The Healthy Enterprise

In this episode, Dr. Steve Schutzer shares his journey from a Bronx kid to a prominent orthopedic surgeon and co-founder of Upswing Health. He discusses the importance of improving patient experiences in healthcare, the challenges faced in the industry, and the innovative solutions Upswing Health offers to streamline orthopedic care. The conversation highlights the significance of direct primary care, functional medicine, and the need for interoperability in healthcare systems. Dr. Schutzer emphasizes the entrepreneurial spirit required to address healthcare challenges and the importance of mentorship and effective communication in achieving success.

Chapters:
00:00 Introduction to Dr. Steve Schutzer and Upswing Health
02:49 Dr. Schutzer's Journey in Medicine
06:02 Mentorship and the Impact of Innovation in Orthopedics
08:51 Creating Centers of Excellence in Joint Replacement
11:55 Challenges in Healthcare and the Role of Legislation
14:50 Direct Pay and Direct Primary Care Innovations
18:01 Functional Medicine and Preventative Healthcare
21:06 The Future of Healthcare and Entrepreneurial Medicine
31:39 The Shift to Entrepreneurship
32:25 Building Centers of Excellence
34:48 Identifying the Ouch Moment
36:12 Innovative Solutions in Orthopedics
39:11 The Evolution of Orthopedic Management
41:28 The Vision for Upswing
44:20 Navigating Healthcare Challenges
47:30 Interoperability in Healthcare
51:27 The Future of Upswing
55:45 The Role of Employers in Healthcare
58:42 Marketing Strategies for Upswing


Guest Information:
  • Guest's Name: Steve Schutzer 
  • Guest's Title/Position: Co-Founder and Chief Medical Officer 
  • Guest's Linkedin: https://www.linkedin.com/in/steve-schutzer-md-81616125/
  • Company / Affiliation: Upswing Health https://upswinghealth.com/
  • Guest's Bio: Steve Schutzer is an orthopedic surgeon specializing in adult hip and knee reconstruction, with decades of experience leading joint replacement programs and advancing value-based orthopedic care. He believes in the power of connected communities and digital technologies—especially in today’s accelerating AI environment—working alongside compassionate human caregivers to solve complex medical challenges. Recognized as a focused, innovative, and visionary healthcare physician leader and strategist, Steve has an enduring obsession with improving the patient experience.
Takeaways:
  • Dr. Schutzer's journey reflects the unpredictability of career paths.
  • The importance of mentorship in shaping a physician's career.
  • Building centers of excellence can significantly improve patient care.
  • Healthcare challenges are often rooted in financial disincentives.
  • Direct primary care offers a promising alternative to traditional models.
  • Functional medicine focuses on prevention and holistic care.
  • Upswing Health aims to provide quick access to orthopedic care.
  • Interoperability in healthcare is crucial for better patient outcomes.
  • The rise of early onset cancers highlights the need for preventive care.
  • Entrepreneurship in healthcare requires resilience and adaptability.

Creators and Guests

Host
Heath Fletcher
With over 30 years in creative marketing and visual storytelling, I’ve built a career on turning ideas into impact. From brand transformation to media production, podcast development, and outreach strategies, I craft compelling narratives that don’t just capture attention—they accelerate growth and drive measurable results.
Producer
Meghna Deshraj
Meghna Deshraj is the CEO and Founder of Bullzeye Media Marketing, where she partners with eCommerce brands, healthcare institutions, and small businesses to scale profitably without outside funding. Under her leadership, Bullzeye has driven over $580M in annual growth and more than $1B in collective direct revenue for its clients. With a background spanning corporate strategy, IT, finance, and process optimization, Meghna brings a unique blend of data-driven marketing expertise and operational leadership. A Certified Six Sigma Black Belt with deep experience in program management and business transformation, she has successfully led global teams, large-scale integrations, and organizational change initiatives. Her superpower lies in marketing strategy and consulting, fueled by a passion for helping businesses grow through innovation, efficiency, and strong client relationships.
Guest
Steve Schutzer
Steve Schutzer is an orthopedic surgeon specializing in adult hip and knee reconstruction, with decades of experience leading joint replacement programs and advancing value-based orthopedic care. He believes in the power of connected communities and digital technologies—especially in today’s accelerating AI environment—working alongside compassionate human caregivers to solve complex medical challenges. Recognized as a focused, innovative, and visionary healthcare physician leader and strategist, Steve has an enduring obsession with improving the patient experience.

What is The Healthy Enterprise?

Join host Heath Fletcher on The Healthy Enterprise as he explores how healthcare leaders and innovators are transforming the industry from the inside out. Whether you’re a provider, tech entrepreneur, marketing strategist, or industry executive, these conversations deliver actionable strategies, innovative solutions, and human-centered insights to help you grow, lead, and make a lasting impact.

Created and produced by Bullzeye Media Marketing — let’s make something great together.

Heath Fletcher:

Hey there. Welcome to another episode of the Healthy Enterprise. My guest today is Dr. Steve Schutzer. He's the cofounder of Upswing Health. He's also a focused, innovative, and visionary health care physician leader and strategist with an obsession for improving a patient experience in health care.

Heath Fletcher:

Looking forward to this conversation, and I hope you are too. Let's get started. Steve, thank you for joining me today for this episode. I really appreciate you giving me, your time. I'm curious to learn more about Upswing as listeners will too, but why don't you, introduce yourself and and explain, who you are and what you've been doing and and where you got to where you are today.

