Episode 45: Free global healthcare is the dream—Charles Nader of Doc.com explains how blockchain, AI, and virtual care might make it a reality

"Definitively Speaking" is a definitive healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us@definitivehc.com. Hello and welcome to another episode of "Definitively Speaking," the podcast where we have data-driven conversations on the current state of healthcare. I'm Justin Steinman, Chief Marketing Officer at Definitive Healthcare and your host for this podcast. Free basic healthcare seems like a fundamental human right. In a world where these days it feels like people struggle to find anything that they can agree upon, I think we can all agree that free basic healthcare for everyone is a good thing, but that's where it gets complicated. If it's free, that means someone has to pay. So who pays for this free healthcare and who determines what's basic and what's not? It gets real complicated real fast. Charles Nader, CEO, and Founder of doc.com thinks he has the answer. Charles has a self-described mission of providing free basic healthcare to the entire world, and he plans to use a combination of artificial intelligence and blockchain to do it. Have I got you intrigued yet? A native of Mexico, Charles has recently featured in a coverage story in Forbes Magazine's Mexico Edition. According to a recent profile, Charles has always been passionate about medicine and helping people in need. That's what compelled him to pursue a medical degree at Anáhuac University in Mexico. As a medical student in Mexico City, he learned how difficult it was for poor people to get proper medical assistant. As a result, this didn't just inspire him to continue his medical education, but also awakened a desire to do something to fix it. His vision was to create a single universal platform that combines reliable and unbiased medical information. He's a serial entrepreneur whose biggest passion project is doc.com, which he's been working on for nearly 12 years. So I'm curious to hear how close he's come to solving the problem of free basic healthcare. Charles, thanks for joining us.

It's a pleasure to be here, Justin, thank you.

We are happy to have you. So I'll get right to the point. How does free basic healthcare work?

Well, our vision for free basic healthcare is pretty simple. Using today's reach of technology, we offer free telemedicine, so that means you can speak to a doctor, psychologist or veterinarian through video chat for 15 minutes at no out-of-pocket cost. And that's what we call free basic healthcare. It's innovative in the sense that it's a very simple one blue button service. You just press a button and it connects you. You have no obligation to give us any credit card information or deposit any money. There's no cost for that initial 15-minute consultation. And it solves basic needs. And that's really what I always felt the world population needed. You know, we need more access to primary healthcare services. It more in line with preventative medicine. It's what general world populations need the most. That start to the healthcare journey is what we want to solve. Giving people access to that basic care and then guiding them towards whatever they may need afterwards. And that's what free basic healthcare is. Press a button, speak to a doctor, psychologist, or vet, 15 minutes are free.

Right, but you can speak to a doc for 15 minutes, but there's only so much that you can really get in 15 minutes. Like, if I need blood work, right, maybe I'm feeling really lethargic 'cause my iron is low, the doctor's not gonna be able to figure that out just by talking to him for 15 minutes. So where's that line on basic?

Well, you'd be surprised what you can find out in 15 minutes. I mean, generally speaking, if you look at primary care clinics, once you sit down with a doctor and you go through an initial consultation within the first 15 minutes, they should determine the generals of what's going on, what your needs are. And from that point on forward, the decision tree is modified or you can choose what path to take. And those first 15 minutes are critical and they're, you know, to determine the basic needs. What can you see? There are limits to it, obviously. If you need, for example, you just mentioned blood work, maybe we can determine within that first 15 minutes that you do need blood work, okay. Then if that's the case, then we can refer you to the right path to get that done. It's not something that we currently do, but we at least can guide you in the right direction. And in some cases, you know, sometimes people think they may need a lot more care than they do. You know, the objective is to cover the basic needs. And the basic needs are being able to have access to a healthcare professional, not fully dependent on AI, someone that you can trust that covers that basic need and be guided into the right direction. In many cases, it turns out saving lives. You know, the outcomes are much better for patients, but just the fact that you have access to this kind of service at no cost is a huge differentiator for world populations.

So let's talk about that no cost 'cause let's be honest, there's no such thing as a free lunch. Somebody's paid for it, right? So who's paying for this 15 minutes of care for everybody?

We pay for that. And our hope is that those patients become users of ours on a regular basis and they purchase products from us or services. So for example, we have three revenue streams and our main revenue stream is selling pharmaceuticals. and over-the-counter products. Most people end up with some sort of prescription or a suggested product. That's our goal. Our goal is from a business side is, you know, to be able to sell products. But we had to find a way to scale and to make this sustainable. And it was a no-brainer because most people, when they go speak to a healthcare professional, they end up needing some sort of product or service afterwards. And that was our goal, to do this in a transparent way and something that was a benefit to society, basically achieve our mission by devising a business model that was scalable, profitable and that also solved the problem or our mission for a free basic healthcare.

So you said you had three revenue streams, prescription being one. What are the other two?

Prescription being one. The second is medical billing. We basically can charge insurance companies depending on the type of calls if you do have insurance. And the third is ad revenues. We have ads displayed during our waiting period and educational content, pretty straightforward.

Got it, so then to some degree you're competing with like the HIMMS and the hers and the Rowes of the world, right? Because you know, I don't have a lot of hair. I see you're very much in the same shoot as me and I get all these ads like, "Hey Justin, go to HIMSS and you know, talk to a doctor and they'll give you a free Rogaine or charge me for Rogaine gain, right? How's what you're doing different from that?

I would say that first of all, our mission is to provide free basic healthcare. It's more broad than just targeting, a specific kind of condition. We want a service that's available to anyone, any age group. We want to be that go-to place where you have any healthcare-related question and you think, "Well, you know, I may need a, you know, I sprain my ankle, or I feel sick." You know, you can go to us and have a trusted service and be guided and be the start of your healthcare journey. And it's much more broad in that sense. And we also designed our model to be functional in any market. You know, I come from Mexico, the healthcare system is very different there, it's very different in Latin America, it's very different in Africa, it's very different in the Middle East, the US is very different. So we needed a model that would work in every market. And even though our main focus right now is the US market, we needed something that would be of impact to the whole world. And really if our business model is focused on selling pharmaceuticals, over-the-counter products, then that's something that works in most major markets in the world.

So I'm glad you brought up the complexities of going global 'cause as I was thinking about this podcast, that really struck me as a big issue, right? I mean, healthcare in US, Canada and Mexico is different. Forget, you know, all the countries in Europe, Africa, a whole other ball of wax. Then you start going all over Asia. So where are you operating today and how do you decide where to go next?

Well, our focus right now is the US market where we're preparing an upcoming nationwide launch. in the US. We operated previously in Latin America, we changed the business model we saw that the data coming in from our patients. And that was really changing our focus to making the business side of things focused on selling products. The beautiful thing about what we're doing is that the margins may be different in different markets, but there's still always margins. You know, its, I would call a noble business because it's something that it's not difficult to understand. You know, there's pharmaceutical consumption in every major market in the world, and that's our focus, you know, it's combining the benefits of providing a free basic healthcare service and joining that with product sales. Essentially we created this model in a digital form. But there's already versions of this in Latin America. Back in the nineties in Mexico, there was companies that started putting small consultation rooms in their pharmacies and they offered either free or very low-cost consultations. And it was a huge help because the healthcare systems are fully saturated in Latin American countries. You know, there's so many impoverished people. And they said, "Well, we need innovations to help us solve this problem." And it was a no-brainer for them to say, "Well, let's allow this to happen as long as they do it under the right regulatory conditions." So we kind of took that to a digital world, and that's, you know, it's something that I think was necessary so it can proliferate worldwide. So that's the vision of what we're trying to do here. And it's helped many people already. It's not just geared to anyone. Anyone could use it. I mean, I used my own example of, I remember I was seven years old. I fell off my bicycle, scraped my leg, ran into my friend's house, my leg was bleeding, his mom was just kind of standing there in shock. She didn't know what to do really. I went into the bathroom, washed my leg off because, you know, my mother had taught me to do that. But I think back to that, and you know, with kids these days, they could potentially have a phone and just, "Hey, let's call doc," press a button and get guided into what doing next. I mean, that's just one case to any other cases. You know, we've had pregnant women calling in with their blotching blood. They don't know that they're about to lose their babies. And that small 15-minute consultation literally leads to that baby's life being saved and to normal things too. You know, people calling about common colds, asking about their studies. So there's a lot of use cases that are beneficial.

So where are you getting the doctors ? Because like for example, the pregnant woman situation is very different than the common cold, right? And you know, there's all sorts of lines around telemedicine, practicing across state lines and certifications and you know, like, heck, my PCP if I go on summer vacation to a different state, he's like, "Sorry, I can't treat you over telemedicine." Even though I have a relationship. So do you have doctors in all 50 states as you're preparing to launch here? And then do you have doctors in Latin America? How do you deal with the language issues?

Our system is separated by states. So state by state regulation, you know, we have to have doctors within certain states. There's different licensing partnerships that are done between states. So if we're within that range, we can cover with a doctor in a certain state if there's a licensing partnership. But ultimately we have to get healthcare professionals in the respective states where their patients are. Part of the challenge is getting more and more healthcare professionals to join us. The way we've gone about it is, you know, we use traditional methods to recruit healthcare professionals and also by word of mouth, you know, it's, if you think about it, if you're a healthcare professional, many of them have done the Hippocratic Oath. If you know that there's someone on the other side that's receiving the service for free, you're fulfilling that. You're fulfilling your duty as a healthcare professional. And it's kind of helped us increase our healthcare professional users because of that. You know, they know that they're helping. There's no obligation to sell anything. There's no weird thing. It's all just a transparent, "Hey, let's give the service to the people." You'll get paid. And in the end, you're helping people out. And most doctors, even though they have specialties, these are the basic things that you learn when you study medicine. So you should be able to guide someone towards the right direction if you're a doctor.

So how many patients do you have using this service today? Or how many patients have you treated throughout your history here?

Total amount, we've treated over the course of, you know, all time over 600,000. We have a very ambitious growth plan for the US and this is the first time we're actually implementing this business model. We've focused on adding a lot of products to our marketplace and making sure that we have a good assortment of things. And you know, the cool thing about how we did this, it's not just traditional things you can find in a pharmacy. You know, we're looking to curate the products more so you can find more innovative things or different treatments that you would normally not find. And you know, we are also doing research ourselves on certain things. You know, we have drugs that we want to help develop and put through FDA trials, just different things that we think could be reduced the cost to the end user. I mean, ultimately, like I said, we're here to provide free basic healthcare and that can extend to other things as well. It starts with telemedicine, but it can lead to, you know, the reduction of many treatments, the cost of treatments and mobile clinics, things like that.

Gimme an example of an innovative treatment that you were just talking about. Something that is not typical at a pharmacy that you're offering through doc.com.

Well, not offering yet, but we are in research right now with a specific type of treatment for cirrhosis. That drug in itself can reduce the treatment cost of cirrhosis or even liver cancer dramatically. So if you would look at traditional treatments, there's treatments that range from $30,000 to $100,000 for the whole treatment. You know, we're looking at these innovations that can reduce the cost of that to a 10th of that, you know, $3,000, $2,000. And that that's something that we could expand globally. And so, you know, you can see where the impact lies there with a lot of people that have this issue. That's one example.

Are you VC-backed? Do you ? I'm sitting here listening to you talk and it's feeling expensive to me, right? You're gonna deliver free basic healthcare to everybody around the globe and sell prescriptions and develop innovative treatments. And I'm just seeing the dollar signs rack up here. So how are you funding this thing?

Yeah, it's a combination of things. You know, we are backed by institutional investors and we have, you know, private investors that came in as well. You know, you have to consider anything in healthcare costs money. And that's very true. But it's also the business model. We believe it can be a multi-billion dollar business. The investment is worthy of it. The financials are worthy of it. So like anything, it's never easy to raise capital, but we've been able to do it.

Got it, alright, so let's switch and talk a little bit about technology 'cause I teased in the intro that you're using artificial intelligence and blockchain. Now, let's just start with the basics. Some people in our audience may not be familiar with blockchain, so could you just provide an explanation at a, like, kind of Wall Street Journal level? What is blockchain? How does it work and why is it important?

Well, first of all, blockchain, a lot of people will have different ideas of what blockchain is. But blockchain in itself is just a very simple way to register any act publicly. So you can take, let's say, I don't know, let's say you have a meeting, you want that meeting to be registered publicly. It's a great form to register it without having it being manipulated by somebody else. So then that's a decentralized aspect of it. So if you wanna register something that happens in a public ledger, that's what blockchain essentially is. The technology allows you to do that. And the virtue of it, one of its main virtues is transparency. If you can register something publicly in that moment, timestamped, and you can say, "Well, look, this is what happened. Here's a timestamp of it, it happened, you know, exactly at this moment." And for someone to manipulate or change it, it's extremely difficult, scientifically proven that it's very difficult. While that gives you a layer of transparency that, you know, we haven't had before, the creation of blockchain, it's very difficult to have that. And when you look at it, you think, "Well, this technology could be applied to many industries to make businesses more transparent, to make data transactions more transparent." And particularly in healthcare, what we do is when we give a consultation, we take in data or there's a product sold, it's accompanied by a blockchain hash. So that means there's a publicly verifiable metric of that action happening. And that's very, very important if you think about the importance of healthcare data, the importance of transparency and the transactions of it. The pandemic was a great example of all these things happening all at once. And, you know, the regulators were flooded with this, all these data points coming into them. And we saw that centralized systems were fallible. You know, there was different reports coming from different places. Now imagine the task that they had at hand is such a difficult thing. And there's a lot of great people within these organizations, but they were just met with a huge amount of data that they were trying to filter and build reports on. It's a great example of how blockchain in that case would've kind of helped to make things more transparent for everyone. And it's definitely, you know, it's definitely something that I think should be implemented in healthcare for the future. Not only the way we're doing it, but on many levels. And it applies to many industries.

So how are you using it? Because I'm still a little confused trying to follow you here. So what are you doing with blockchain in doc.com?

So basically use the service, you press a button, have a consultation with a doctor. At the end of that consultation, we took in data, we took in your healthcare information, we built out a prescription, that information, you know, it goes into our base, our database, and that prescription is given to you and sent out. Now both of those moments are accompanied by a blockchain hash. So in that moment, you know that there was x amount of data taken in your healthcare information and your prescription was also hashed. That's important because you can at least have something that's an identifier of your consultation happening. Now, it may not be that important for you at the beginning, but down the road as things accumulate over your healthcare journey, you want to have transparency and you want to know who's looking at that data. If someone accesses other than the company, if someone views that, there's also another hash that happens at that moment. And so that is just another layer of transparency that makes things better for patients. It makes things more transparent for the company. It makes things more transparent for investors as well. You know, same thing happens when there's a product sold. It's a company by a decentralized blockchain hash. No one can go in and say, "Hey, you know, there was some weird numbers here." And that's what we wanted to prevent. You know, there's a lot of strange things that happen when you look at financials at different companies. There's a lot of financial engineering and we wanted to avoid that. There's a path towards total transparency and transparency, taking advantage of blockchain to offer that transparency just builds more trust. You know, we're focused on our mission, we're focused on increasing our sales, doing a good job, why not be transparent about it? That was really the key way we are using blockchain and it's a simple thing, but that can also grow into other things. You know, there's rewards programs and different things that can evolve from that that use blockchain technology. And, you know, we plan on doing that in the future as well. And being an example for the public markets of the use of blockchain technology in this setting,

But doesn't like, I mean, Epic and Cerner now, Oracle offer EMRs and they have to have that same type of privacy control and transparency. And who's looking at it? Why is what you're doing different or better? Or are you saying they're not doing that?

They're not doing that. If you ask them... If a patient asks them look at the process that you have to go through to know where your data was sent and what happened. There's no decentralized, there's no publicly verifiable method to say, "Look, this aligns with these signals," and no one has that level of transparency. You would have to use blockchain in order to have that level of transparency. Is any organization on this planet using any decentralized method or transparency? And the answer is the only ones that are doing it are blockchain=related organizations or companies. And that's where it ends so far. No one's really implemented this into, you know, product tracing. That's another thing that we're doing where every time a product is sent from one place to another, there's a blockchain hash. Now there are other ways tot trace things, yes, of course, but at least you have that additional layer of trust that you can say, "Well look, at least there's a publicly verifiable metric that is out there that we can trust. It wasn't manipulated in some way." And in many cases, you know, that's better than what's out there. And anything that we can do that's better than what's traditionally out there, you know, we will try to implement. I'm a true believer in that blockchain transparency. I think, you know, as time goes by, more and more people will realize the benefits of it. You know, it can be applied to so many things, so many industries. And it's really the virtue of blockchain technologies, the transparency aspect of it.

So when we were prepping and talking a little advance of this podcast, you mentioned to me that Covid vaccine delivery is a prime use case for blockchain. How would that work? Why do you feel that way? And you know, I guess the follow-up question would be is wouldn't you consider vaccines part of free basic healthcare?

Well, like I said, we have our own version of free basic healthcare. Free basic healthcare is giving people access to healthcare services with doctors, psychologists and veterinarians. 15 minutes for free. That's the most basic format that we offer. Obviously we'll try to expand it into whatever we can down the road because it is our mission. You know, if that means, hey, you know what, now not only you get the 15-minute consultation and a couple of years from now, you'll also have, let's say a eye test at a mobile clinic as part of the free basic healthcare model. There's many things that we want to add to it. So vaccines could be one down the road as well. The aspect of applying blockchain to Covid vaccines, what we talked about was the actual data capture of all these stats that were coming in. Now, many of the statistics that were coming in, like I said, the regulatory agencies were flooded by information coming in, left and right, left and right. Now, it was very clear that there was fallacies within the reporting and it's, you know, it's normal when you're flooded with the pandemic, who wasn't going to expect something like this to happen? So moving forwards, a solution to that is saying, "Okay, what can we trust? We can trust the blockchain. It's a decentralized metric that that's there on the cloud. We can trust that. So why don't we go transferring the way we capture data onto the blockchain and that way next time something like this happens, we have a more trusted source of information. So we have less fallacies into the reporting." And I think that's just, it's common sense. You know, we would want to improve and use the reach of technologies to improve these things. So that's what I meant by apply to Covid vaccines, the Covid pandemic in general.

That helps. So you also mentioned that you thought the formula for success in healthcare is to combine access, analytics and transparency.

Yeah.

What happens when you combine all three of those things?

Well, have you ever heard the story of Dr. John Snow?

I think of John Snow as "Game of Thrones." So maybe gimme a different story.

Exactly. Well, John Snow, he was actually named after Dr. John Snow, the guy from "Game of Thrones." They have the same name. He was a doctor in London back in 1854, I believe, around that time. He is considered the father of epidemiology. Now, one of the great things that he did is back then the cholera epidemic was rampant. There was people leaving London because they basically didn't know where they were getting cholera from. So they thought it was in the air, you know, people were dying. And the crazy thing, it was women and children, a lot of them were dying from cholera. So what he did is he went door to door down the streets of London and he just asked questions. He said, "Hey, who died here?" Or "Who's sick?" And he would write things down in a little notebook, go street by street. And he discovered that when he got, you know, to a section of the road where there was a brewery, he discovered that only four, I think three or four people within the brewery had been infected with cholera and everyone else hadn't. So he connected the dots and he said, "It has something to do with the water." Everyone here is drinking alcohol. Women and children don't drink as much alcohol as men. And he's like, "Ot has something to do with the water." Now that led down the road to this whole effort to clean water. And they didn't know. Actually, at the time, germs were theoretical. They didn't know that germs existed. You know, look a glass of water and say, you would say, "Oh, it looks clean," but you know, it could possibly have cholera in it. So that small effort that he did going street by street, taking down that information and then displaying it to a form of people saying, "Hey, this is trusted information." It led to the saving of billions of lives down the road. That shows you two things. One is the analytics of it, you know, someone connected the dots. They took in that data. They said, "Okay, there's something weird going on here." You know, they figured out that it was water. It's wasn't airborne. It was the water that was contaminating people. And a lot of people got saved because of that. And the second thing was the transparency aspect. They trusted him as a doctor 'cause he was a medical professional. They said, "We can trust his data." And despite that, he still had resistance. You know, it wasn't like just easy, he just presented it. He still had resistance. So what better to use technology to solve both of those things, transparency and analytics. And then the third thing is access. Now how can we increase those two things, the analytics and the transparency? Well, we can also use technologies to increase the access to capture more data. And we have the ubiquity of smartphones. If we can do that, then we can have a dramatic increase in the outcomes of health for everyone. So really I think it leads to more preventative healthcare. It just leads to solving many of the world's problems. And it's not just traditional healthcare, it's mental health. You know, it's, you know, I mentioned veterinary health 'cause I'm an animal lover myself. And a lot of people, they care more for their animals than they do for themselves. But I believe it applies to all living things. It's the same concept for everyone. And that's how analytics, access and transparency combined create the best healthcare solution.

I wanna ask you one, maybe two more questions before I like, let you get back to your mission here. You know, you mentioned earlier, and I mentioned earlier that, you know, you were born and raised in Mexico, and I'm really wondering how your background has influenced your perspective on healthcare and healthcare delivery.

Oh, it's influenced me in a huge way. You know, I used to do rounds at the general hospital in Mexico City, and on some days there's people that form a line around the whole hospital and they come from the outskirts of the city. Now Mexico City's at a huge, huge city. It's one of the largest cities in the world. Imagine taking a bus, spending literally five to six hours on a bus or a train to get to Mexico City. And then once you get there, you form part of a line and you have to wait another three, four hours or potentially up to the next day to just see a doctor for some sort of ailment. That's a situation that many of the hospitals in all of Latin America, actually many parts of the world have this situation. And a lot of the cases, over 50%, at least in the experience that I had, were things that could be solved at home. You know, it was like someone would come, they would be hurting for a day or two. Oh, there's something really wrong here. They'd show up to see a doctor and their doctor's like, "Well, you had tacos last night." Such a simple thing like that, you know, "Hey, you probably ate some bad salsa." And it, you know, sometimes it was something like that. And other times it was something, you know, just some family member panicked and it caused another family member to panic. And they ended up saying, "Well, let's just go to see the doctor." So for me to see that it was just so inefficient knowing the technologies that we had today, you know, this was years ago, this was 12 years ago. It just seemed that there was something that could be solved understanding the reach of the technology that we have. We just had to find a way to get a free basic healthcare service to them and make it something that's scalable and sustainable. And that became basically my life mission. I just thought it was the best thing I could do with my life inspired by, you know, Elon Musk and Reid Hoffman and Chris Yeh and all the people that I always admired in the business world, people that I thought, wow, they're changing the world. You know, I read Jim Rohn books. It was very inspiring for me to see them. And I thought, well, for me, this is the ultimate thing. And it became my mission, my purpose in life. And that's basically what I've been doing, you know, all these years, these, now it's 12 years to dedicated my life to this. So it was a big influence. And, you know, I just thought, well, we can help these people, you know, what better thing is there to do in life?

Well, I think on that uplifting and mission-driven, no, I think we're going to end here, but you know, I stand in awe of your passion and your drive to really pull this all together here. And I wish, just wish you the best of luck and I hope you're able to pull this thing off.

I appreciate it, I appreciate it, we're moving forwards. There's a lot of great people that are working with us. You know, it's not just me. There's a lot of very intelligent, amazing people and we're pushing forward doing a great job.

Alright, well, we will watch and maybe have you for a follow-up visit at some point. And for all our listeners out there, thank you for listening to "Definitively Speaking," a Definitive Healthcare podcast. Please join me next time for a conversation with Squire Servance, the founder of Syridex Bio. Under his leadership, Syridex Bio is in the process of launching the first of several $10 million investment funds dedicated to researching and developing advanced medicines and therapies to treat medical conditions of disproportionately impacted Black, Hispanic, Asian American, Native Americans and other racial or ethnic minorities. Squire's strength lies in his capacity to connect scientific innovation with tangible real world outcomes. He not only trained as a cell biologist, but he holds a JD and MBA in corporate finance and a certificate in health sector management from Duke University. Squire and I are gonna have a wide-ranging conversation about how to bridge the gap in healthcare inequities in the United States. I hope you'll join us. If you like what you've heard today, please remember to rate, review, and subscribe to the show on Apple Podcasts, Google Podcasts, Spotify, or wherever you get your podcasts. To learn more about how healthcare commercial intelligence can support your business, please follow us on X or Twitter @definitivehc, or visit us at definitivehc.com. Until next time, take care, please stay healthy, and remember, while there's no such thing as a free lunch, you might just be able to get your 15 minutes of free healthcare.