way. How about the doctors? What's the summation on the supply side? Well, new physicians entering is relatively flat, less productive as they move away from private practice and the administrative burden is higher, less patient interaction, as I mentioned. And by the way, it leads to lower patient satisfaction. More than two out of every five active physicians will be older than 65 in the next decade, which could lead to lower physician output, which would only continue the same trend that we're seeing now. All of these forces on net balance has led to the physician shortage, longer wait times and higher healthcare costs for patients. That was the real driver behind the formation of medics. These issues I mentioned today were the same issues that I was talking about in 2004. Medics was in place and medics has grown, factoring the COVID year out every year since 2004 and helping thousands of hospitals to try to recruit and staff the right kinds of doctors to meet the demands that hospitals face every single day. Let's move to the innovative part of what we've been working on. So there's really three things going on in staffing that I would consider innovative and pretty interesting. Digital marketplace, crowdsourcing, and managed service providers, MSP. Although medics operates in a very heavily regulated market, we've continued to operate and find ways using free market principles. Our doctors, we pay our doctors directly without third-party billing, and we charge hospitals directly. So the medics component is free market. It's driven by the supply and the demand. So we've stayed out of the heavy regulation, fortunately, in that regard. Okay, let's talk about the digital marketplace. What is the digital marketplace? Well, let's talk about the gig economy. Some of you have already familiar with this because, to some extent, you use Uber, or you are some Airbnb. I mean, these are all sort of like gig economy kind of concepts. So the gig economy continues to disrupt, enhance, and transform traditional work models, methods, and means, and infrastructure. As organizations around the world utilize, explore, and reconfigure contingent work across marketplaces, there's an increasing spotlight on the human cloud, the fastest growing segment of today's technology-fueled gig economy. The human cloud is an emerging set of online digital labor marketplaces where talent and those looking to hire talent can engage, and one can engage in one another in a work arrangement. The idea is to disrupt the chaos in inefficient markets, and this has really been seen in healthcare significantly over the last two years or so. The one big area that we see that's making a huge potential difference is crowd sourcing. This is the next generation idea for staffing and recruiting agencies. On one side, it functions as a virtual pay-to-pay platform for top-producing recruiters. On the other side, the platform performs like a high-powered agency servicing clients, candidates, and consultants. It adds flexibility and scale to help identify talent and underserve locations and difficult skill sets, such as physicians. The model is incredibly scalable. As people join the crowd, it could be measured in tens of thousands of people. The last innovation that's worthwhile is to talk about managed MSPs, managed service providers. Today's healthcare talent environment is growing in complexity. Many healthcare systems suffer from clinician clinical shortages and high labor costs due in part to a lack of strategic planning. There's a critical need to control cost and increase revenue in order to provide quality of care. MSP is typically administered as part of an organization's contingent workforce program. It may encompass most, if not all, flexible work arrangements, including temporary staff, independent contractors, freelance and gig workers, payroll, talent, and statement of work suppliers. By integrating technology that supports key processes, such as supplier management, scheduling logistics, and credentialing, and telehealth. Using these technologies to help manage contract healthcare workers and providing visibility and data analysis, partnerships, and better alignment to provide accountability between the hospital and the agency. And this is something, MSPs have been something that has been around really for decades, but it hasn't been seen in healthcare. And this is a move that healthcare staff and companies are making, and it is making a difference. The one thing that happened with Obamacare unintended consequence perhaps, and although maybe some good economist, I know John C. Goodman pointed this out 15 years ago, the one outcome of Obamacare was gonna be a consolidation of hospital and systems. And I think 15 years ago, when he made that prediction, he turned out to be correct. Hospitals have either went out of business or consolidated to keep pace with other systems. And so the large got larger. And with that they became more complex and more sophisticated and staff and companies had to do the same to keep up. The one requirement that these companies or these health systems want is visibility. They wanna know what does my healthcare spend? How much am I spending on overtime? And they wanted a whole bunch of data and companies, healthcare companies, staff and companies had to be up to that challenge. So we had to digitize, we had to spend quite a bit of IET, building infrastructure to allow us to be able to provide that kind of information to healthcare healthcare groups. So I think we're on the other side of that. I think we've spent quite a bit of money and time. And I think that it's now paying off because we become more efficient. We've been providing better solutions to them. And I think that they appreciate it. The last thing that has transformed the staffing is social media. The advent of social media to be able to reach physicians that will run reachable prior or really any healthcare professional, we can leverage technology and this third party platforms as we know like LinkedIn for example, has made a world of difference in trying to recruit. So all of this stuff has made healthcare staffing although challenging, it has made it better. Technology, absolutely 100% works. Thank you very much. We're gonna have a break.