Steve Schutzer:

Yeah. Heath, thanks so much for the opportunity to be with you today and share a story. You know, you look back over your career and your life, and you wonder how it all unfolded. You know?

Heath Fletcher:

Yeah. Series

Steve Schutzer:

of events that are never planned and but, you know, a door opens and you sense it and you take it. But I I'm just a really I I consider myself above all a very lucky kid from The Bronx, born and raised in the city.

Heath Fletcher:

Mhmm.

Steve Schutzer:

My parents were the first folks, in their families to go to college. My dad actually is a politician, which makes makes me some of my success. Because he never forgot anybody's name or could always shake a hand. But, really, I did learn a lot from my dad in terms of how to communicate. Yeah.

Steve Schutzer:

He was an attorney, and I I, actually clerked for him one summer when I was 15 thinking about law. And I said, dad, you do anything in your life other than talk. I didn't like that at

Heath Fletcher:

all. It does.

Steve Schutzer:

At that point, I knew, being a lawyer wasn't for me. But, you know, I really kinda gravitated to to the sciences and always had a bit of an inquisitive mind trying to solve solve problems. And when I was in med school, Heath, I I wanted to get and it was a lot less expensive then, obviously.

Heath Fletcher:

Right.

Steve Schutzer:

I wanted to get off my parents' bills, so I I I took a navy scholarship. I signed up with the US Navy, and they covered a great bit of my medical education. Of course, the payback was, you know, I I had to enlist Yeah. When the time was right. And, you know, talking about certain things that kinda work out where you were in planning, they wanted me, as a surgeon.

Steve Schutzer:

But then one year into my surgical training, they said, we need you now. And I said to the navy, I'm not ready now. They said, son, we need you now. And I I I realized that I had signed something I really probably didn't read completely.

Heath Fletcher:

Right.

Steve Schutzer:

They they had they had me. So long story short, again, under the category of these things kinda work out, I, I was actually dating a woman at the time. I said, she's not gonna be here three years from now. So so I didn't get married. And, and I became a primary care physician in the military.

Steve Schutzer:

I ran a medical clinic in Puerto Rico for a few years in the Navy. But, you know, these things just start to formulate your worldview. Right? And Yeah. People said that all all through my career, I obviously went back to become an orthopedic surgeon, but I think like a PCP.

Steve Schutzer:

I think like a primary care doc, which I think is a compliment.

Heath Fletcher:

Mhmm.

Steve Schutzer:

I think beyond the bones and the joints and all that stuff. But, but that's what I did. I went to, med school at UVA. Very lucky to to get into UVA and then did my surgical training in Rochester, New York, in surgical training. And then I, again, went into the navy, came back to do orthopedics, at the University of Connecticut here in Hartford.

Steve Schutzer:

And then, you know, once you're in an once you decide you wanna be an orthopedic surgeon, there are about 10 different subspecialties, Heath, that you're gonna spend your most of the orthopedic surgeons don't do general orthopedics anymore.

Heath Fletcher:

Okay.

Steve Schutzer:

And, for me, a love of carpentry, and I rotate on all of these different orthopedic subspecialties. But I I can tell you, Heath, giving somebody their legs back is such a gift. Right? So I became an arthroplasty surgeon, otherwise known as a total joint surgeon.

Heath Fletcher:

Mhmm.

Steve Schutzer:

And so for thirty seven years, I replaced about 12,000 worn out joints, hips and knees in particular. And it was just a great, you know, to see people of all ages get their life back, you know, until I haven't had a joint place. My wife has. But just to be disabled, you know, 40 years old, 50 years old, 80 years old, and to get that back, it was just was just a gift that I was given to able to to to do that. So that's a little look at my, you know, orthopedic career.

Heath Fletcher:

When they said we need you now, you had to put your education on hold then, and then you went and and you went and did your enlist you went to your enlisting, and then you came back and finished your education. Was that right?

Steve Schutzer:

That is correct.

Heath Fletcher:

Okay. Cool.

Steve Schutzer:

I actually had a little hissy fit because I said, I talked to the politician, dad, you gotta fix this. Alright? I'm not going to the navy now. I'm just getting started. He said he says, son, you're stuck.

Steve Schutzer:

Did you read this contract? So but, you know, it was one of those things, and it's important for listeners, young listeners, to know that everything doesn't always go your way, but make something of it. Right? It was the best thing in the world for me. I made the right decision for my spouse, and I learned primary care.

Steve Schutzer:

And I, you know, I was still very young. I was a little ahead of, of my years. So I went back to do my, surgical training and then orthopedic training, and then was blessed to get into Mass General, in Boston for my joint replacement training.

Heath Fletcher:

And you saw the world. So you saw Yeah. Things from a different perspective too, which is also very helpful. Yeah.

Steve Schutzer:

You know, when I worked, when I was a diving medical officer, a little high a little sideline.

Heath Fletcher:

Oh, okay.

Steve Schutzer:

I know the Navy SEAL team very well and, you know, talk about folks that are inspiring. They're just superhuman beings. So had an honor to be their team doc for a number

Heath Fletcher:

of Wow.

Steve Schutzer:

So great experience if you you can see how things start to formulate. Yeah. Very, very blessed.

Heath Fletcher:

So then you came back, and now you're practicing. And you did that for how many years did you continue doing that?

Steve Schutzer:

So I I finished in Boston, and I had opportunity this, again, these are the decisions that you have to make. I I I was invited to stay in Boston with my mentor, who I love. He's still still alive, and he's smarter than I'll ever be. An opportunity to stay there, which was a great opportunity. Mass General would have been quite a deal, but, you know, I just didn't wanna be a small fish in a big pond.

Steve Schutzer:

Mhmm. And, again, I I had done my orthopedic training here in Hartford. It's only 90 miles away. It's halfway between New York City where my family was and halfway to Boston. And I decided to come back here in Hartford and and try to make a a bigger impact in a smaller community.

Heath Fletcher:

Mhmm.

Steve Schutzer:

And but I I wanna highlight one important comment here because talk about mentorship, and that's what I'm trying to do now with my life. But my keep in mind, at that point, I was, what, 31, maybe 32. Mhmm. And my mentor was a taskmaster. He was not easy.

Steve Schutzer:

He was really he expected his fellow he had two fellows every year. He expected us to know everything about every patient. And I don't mean just their bones. I don't know their electrolytes, their blood loss, and everything in the management. He counted on us, and, there was no BS ing this man.

Steve Schutzer:

But every morning, we'd have rounds at 06:00 over the cases for the day and the patients. And he would look over his wire rims like this, and he'd say, Steve, don't forget. You gotta leave it better than you found it. That was every freaking morning. You know?

Steve Schutzer:

And I'm okay. I got a lot of work to do. But you know what? It actually stayed in my brain that when I finished and I left Boston, we stayed very close with that doctor William Harris is his name. Stayed very close.

Steve Schutzer:

I still see him to have dinner once in a while. But that stayed in my mind, you know, because he had he had such an impact on orthopedics. Without going into too much detail, before the year February, Heath, the implants that we would put into people would last ten or twelve years.

Heath Fletcher:

Oh, wow.

Steve Schutzer:

That's it. Especially young people who beat them up.

Heath Fletcher:

Sure.

Steve Schutzer:

Yeah. Eight year olds, it doesn't matter. Yeah. So consequently, we had patients wait until they're 55 or 60 in pain. And yeah.

Steve Schutzer:

Well, he he took eight years to to make a new material called cross linked polyethylene. And without boring you with all of the chemistry behind it, we released that he released that in the year 2000 with a promise of extending the longevity of these implants.

Heath Fletcher:

Oh, wow.

Steve Schutzer:

Comes now twenty five years later, the patients that I did in the year February, those that are still alive, look like the day I put them in heat.

Heath Fletcher:

You're kidding. Wow.

Steve Schutzer:

No. No. And he really deserves a Nobel Prize.

Heath Fletcher:

No kidding.

Steve Schutzer:

No. He he changed the world because this cross link sure he had one patent on it then another patent. But now that is a standard implant around the world for the last twenty five years. So if you know anybody that has a hip or knee, shoulder, and ankle, they really owe Bill Harris a a debt of gratitude.

Heath Fletcher:

Isn't that interesting? I've seen the parts actually that go in. In fact, they're they're quite when you see them when they're not in place, but you see them, they look like, you know, toy parts, you know, plastics and and various things. I've seen the parts before they go in for a hip replacement.

Steve Schutzer:

There you go.

Heath Fletcher:

And you would notice. If you, you know, if you didn't know that that's what they were, you you would have no you wouldn't even guess that that was going to be a new hip for somebody. But Yeah.

Steve Schutzer:

And Yeah. So and the problem that was solved with this new material is the bearing surface. Yeah. All the other stuff had been fixed. But when it comes to metal against plastic, how quickly or how durable is that material?

Steve Schutzer:

The heath jumping on it, shooting some baskets, or whatever you like. Right? Anyway, that was a major milestone in my life because that thought of leaving it better than you found it.

Heath Fletcher:

He really he really gave he really gave that to the industry. Yeah. Everybody can leave it better than they found it. Many many.

Steve Schutzer:

Yeah. No.

Heath Fletcher:

What a legacy. Yeah. What a legacy. And then you went ahead and you I I think I saw or heard you did over 10,000 surgeries in your career.

Steve Schutzer:

Is that true? And Wow. You know, along came this other opportunity that we'll talk about these centers of excellence, which necessitated me cutting back on my volume. So here again, these opportunities arise. So let me just go into a little bit about this.

Steve Schutzer:

But around 02/2006, 02/2007, we kept hearing about this epidemic of joint replacements as people in my demographic, I've been a baby boomer, came of age. Just the explosion of volume. Yeah. Not not to mention maybe we were a little more active than our parents were. But we we heard about this impending volume about to descend upon us.

Heath Fletcher:

Mhmm.

Steve Schutzer:

At a time, Heath picture this 02/2006. I was getting three cases done in a day, right, an eight hour day Wow. With two hours between cases. Right? Having no personal input in anything other than I bring my patient, I do my case, They let me do the materials that I want, but I had no no input on any of the operational aspects of the patient journey.

Steve Schutzer:

None. So I was doing three pays three cases a day by 04:00. And and and, you know, so we we had an idea, an inspiration to build a center of excellence for joint replacement arthroplasty here in Connecticut. And it was not it was a big deal because we had to bring together a lot of egomaniac orthopedic surgeons and say, listen. We can bring together a lot of volume, and we can leverage that volume to a willing hospital partner.

Steve Schutzer:

Now today, you know, many of these are done in a surgical center. But Mhmm. 02/2006, 02/2007, I told they were hospital based.

Heath Fletcher:

Hospital. Yeah.

Steve Schutzer:

So we had this idea with and long story, we built a management company of 10 arthroplasty surgeons. We assembled a lot of volume, and we went to one hospital and said, listen. We have an idea. We wanna build a hospital within a hospital. Right?

Steve Schutzer:

Let us show you how to do it. Let us run it. We'll show you the money, but let us run it. And we went to hospital a. No need to mention who that was.

Heath Fletcher:

Yep.

Steve Schutzer:

And they said, you know, if we do it for you, we have to do it for everybody. And we said, are you sure? And they said, no. No. No.

Steve Schutzer:

No. And that was my base hospital.

Heath Fletcher:

Right.

Steve Schutzer:

So we went one mile across the street to a smaller hospital, faith based. And we said, listen. We have this idea. We wanna build a center of excellence. And they said, dude, here are the keys.

Steve Schutzer:

Come on down. It's yours. Are you kidding me? Within the limits of the law, and the contract said the last par every paragraph says that this whole Saint Francis retains the authority. It's their space.

Steve Schutzer:

We don't own any of it.

Heath Fletcher:

Right.

Steve Schutzer:

We're there to manage it. Right. And it was a a very novel idea. Everybody was laughing at us until they stopped laughing because the surgeons were coming from 50 miles away to our unit. Now why would they do that?

Steve Schutzer:

Because rather than do three cases in a day, they were doing eight cases in a day.

Heath Fletcher:

No kidding.

Steve Schutzer:

And they were we were collecting their data. We had protocols. We had a family. We really were a hospital within a hospital. We wrote this up in the New England Journal of Medicine, and it was so successful for joint replacement.

Steve Schutzer:

You know, sometimes professionals are jealous of one another. You know? It's a natural thing. Yep. So my my spine colleagues that hated us for a year, hate us, you know, all that.

Steve Schutzer:

And I said after a year, I said, you know what? This lease seems to be working out pretty well. Could you share your agreements with us so we can build a spine center of excellence? And we did that. And then the sports doctors came forward and say, hey.

Steve Schutzer:

We wanna do this in sports. We gave them that. And then the trauma doc. So long story short, within two or three years, we had four centers of excellence, subspecialty based, all private, working with a hospital partner. Mhmm.

Steve Schutzer:

And they asked me to be the physician executive overseeing all four of them so I can keep going.

Heath Fletcher:

And

Steve Schutzer:

it was just the most amazing experience, Heath. And and it really became a prototype of how physician entrepreneurs can work with hospital systems that allow us the latitude to just let let us show you how to do it. Right? We don't we don't expect you to know everything, but just let us show you how to do it. And the COO actually said to me, this is a direct quote.

Steve Schutzer:

He said, Steve, my job is say yes and get out of your way. Now you don't hear that much anymore here. A problem. Yeah. Right?

Steve Schutzer:

Everybody got their own lane, and they protect their lanes. Yeah. This is how it was for about fifteen years. So gives you a little idea of the success we had. And Yeah.

Steve Schutzer:

It was just an amazing run. And, you know, to call yourself a center of excellence, I don't know how it is in Canada, but there are billboards over every highway. We're the best in the world. But we had data to support that. Right?

Steve Schutzer:

Yeah. We were validated by the Validation Institute. We were validated by the American Board of Orthopedic Surgeons. So it wasn't just a lot of nonsense. These were validated.

Steve Schutzer:

The frustrating part, and this can segue perhaps into the next conversation, is that for all that we did to create an unbelievable patient experience and to create very low price points, we never moved the market. And that was my first foray into health care. Right? I thought with the prices being as low as we drove them

Heath Fletcher:

Mhmm.

Steve Schutzer:

With the experience being five star Nordstrom's

Heath Fletcher:

Yeah.

Steve Schutzer:

That employers and health and and and the payer, they would be banging our doors down. Yeah. Right? But that you know, then then I started to have an awakening how difficult it is.

Heath Fletcher:

So what was that what was that hurdle? What was it? What was the difficult part?

Steve Schutzer:

Oh, boy. I'll tell you. We can talk about that for hours, but it wants to do a little bit with financial incentives.

Heath Fletcher:

Right.

Steve Schutzer:

That's one big thing. Okay. And then we have the status quo. Right? And and I'm sure you're following all of the problems with employer sponsored health care and all of the opportunities they have to fix it.

Steve Schutzer:

It's just overcoming again, there are financial disincentives without, you know, without pointing to one stakeholder. There are brokers and there are TPAs, and there are consultants that are between me Mhmm. And the person who's paying the bill.

Heath Fletcher:

That's right.

Steve Schutzer:

Layers of intermediaries.

Heath Fletcher:

Yeah.

Steve Schutzer:

And each of them have a hand, you know, in the pie. And if if they, you know, if they're doing well, there's really no reason for them to change. Are you familiar with a piece of legislation, maybe in front of your other, guests, called the Consolidated Appropriation Act or the CAA? No. Okay.

Steve Schutzer:

That's that's critically important. That's it was signed into law by president Trump and his for a few days before he left office, January 2021. And, basically, what it does is it's it's one of the longest piece of federal legislation in history. It's 5,000 pages.

Heath Fletcher:

Oh, wow.

Steve Schutzer:

No one reads it, of course. But embedded in that 5,000 pages may be the most consequential federal legislation in fifty years. Because what it does, Heath, is it makes it explicitly clear, black and white, no gray, that the employer has a fiduciary responsibility to act on behalf, solely on behalf of their employees in making their health care decisions. Mhmm. Just like a four zero one k retirement plan.

Steve Schutzer:

Right?

Heath Fletcher:

Okay.

Steve Schutzer:

So it's in black and white language. And I thought when this was signed, this would solve the problem. The problem is that employers still don't know about it. Many of them don't know about it. Or those that do, they go, well, doesn't apply to me.

Steve Schutzer:

Keith, it applies to all employers with over 50 employees or more. And the penalties that they're at risk for are substantial, and they're personal.

Heath Fletcher:

Really?

Steve Schutzer:

And they're not covered by any they are the employer's responsibility. Right?

Heath Fletcher:

Wow.

Steve Schutzer:

And the language is extremely clear that it's not black and white as a lot of legislation is. So now what you're seeing emerge on the scene are, claim breach claims.

Heath Fletcher:

Oh, okay.

Steve Schutzer:

Mhmm. By employees, and they're usually in very large companies. The big one was J and J about a year and a half ago. Mhmm. Wells Fargo had one, where employees are saying, wait a minute.

Steve Schutzer:

And and it affects the employees because, listen, employee goes let's say they need a medication. They can buy it out of pocket for a $100.

Heath Fletcher:

Right. If they

Steve Schutzer:

buy it through the health plan, it's $2,000, right, of which they pay co insurances and co pays and deductibles. They don't even need it, but they have to use the health plan.

Heath Fletcher:

Right.

Steve Schutzer:

Right? So that's the genesis of these lawsuits now. So there there's a little saying now, if you can't legislate, litigate. And that's what we're starting, unfortunately. That we're just trying to see unfold.

Heath Fletcher:

Yeah. Yeah. And you're you were we're seeing more direct pay too, which is is also interesting because it's it it cut it cuts through a lot of that a lot of that debris, doesn't it?

Steve Schutzer:

Yeah. Let's talk about that for a second because, you know, again, I've been involved with these initiatives now since 02/2006, banging my head against the wall. And but I I live for bright spots. Mhmm. You've gotta live for bright spots.

Steve Schutzer:

You find them. You stick to them. You enhance them. Right? And one of the bright spots is direct contracting, direct pay.

Steve Schutzer:

And when I first heard about that two or three years ago, I said, why? We have insurance. Right?

Heath Fletcher:

Right.

Steve Schutzer:

And and here's the here's one reason in in a nutshell. Be because employ an employ let's say you want your joint replacement done. You can go to Oklahoma Surgical Center, internationally known now. All treat you look at the website. Oh, I can get a hip replacement, $17,000, all in.

Steve Schutzer:

I go to my employer and say, hey. I can get a hip replacement, knee replacement, $70,000. Can you reimburse me for that? The employer goes, I'm paying 68 or 70,000. I'll send you in a first class seat to Oklahoma.

Steve Schutzer:

And you and your spouse up to a hotel, I'll reimburse you to $20. I'm ahead 60.

Heath Fletcher:

Yeah.

Steve Schutzer:

So that's what we're trying to see now. The employers are reimbursing their employees for paying out of pocket. Mhmm. Pay cash.

Heath Fletcher:

Right. That's where these health care spending accounts are all starting to arise too. Right? Same thing. Yeah.

Steve Schutzer:

They're being looked at and modified by congress now to make them more flexible. Mhmm. Right now, they're very limited as to what they can use the SHSA for, but they're trying to make them more flexible. But even if they were to simply pay out of cash, if the employer goes, yeah. I'll pay for your ACL, Oklahoma, or anybody else that has transparent pricing Yeah.

Steve Schutzer:

In cash.

Heath Fletcher:

Yeah. Right? Yeah.

Steve Schutzer:

So this whole movement to direct contracting, cash pay is one of the ways we might be able to disrupt and topple, it's a big word, topple, the, you know, the major insurance carriers.

Heath Fletcher:

Mhmm.

Steve Schutzer:

That's big

Heath Fletcher:

And unless the insurance actually, I've had conversations about insurance about how potentially some of them are looking to change their incentives towards more preventative health care too, where there's incentives to actually hit benchmarks where your your medical records are showing an improvement in your health care. You've lost weight. Your blood work is looking better. And then there's incentives by insurance companies to say, we'd rather you look. We'd rather you take care of yourself than wait till something happens, and then we gotta cover your ass.

Heath Fletcher:

But, have you heard of any of that?

Steve Schutzer:

Yeah. You know, I'd like to, I'd like to say I I first of I agree with you, but I'd like to say that's really happening. Because keep in mind, one of the shortfalls of of the, Affordable Care Act was that it set the m medical loss ratio, the AML ratio at 85%. Mhmm. So they can only take 15% of premiums towards profit.

Steve Schutzer:

Well, the higher the premiums

Heath Fletcher:

Right.

Steve Schutzer:

The bigger their piece.

Heath Fletcher:

Yeah.

Steve Schutzer:

Well, that's a major obstacle. It it again, it's those financial disincentives. Having said that, the other bright spot that I cling to before we talk about, upswing is a direct primary care movement. And that's kinda tied to the first thing we just spoke about direct, the direct contracting.

Heath Fletcher:

Mhmm.

Steve Schutzer:

Because as you are you following the direct primary care movement?

Heath Fletcher:

Little bit. It came up in a conversation the other day, but you can elaborate for sure.

Steve Schutzer:

It's another one of those bright spots that we have to accelerate and amplify. Mhmm. So it started as as concierge medicine. So when my folks were alive living in Florida, I bought them a concierge doc, so I knew somebody would take care of them.

Heath Fletcher:

Right.

Steve Schutzer:

But these are the docs. I I forget what I paid them, but they made a decent, you know but they were had a they limited their panel to 500. My folks had their, cell phone in case they needed something or showed up in the ER. So that's what you were buying.

Heath Fletcher:

Right.

Steve Schutzer:

And but that was really no. I would just know everybody couldn't afford that, and I was very lucky I could. But along comes this direct primary care, probably five years out now, but probably most known, by the Health Rosetta was one organization. The other one is called Hint Health, which stands up these direct they call them DPCs. But, basically, what they do is they don't take insurance.

Steve Schutzer:

They limit their panels to somewhere around eight 100. They get paid on a subscription fee, and it varies depending on the model, somewhere between 50 and a $100 per household member per month, depending on the model. The models do vary. Some of them use more nurse practitioners. Some are doctors.

Steve Schutzer:

The employers are now saying, well, listen. So for, you know, $1,200 a year, I can keep a family healthy because they know that basic primary care today, to no fault of their own, not blaming them, they have fifteen minutes to see a comorbid diabetic. And Right. Who can do that? Right?

Steve Schutzer:

No one can do that. But the but the DPCs can actually do that. They spend the time. They have one hour sessions with their patients. So this is another big movement that needs to be amplified, direct primary care.

Steve Schutzer:

And this company called Hint Health stands up 10 to 16 new DPCs per month, but they tend to be small. Right? The two and three and four are one. But there are some that are very big and that we're working with now through Upswing. So that's another big, big bright spot, and the employers are stepping up to do that as well.

Heath Fletcher:

That's a shift for sure. Yeah. That must be inspiring to see. Yeah. It

Steve Schutzer:

is, and it's good for patients. You know, there's a whole layer of primary care that I'm I'm enthralled with before direct primary care. That's called functional medicine. Right? And not to pitch somebody else, but if you ever want a functional medicine physician on, that is really fascinating to me.

Steve Schutzer:

Are you familiar with functional medicine?

Heath Fletcher:

No. Not that much. Don't throw me in.

Steve Schutzer:

So, you know, DPCs are great because they take care of sick patients, and they make them a lot better.

Heath Fletcher:

Right.

Steve Schutzer:

What about getting to the patient before they become sick? Mhmm. Novel idea. Right? So these functional medicine doctors probably and there are some that are very, very famous.

Steve Schutzer:

Doctor. Mark Hyman tends to be one of them, very well known guy here in The States. They are they're they're MDs, but they look at, they approach health care as as a as a research scientist. Most of them have a degree, listen to this, in nutritional biochemistry.

Heath Fletcher:

Right?

Steve Schutzer:

Because they look at everything we stuff in our mouth as, you know, just like taking a pill.

Heath Fletcher:

Yeah. Yeah. Yeah.

Steve Schutzer:

You you take a bite out of piece of chicken. Who knows what hormones and ingredients and pesticides and crap that it has in it? That's what they look at. So

Heath Fletcher:

little more holistic. Right?

Steve Schutzer:

Well, very holistic.

Heath Fletcher:

Yeah.

Steve Schutzer:

But also very at the cellular level of Right? Yeah. I'm gonna pitch a good book called good energy that I'm just trying to read by a young functional medicine doctor. And it it it looks at everything at the cellular level. So functional medicine docs have a saying about traditional primary traditional medicine that we like to name and blame.

Steve Schutzer:

We say, Heath, this you got a diagnosis. You know, this is your diagnosis. And if you don't get better, we blame you for not getting better.

Heath Fletcher:

Right.

Steve Schutzer:

You know, that's kinda true in some ways. Yeah. But what the functional medicine doctors do, they they think and they link. Okay. So Heath has four or five different health problems.

Steve Schutzer:

Is there a root cause of them? Could it be his diet? Could it be his medications? Could it be all of those things that are linked together

Heath Fletcher:

His stress level.

Steve Schutzer:

Stress. Oh, it's rude to all of it. Sleep. Yeah. Sleep.

Steve Schutzer:

Press.

Heath Fletcher:

Or lack of. Yeah. Diet and activity.

Steve Schutzer:

Yeah. The impact of lack of sleep of cortisol on your cell function is something that

Heath Fletcher:

we Yeah.

Steve Schutzer:

Think about. But think about how wonderful a world we would have if we prevented people from getting sick in the first place.

Heath Fletcher:

Right. Right. It kinda ties into with that with psycho neuroimmunology too. Right? That's a an interesting combination, a a three way intersection of those studies and which talks about, you know, keeping the body in a state of homeostasis so that it's functioning in a in a balanced environment as opposed to being, you know, living in a state of survival.

Steve Schutzer:

So important. Yeah. Especially for young people because, you know, this is a disturbing statistic. If you look at the rise of early onset cancers

Heath Fletcher:

Mhmm.

Steve Schutzer:

It's not in 80 year olds. I mean, everybody did cancer in the eighties. They're in 30 and 40 year olds.

Heath Fletcher:

Wow.

Steve Schutzer:

And it's going

Heath Fletcher:

That's too early.

Steve Schutzer:

It's going like this.

Heath Fletcher:

Wow.

Steve Schutzer:

Yeah. That's very weird. It's gotta be something in the environment. Right?

Heath Fletcher:

Yeah. In our yeah. It's something that we're doing. I mean, do we really know the effects of cell phones yet?

Steve Schutzer:

Yeah. No. We don't.

Heath Fletcher:

We don't know. Yeah. We don't know. We've only, you know, we've only been carrying around, portable cell phones for twenty years. So

Steve Schutzer:

Yeah. Don't know. It it is very scary, and it it really starts with the neonate, the baby, you know, the in utero, the mother's diet, and all

Heath Fletcher:

of that.

Steve Schutzer:

So I'm I'm really excited about functional medicine. We had someone on our podcast couple of months ago that just blew me away.

Heath Fletcher:

Exciting. I'm look into that more. Yeah.

Steve Schutzer:

Thank talk about that offline. But do you wanna know a little bit about upswing?

Heath Fletcher:

Yes. Because I wanna go back to something you said earlier, and that was entrepreneurial medicine. And it it was interesting. Listening to you talk, it's great because you you've kind of, experienced, you know, a world when you when you went into practicing and you and you discovered areas that weren't really working. And I've heard this before.

Heath Fletcher:

It's like you, you know, people choose their profession. They go to school. They choose their profession. They get their jobs. They start their practice or whatever it is they're doing.

Heath Fletcher:

And then they find that something doesn't work, you know, and particularly a lot of our conversations are in health care. So it's like, this didn't work or this isn't working. So I had to come up with something to fix this. And and and I and I I don't think every doctor or or medical practitioner decides to be an entrepreneur because it's a it's a very different profession to be practicing medicine or being an entrepreneur. But so many cases where you gotta be both or you morph into being both.

Heath Fletcher:

And so this is where this is where you're coming to now is upswing. So at some point, you had to shift, gears and become an entrepreneur. And that's where Upswing

Steve Schutzer:

came in. If you think about the early part of our conversation with building these centers of excellence, that's entrepreneurship. Mhmm. It's not tech entrepreneurship.

Heath Fletcher:

No. But it yeah. You're right.

Steve Schutzer:

Yeah. Entrepreneurship. We had to solve a problem.

Heath Fletcher:

Yeah.

Steve Schutzer:

For me personally, it it it you know, listen. If you have 45 orthopedic surgeons, you can't manage by fiat. Right? Good luck. Yeah.

Steve Schutzer:

You'll get to be able to figure it out the door. So I had to change my personality. I had to read about social sciences. Again, I talked about my father. He was a a very effective politician.

Steve Schutzer:

How did he he was a Democrat, but he ran both sides of the aisle. And, you know, you had to learn how to communicate and persuade. I also studied martial arts, and I learned the art of being soft and not being hard.

Heath Fletcher:

Right.

Steve Schutzer:

So all of those things became effective for me as my tools. You know, we all tend to react when someone gets in your face and tells you, go screw off. You're a jerk. That, but, you know, you gotta take a step back and not process that a little bit. So Yeah.

Steve Schutzer:

All of that Maybe

Heath Fletcher:

do they have a point?

Steve Schutzer:

Yeah. They have a point. And, actually, while I while I was before we started these management companies so forth, I actually developed a couple of implants, orthopedic implants that to solve a problem. I worked with doctor Harris. We had a couple of patents on implants too preceding, these, arthroplasty institutes.

Steve Schutzer:

But yeah. It, so what happened was just before COVID, probably five or six years ago now, my partner and I my partner, doctor Jay Kimmel, ran the sports program. Really great guy. His wife is actually a a psychologist to help help my training about it, and she's interested in in motivation. So I learned from her.

Steve Schutzer:

Dan Pink, another one. But, anyway, Jay said one day, you know, looks like we've fixed the surgical part of orthopedics. Right? We had these humming surgical centers and all that. It was beautiful.

Steve Schutzer:

But, Steve, what about when somebody rolls their ankle or they pull out their back picking up their kid? And because, Heath, I can't tell you how many times I have and and, again, my hip and knee surgeon, how many times I've seen patients come into my office having had major spine surgery. And I look at them walk in the office. I said, god. Your hips are shot.

Steve Schutzer:

It's not your back at all. What? Y'all many, many times.

Heath Fletcher:

Oh my god.

Steve Schutzer:

I'm not blaming anybody. Sure. But, you know, we all have tunnel vision.

Heath Fletcher:

Right? Yeah.

Steve Schutzer:

If you go in, you're complaining of leg pain and you'll get an MRI, and your MRI shows a little something in your disc.

Heath Fletcher:

Yeah.

Steve Schutzer:

The spine's operation. Right? Wow. And and all of the patient and and not quite as radical as that. And, again, not pointing fingers, but patient sees a primary care doc.

Steve Schutzer:

They're not trained in orthopedics. Right? So they send somebody to get some get some physical therapy. Yeah. Now, again, not blame physical therapists, but they don't have a diagnosis.

Steve Schutzer:

Go get some therapy. So they go back to the primary care doc, and it still hurts. Well, let's get an MRI scan. Well, the MRI scan in people 60 are always gonna be abnormal in any part of your body. Right.

Steve Schutzer:

And then it leads to seeing a surgeon and all that sort stuff. So bottom line is, so, Jason, what if we built a company to catch the patient, and we call it an ouch moment. And we all have ouch moments. Right? You probably got an ouch moment.

Heath Fletcher:

Yep.

Steve Schutzer:

And now you know now you know me. You've got my cell phone and my email. So reach out to me before you go to emergency room.

Heath Fletcher:

Okay. But

Steve Schutzer:

but if you don't know a Steve or a Jay or someone like us and it hurts really bad, you go to the worst place in the world. You go to emergency room. You walk in. They get some X rays. They give you prescription for some Vicodin.

Steve Schutzer:

And they said, go find a surgeon. Right? And and, you know, or or you go to your primary care doctor, urgent care. But who you see for that very first visit for whatever your problem may be dictates the cost and the outcome of that journey.

Heath Fletcher:

Right.

Steve Schutzer:

Right? And we have data to prove that. Yeah. So we built a company to give people answers to the questions that the two key questions are, what do I have and what do I do? Right?

Steve Schutzer:

Those are those two key questions. And we built technology to give people those answers, and it's pretty darn accurate. We built the algorithms so you can go on and you can get an answer. You plug in some answers to these questions. And you got a pretty good insight as to what your problem is and what to do about

Heath Fletcher:

it. Interesting. Okay.

Steve Schutzer:

PDFs and all that sort of stuff is when do you go to the ER. Basically, he if you were playing soccer, he rolls your ankle, and you finish the soccer game, you don't know to need to go to the ER. Your ankle's not broken.

Heath Fletcher:

Right. Right.

Steve Schutzer:

So, anyway, we built these algorithms, then we hired athletic trainers. Are you familiar with athletic trainers? Yep. Okay. So little dirty secret, not such a secret anymore, but they are the most underappreciated stakeholder in orthopedics.

Steve Schutzer:

Right? They're they're underpaid. They're undervalued, but they're really good at front end management. This is what they do.

Heath Fletcher:

Right.

Steve Schutzer:

They see you or your kid on the field. They make an assessment. They go, you know, it's a little sprain. It doesn't need to see a surgeon. So they do immediate assessment and triage.

Heath Fletcher:

Mhmm.

Steve Schutzer:

So our front door is technology and athletic trainers. Oh, really? These assessments, and they're very low cost. Right?

Heath Fletcher:

Right.

Steve Schutzer:

And then they then they have three choices. They say, you know what? I'm really worried about heath, shoulder, neck, back, whatever it may be. I'm gonna set you up to see one of our orthopedic docs same day or within twenty four hours. And, you know, it takes three weeks to get in to see an orthopedic surgeon in

Heath Fletcher:

this.

Steve Schutzer:

Right. In Canada, probably six weeks or a month. Who knows? But we do that within twenty four hours. Or the or the athletic trainer may say, you know what?

Steve Schutzer:

I can manage this low back strain with some exercises and so forth. Don't need to go anywhere. Right?

Heath Fletcher:

Right.

Steve Schutzer:

Or we have our own physical therapy. So three options that the trainer can do. All virtual.

Heath Fletcher:

Yeah.

Steve Schutzer:

Right? So and what we're doing now, the results really quickly is that we're managing eighty five percent of the patients that come to us without escalating out of Upswing.

Heath Fletcher:

Right.

Steve Schutzer:

So just use your imagination.

Heath Fletcher:

If it's I just gonna clarify too for listeners that we're talking about Upswing now is is this is this system that where where you're that's your front line is the athletic trainers. Yeah. Okay.

Steve Schutzer:

That's right. Yeah. The we call it the front door Yeah. Is the technology. And, again, we can't do a demo right now, but the technology and the trainers are the front door, and they're available all the time to make that initial assessment.

Steve Schutzer:

And sometimes the trainer may say, you know what? Heath, actually, you can't walk on your ankle or you blew out your back and your foot is numb. You need to go to the emergency room. There there's a reason for it. Right?

Heath Fletcher:

Right.

Steve Schutzer:

But imagine of those eighty five percent that we're managing all virtually with our technology. We get MRI scans now on our own and all that sort of stuff. Imagine if they went through traditional route, how much that would cost, not just to the people paying the bills, but people pay copays and out of pocket and so forth.

Heath Fletcher:

Right. And adding to the lineups and the backups and

Steve Schutzer:

Exactly.

Heath Fletcher:

And the wait time in the in the ER and and what have you. So all that, you just alleviate all that problem. Yeah. That clog. Wow.

Steve Schutzer:

So we we we say that and I wanna point out something because if you look I just wrote a paper. I'll share it with you when it's finished. The evolution of management of orthopedics. It started with Walmart in our country in 02/2012. I don't know if you remember this at all, but Walmart started a center of excellence program with the Cleveland Clinic.

Steve Schutzer:

No. Really? Do you remember that, or you maybe didn't know that? I don't know. No.

Steve Schutzer:

Every Walmart employee that needed a cardiac procedure to Walmart. You're to to

Heath Fletcher:

leave them.

Steve Schutzer:

Because they had a Walmart because they have the best heart program in the country. They negotiated a bundle payment, a package price. Right? And they all went there. Well, that spawned an era of bundle payments and centers of excellence.

Steve Schutzer:

Lots of them. And I love them. Right? Yeah. Big focus on centers of excellence, negotiated price point with a warranty.

Steve Schutzer:

Surgeons are vetted out for the highest quality. Lot of focus on the surgical side. Mhmm. And and my COEs that I was telling you about, we play with all of them. So it's important.

Steve Schutzer:

The next evolution, just before COVID came companies like Hinge Health and Sword, the virtual physical therapy companies.

Heath Fletcher:

Mhmm.

Steve Schutzer:

And they fill the gap. And along comes COVID shutdown. You really needed virtual physical therapy.

Heath Fletcher:

So kidding.

Steve Schutzer:

Exploded in both. And they do a great job of what they're doing. We actually have a partnership with Hinge with Upswing and Hinge have a partnership. So we work together.

Heath Fletcher:

But

Steve Schutzer:

the problem is, first, one is all surgical, then one is all physical therapy, but it doesn't tell when a patient needs to go to surgery. Mhmm. It doesn't tell when a patient needs to stay out of the ER. There's still a gap at the front end. Mhmm.

Steve Schutzer:

And we call that the white space of orthopedics. And that's what upswing fills, that very first ouch moment. What do I do?

Heath Fletcher:

Right.

Steve Schutzer:

Come to us. We'll we'll give it to you exactly what to do. Right. That makes sense?

Heath Fletcher:

Absolutely. