Tech-Enabling Children's Healthcare w/ Darius Monsef, Founder & CEO of Brave Care

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June 17, 2021

On this week’s episode I chat with Darius Monsef, Founder and CEO of Brave Care.

Brave Care is creating a new, better healthcare system for kids by providing primary, urgent & remote care catered just for them, 365 days a year. By tech-enabling a system that’s been long overdue for an upgrade, Darius hopes to make Brave Care the premier children’s healthcare partner for parents.

Interplay is lucky enough to be an early investor in the company and we absolutely love their mission.

Darius is a serial entrepreneur with multiple successful exits. You might think that things get easier for entrepreneurs with each new company they start, but the journey is always an arduous one. Darius and I explore this topic (which includes a thoughtful and - IMO - very helpful discussion about wealth in the tech community), why he went through Ycombinator multiple times, the startup scene in Portland, and much more.

It was a great conversation. I hope you enjoy it.

Show Links

Transcript

MPD: Thanks for being on.

Darius Monsef: [00:01:43] It's good to be here. Thanks for having me.

MPD: [00:01:45] Yeah, absolutely. So I'm going to start off by Doris by just introducing you. Uh, I'll help people get ramped up a little bit. We can dive into more topical issues. Sure. So for those who don't know, Doris, he's a serial successful serial entrepreneur.

He is on his fourth venture backed company. His current venture, where he is the CEO and co-founder is a company named brave care. The company is re-imagining health care for children, uh, for full disclosure, interplay is an investor and suffice it to say, we think he's doing something awesome. So pay attention, uh, before brave care, he was a co-founder of a number of other companies, including Sidebox credit market.

He's had successful exit. Um, and before going out as an entrepreneur and I may be integrated in some of your entrepreneurial story, he spent some time as a head of growth at Zapier. And I have a question for you after this, because I don't think anyone knows how to pronounce the company name. There's a lot of Zapier and Zapier.

No one knows, you know, to correct each other on that. It's confusing. Uh, he did a tour through Autodesk, Microsoft, um, and you know, there's another side to Daria's, which I don't know if we're going to cover too much today. He has an eclectic side and I don't know if it's all true, but at least he, at least he lists online that he is a ballroom dancer and cattle rancher.

So there might be some times opportunities to talk about that you went deep.

Darius Monsef: [00:03:05] There you

MPD: [00:03:05] go. Uh, and he's very passionate about impact and involved with a number of charities, including Make-A-Wish and others. And I think it's no surprise that his current vendor. Is oriented towards the social impact of having a positive impact on children.

What did I miss before we jump in?

Darius Monsef: [00:03:20] Uh, also co-founded two different nonprofits, but I sort of, that could be in the realm of successful ventures, but, you know, basically trying to build things that make the world a little bit better, both for-profit and, um, I

MPD: [00:03:31] love how prolific you are. So let's start off, uh, maybe go reverse order.

Would you start by just giving an overview of brave care? So folks have some context to what you're working on.

Darius Monsef: [00:03:40] Sure. Yeah. I met my co-founder. Who's a pediatric MD when my middle daughter split her chin at a bike park, uh, as a parent of a nine, six and three year old young kids. Uh, although we are most concerned about the injuries of the first one, we sort of three kids and a little less concerned about them, but I met him in an emergency visit.

Uh, my middle daughter needed to get her chin stitched up and I am in a fortunate position to have access to whatever healthcare I need for my kids, but got to experience the really uncomfortable position of a parent. Who's really concerned about their kid in these urgent situations. Um, met him, got incredibly good care and sort of came out of that going.

I think every parent deserves access to that, regardless of a financial position, a lot of parents end up in the ER there's 25 million ER, visits a year for kids that are mostly unnecessary because they don't have action, uh, access to after hours or weekend care options. So brave care is trying to take primary urgent and remote care, build it out of the same, you know, kid friendly, but pairing, uh, Design clinics to make everybody the two sides of our transaction, the, both the parent and the child fairly comfortable so that we can deliver the best medical care possible.

Um, we, I come from a technology background, so using technology to, to build the best personal and thoughtful experiences, not putting technology between a patient, um, and a parent or a child, but using it as a way to make it a more efficient visit for, for both sides of that. And the ultimate goal is to be the national children's health care partner for.

MPD: [00:05:16] That's amazing. And, you know, hell hath no fury like a frustrated customer who happens to be a serial founder. Yes. Yeah. So we actually I've had a, a bad urgent care, uh, experience and same type of thing. I feel like stitches is the reason you go to the ER, as a parent. And my little guy, uh, ripped open his eyebrow when infrastructure is fine, doubt the stitches, they got it done $26,000 bill for three stitches.

And so the game is clearly dysfunctional and they expect you to dispute it, right. They're just taking advantage of people who don't know the, how the system works and you have to fight. So I I'd love to hear how you are approaching the market differently. So folks could, you know, get an understanding of.

More than making healthcare affordable and good. How do you do it? And what is the, how does it experience fundamentally different from

Darius Monsef: [00:06:07] parents? Yep. So part of what you're talking about is we typically just say we're 10 X, you know, cheaper one 10th, the cost of an ER, visit in New York. Uh, we wouldn't even have been $2,600.

And I think my daughter's stitches were four or $500, so substantially less. And it's about so much more mailable economies of, uh, basically a much larger organization or rental hospital. They charge more just for the basic visit fee. And then all the things you sort of experience with just. You know, uh, an unfortunate need to dispute costs rather than transparent pricing.

So what has been challenging about healthcare is I come from consumer tech and, you know, the common startup mantras move, fast break, things like that. Doesn't really work in the healthcare it's regulated. As in some ways it should be, you have medical licensing. We have payer agreements with get hit and privacy compliance.

There's a ton of layers of bureaucracy. Fortunately, that also means there's a lot of room for improvement. It's just hard to get it done in this space. Um, I. Great. Co-founders who have medical backgrounds. I try and tread the balance of naivety about how healthcare currently works, because I'm not trying to integrate and only improve some bullshit in the middle.

We're trying to dramatically move it forward. So I don't really want to calibrate to how it is now. And then look for improvements. It's just what could or should it be? And that is access. You know, either through technology or just broader hours of an in-person, is it, um, patient data, 74% of healthcare data is still transferred via fax, which is insane.

Uh, or it should be digitize all these patient records without the Manila folders on the wall anymore. But now they're digital Manila folders because those images that were scanned haven't even been OCR so that we know what's in them. They're just images that one person has to go reference. So. Such dramatic improvements can be built if we just built the best clean single queryable data set of lots of, you know, wellness tracking events for kids tracking, escalations, and then ultimately outcomes.

So that whether us or a children's hospital, you could someday just say, here's all this data, like go stop these really unfortunate events from happening in the future. Um, so it dramatically moves forward with actually modernizing it and not modernizing it where. You need to walk in and talk to a robot or whatever, especially in pediatrics, like kids believe in magic still.

So if this space is scary, if there's not somebody warm and personal on those to get on their level versus being a giant adult, there's a lot of things that can disarm a kid. And that really helps you, uh, deliver the best care. And we can talk a little bit about it or not, but a tele-health has limited impact in pediatrics.

COVID was the perfect opportunity. To use this technology to open up access and transform it. And in pediatrics, you need the patient to be able to accurately describe the issue that they're having. I can tell you, I have a strained ACL on the back of my knee on full extension. I have a sharp pain.

Otherwise it's a dull ache. My nine-year-old is just going to say her leg hurts. You might even say her back hurts because she doesn't understand sort of referral pain. And a two year old has no ability to communicate any of this. Even in person, the difference between a family practice or somebody who hasn't been as experienced with kids, isn't, it might be less skilled at really getting the kids to relax and be disarmed so that we can get good information out and we can do a good diagnosis and treatment.

So that's where the specialty and specialization and, you know, working with kids comes in and then the technology is, well, how do we open access without removing this personal relationship that you can form with somebody who knows your kid and knows how to treat.

MPD: [00:09:47] So you're cleaning the data. I get that part for the folks listening.

Why would they choose to go to brave care over their current combination of a pediatrician? ER, urgent care, Kim

Darius Monsef: [00:10:00] build the most complete solution. So I have been to brave care, 24 times as a patient, as a parent, not as the CEO walked in and dependent on them to take care of me the same way they take care of somebody else.

Um, Unpleasantly. I am a regular consumer of my own services because a lot of those visits are urgent or unplanned, but trying to be one consistent partner for a family. So, you know, the primary care visits, those are scheduled. We know those are coming. The unplanned unfortunate, urgent care options. We're open 10:00 AM to 10:00 PM, seven days a week.

You can do a walk-in same day appointment. So even the challenge and often white people, over-utilize the ER, especially 21 million single parents in the room. They have jobs that don't particularly give them time off during working hours to get in. And then I've got to pull my kid out of school in order to this appointment.

So. They're trying to make a good financial decision by going after hours, but then often the only thing available after hours ends up being an ER. And so simply being able to have, Hey, 7:00 PM on a Saturday, if that's when you need to get your well visit in for your kid, that's fine for us. So the convenience of access, meaning the hours and availability.

We have 24 7 chat through our app. We staff our own pediatric triage nurses. So again, it's not just somebody who answers and says, well, let me get back to you. We are able to understand and give you good, actionable information through the chat service. And then we have x-rays and pharmacy onsite because it is again, I've been in a clinic where we needed Tamiflu.

And now I got, gotta hold a couple of sick kids and go to the pharmacy and wait for 30 minutes. It's like, let's just do that for you in clinic and let you get home and get back to your life. So trying to really provide the most complete offering for parents and then use technology to ultimately give you your child's personal health record in an app.

So that over time you can track progress to early intervention or just best support your kid where they're at.

MPD: [00:11:53] What do you think the most common use cases will be for the data side of it, the early intervention. And where do you think that really manifests for folks?

Darius Monsef: [00:12:01] I think there's a lot of opportunity for subtle intervention.

So my wife is a speech language pathologist focused on early intervention and language delays for kids, which is the longest way to say speech delays. Um, but her skill is, you know, helping kids. Move their mouth in a way, and basically form language she can hear and know that this kid's got this little issue and it's often hard for her in a social setting, obviously to bring this up and suggest it to a parent.

But it's one of those where the sooner that you do that intervention, the kid's going to have an easier time communicating. They're going more confident, social, like it has such a dramatic impact in often it can be this small, but fixable. That we can hear, like, that's an easier example to sort of like, oh right.

I can hear when a kid has a lisp or maybe there's a delay in some of the words, but we want to figure out is what are all the other things that might be under them? Height, weight, motor skills, other things that we probably are collecting and all those digital Manila folders we can't get access to. But if we put them all into one.

It's just an opportunity to help every kid reach their potential by using the information that is being collected. It just isn't usable. Right.

MPD: [00:13:09] Are there other research organizations that are compiling the data and making sense of patterns and signal in it, or has that not even been done because all these Manila folders,

Darius Monsef: [00:13:19] I think there are physicians doing it.

I mean, we've got great children's hospitals around the country. They're doing it with the ax, with the data they have access to. But even, I don't remember how many there were. Um, there are. Probably hundreds of EHR, EMR is this is the software that every clinic uses to run their business. Those don't connect to each other.

We've had to move a couple of times and like I'm getting PDF images. Every single time I move the data does not connect and sync. So our hospital systems are having access to only the data that has been collected. There are very large players like epic that do probably have a lot of patient data, but it's not.

Anywhere near as substantial as it could be that we have access to.

MPD: [00:14:02] That's not the way we think of things in the tech community.

Darius Monsef: [00:14:06] No, I'm often, you know, the interesting balance to being between being a consumer kind of oriented startup as well as a healthcare is that the consumer startup people, when I'm pitching them and I could show them our check-in app.

An iPad. We just hand to you, so you don't have to sit in the visit room and then it's this really beautiful step through, take a photo of your insurance card. If I demo that to a consumer investor, they're like, yeah, whatever. It's like, no, no, no, no, no. But like in healthcare it was really hard to do, like, this is magical in this space.

This is just super basic in any consumer app. So right in healthcare they're they're miles behind where we could be compared to anything

MPD: [00:14:41] else. So how's it

Darius Monsef: [00:14:42] going? It's going very well. Um, it's was a hard year. Um, so our story, basically two years ago, we got started. We, I took over the clinic. I went into versus a patient.

It became our first brave care clinic. And honestly, we started in a position really tackling the ER, the urgent care side of things. Let's pull these millions of ER, visits away by having urgent cares. What we learned about moving forward with that though is. Nobody wants to have a relationship with an urgent care.

I'm like actively trying never to come to you. And so if we wanted to build a relationship and have a consistent touch point, that was to move into primary care, which is exactly what primary care is. It's a relationship I'm expecting you to come in at least once a year. And so, as we got started, we sort of evolved the platform to say, oh, well, primary care really adds value to the urgent care.

And when you are somebody's primary, you can capture the urgent. So there's this reciprocal relationship between those two sides of sorts. And then we are always going to build great technology because it's my background and where there's opportunities, but COVID allowed us. Basically, we were growing very well.

We went through Y Combinator, summer 19 batch. So it gets to be a year and a half ago had raised a big seed round, really had the resources to go and grow, open more clinics. And then COVID sort of took the wind out of our sales early March. Um, Had anybody provide any other data? So I believe it's true. I think we were the first of any company to ship a COVID symptom checker.

So March 2nd, 2020, we repurposed the logic sort of tools that we had built for symptom checking to build a COVID symptom. When we shipped that we very quickly responded and built tele-health for, for 14 different things. But limited utility. I mean, there's only kind of visually diagnosable things. And if you looked at we've done more than 13,000 visits, now we're going to publish a paper on it.

But it's like 70, 80% of those visits that we did in clinic had to have been done in clinic. It's a shot, a stitch, a lab, and x-ray breathing treatment and things that there's no dongle on. Uh, any device that's going to facilitate in the near term. Right. So we did what we could. Um, it was really hard there through the fall, but the harder thing that we did was we raised a little bit more money to maintain the momentum we had sort of like leaning into the abyss instead of doing this.

I understand why startups would do it. We'll skeleton crew. Let's make sure we survive. What we saw was that. You know, as a startup, you kind of planning to lose money every month for some long period of time, that's not how normal businesses operate. So COVID just meant I was bleeding more than I was already planning to bleed, but for a typical kind of small business clinic that's can be catastrophic to have several months of no income or very little income.

So as the overall capacity for pediatric care would be reduced. If we leaned into this and got our second clinic built a mobile clinic, increased capacity, the goal was that when there would be a return in demand, we'd just be better positioned to capture it. So it turned out to be the right decision. We went ahead and.

During a pandemic with riots and a recession, and then fires in Portland, Oregon. We still got our second clinic open, which was hard to do, and we had our mobile clinic. And then in the fall we saw a pretty dramatic return, uh, in visit volume. A lot of that underline is COVID tested. We do rapid COVID tests, um, in both of our clinics.

So enough overturning growth to validate all these assumptions that we had when we started to be able to go raise our series a, which we just closed, which appreciate your support and to do the next phase of this, we've made it, made it work in one market. I think Portland was a great market and that it is a lot, like I'm an importance of special city for a number of reasons, but it's a lot like 70 other cities that are half a million to a million population in the us.

By making it work in a city like that just better helped us understand that we could also do this in a number of other cities. And our expansion plan is not tier one high density, urban markets, because often that's where families or people defer families for careers. We want to know that we can exist in tier two and tier three markets where people have more kids and get started earlier.

So the series a is letting us drive that expansion, which is what we're doing now. We're opening four additional clinics building the next couple. Um, mobile clinics and then having to build all of the software on the backend to enable us to deliver care. So, uh, it's, it's good. I, you know, it's always fun coming off of a fundraising announcement cause you get a lot of congrats on social, right?

It's like getting a giant credit card. It's like, thanks. I have a lot of work to go do with this money now, but it looks nice. Feels nice. I think it is not easy.

MPD: [00:19:05] You have to hire people.

Darius Monsef: [00:19:07] Yes, that's tough also because we've been well capitalized here and it was required because we had to do hard things was it's it is I think, dangerous and easy to spend money when you raise a lot of it.

So that's also the balance of not leaning so much on like, oh, just hire the person to solve this problem. But like, do we really need to solve it? There's another kind of critical eye that really has to be used when you're welding.

MPD: [00:19:29] Hmm. So what, what cities are you going to next? So where should listeners look for the next brave care locations?

Darius Monsef: [00:19:35] We're already two in Portland, sort of a home market. We'll expand them to the Beaverton area. Portland, Austin is our first sort of major new market that we're opening. And we're, uh, also moving into North Carolina. It's an exciting opportunity for us to test out a different way to expand into new markets, which popped up in, in North Carolina.

MPD: [00:19:52] That's fantastic. So can we talk about Portland for a second? So it's not one of the primary startup hubs historically. Yep. The world is decentralizing and a wonderful way. What is the, what's your experience as a founder in Portland? Is it a viable place to be doing business? What do you think about the, uh, the region?

Darius Monsef: [00:20:14] I have mixed feelings of it. I've sort of lived on and off in Portland for 15 years. I started my first company color lever is the first thing that ever became venture backed. And then I had an, uh, an exit. So, uh, there is a love frustration with the market. I think in terms of a community to live in for my kids to sort of feel more normal and be around it makes the people think Portland's great for that.

So quality of life is incredibly high. There is a tech scene. Um, I it's clearly not as strong as some other markets. I mean, LA San Fran, Cisco now Miami New York, like you just around so many other peers that are actively doing what you're doing. Uh, Portland, I still think is probably a lot more optimistic or ambitious about doing startups than it actually is happening in market.

I think as me, interesting post COVID how much more it gets distributed though. Cause I, despite, you know, even my previous company that I co-founded site box had a very big exit for Portland. Tech startup scene, right after that raising money for brave care. I don't have any Portland investors. Yeah, I went, it was, I went back to the bay area and LA and New York and Boston.

I, we didn't have. Maybe for me, because I'm used to things moving faster, the kind of investor that I wanted to spend my time with gear in Portland. Um, but I think again, this sort of a decentralization of where startups need to be. Uh, I didn't, even for my series, a huge benefit of doing it during COVID is I ended up doing in-person so I wasn't flying all over the country.

Like I normally am. So if we're okay, doesn't matter. Yeah. If we're doing this now, maybe I can keep my company here. I don't get pulled to the bay or somewhere else where I need to have these in-person meetings. So I think. Hopefully the startup scene catches up to the high quality of, of life here. Um, but again, I think it's a mix, uh, sort of give and take

MPD: [00:22:03] with remote investing fundraising process right away.

You don't have to meet the invest investors in person. What is missing from the Parlin ecosystem for folks listening, who are, would be entrepreneurs or entrepreneurs and other cities, which should they come and ask to Portland or help build to put pajamas?

Darius Monsef: [00:22:21] I think it's boost it's builders is exactly the point.

Um, Portland again has benefited from some incredible, you know, Nike's here, uh, Columbia sportswear. There's these big companies that I think have built great products and companies, but people that come Intel's you come from kind of long-term employment. There's just less. Risk tolerance to go actually do this startups.

And so I think a lot of the community here has historically dabbled there, dangled their feet in the water. Yeah. Versus that I'm going all in on this thing. Cause I believe it to be true, fail or succeed. And I try and find those. I small, I make tiny angel investments, but mostly I do it because fortunate enough to one be privileged in many ways.

Ways, uh, but one of them is, uh, previous experience living in San Francisco, going through Y Combinator, twice, having access to a lot of investors, meeting founders who are here in saying, look, if you're going to go all in on this, then I will back you early and I'll try and help you through this fundraising process.

Cause that's really counterintuitive in a lot of different ways. What no offense y'all look for and how you run your processes. It really is an opposite sometimes for how I run my company and how I think about what I'm doing. So just helping somebody navigate these things just cause I've done it before two times absolutely is something that I think is helpful for the kids.

MPD: [00:23:38] And you had moved to Portland from San Francisco, the bay area, right?

Darius Monsef: [00:23:42] He has a little, there's a couple other stops there in between. So my wife and I are both born and raised in Hawaii. Um, we, I was at Microsoft at the time. We met second grade, uh, when we first met, but ten-year high school reunion was the full reconnection of us getting together.

She was in San Francisco. I really wanted to do this startup. That I'd started full-time. So I moved from Seattle. I left Microsoft and I moved to San Francisco full-time with all that. I owned in a car and no savings, but luckily she was very supportive of it. She saw some potential, she should be an investor because clearly.

Not a lot of resources at the time, but, um, lived in San Francisco, went through Y Combinator. When we got ready to have our first kid, we tried to move back to Hawaii, um, and live there. And then probably a year into that, I got sucked back cause there was zero community out there to support what I was doing.

So we moved back to San Francisco and then post exit to Autodesk of that company. Getting ready to have her second kid. We moved home to Hawaii. Again, this is where a post exit. I can choose how to spend my time. Again, very, uh, lucky in being able to get an exit that would set us up that way. Uh, this is where we bought 40 acres in our hometown.

I got cattle. Well, I spent, I would say three years started jokingly losing my mind. Um, and then ultimately I ended up losing your mind. I for better or worse am most fulfilled by doing hard things. And startups are every single day. Some there's some challenge. There's something that I have to rise to. Um, I should know this as being from Hawaii.

Hawaii's culture is a little bit of the opposite of that really. It's, it's there to relax or connect with nature and not your device or all the busy-ness. So when I got home having come off of a decade of high energy startups, I filled my life with all of the same. Chaos and stress, but none of the fulfilling, it was just like I had land to take care of.

I had a house we were building, it was just busy-ness with none of the fulfillment, my analogy. I was chain sign water until that motor blew. And I really had like a popping depressive moment where. Oh, all of these layers of privilege are hiding the fact that I'm depressed. I'm not happy even with all the things that I was able to have access to what mattered most to me, it'd be the fulfillment of building and making wasn't there.

And again, supportive wife and that we've basically had a dream life in Hawaii is like, I think we have to move out of here. We got to go. Didn't want to go back to the bay area. We really, again, we mentioned this a little bit earlier. I'm trying to sneakily get my kids to not know all of the privileges they have and just sort of live a more normal life as long as possible.

And Portland felt like a great way to just live in a normal community and be around that. She let us do this test and move back to Portland, uh, which fortunately worked well. It gave me the energy and inspiration again. And then my daughter obviously got hurt, which is how we started brave care for COVID.

We moved back there early on because we felt like man, there was space. We have now been in Hawaii, although important Portland right now for more than a year, just because there was lower, lower COVID case rates. And it was a nice place there. If you're going to run things remotely, having them all three kids be able to be in school was it was a pretty supportive environment.

MPD: [00:26:57] That's great. So one thing you kind of alluded to there's, um, choosing to go to Portland versus back to San Fran and given that there's a huge ecosystem in the valley, um, you are networked in the valley. Why not raise the family there?

Darius Monsef: [00:27:12] It's probably a couple of things. One. Obviously it makes sense. A lot of my friends are all startup founders and my wife one does not care about technology or startups or any of that.

It's a good balance for us to have in our home. But also it means like when you have a dinner conversation with a group of people, it's not even just about the device, it's about the SDK that just released for the new version of whatever. It's like, that's not interesting normal people conversation. So it was always harder for her to engage.

In just what people were interested down there. Um, and I think also, you know, because I had this position of the fortunate place of already building those relationships, I knew that I can same day fly to San Francisco. If I needed to, if I needed to maintain those socials, I could from Portland, but really setting my family up for the best life felt like Portland would be the place to do it.

Um, and then also. The hyper we've talked a little, those two, that's just the focus on wealth that happens in San Francisco. And it's fine. Cause it to be fair, it's a lot of our motivation. Like honestly, you probably, it shouldn't be your only motivation to go do entrepreneurship in Texas, but clearly that is the most massive exponential way to build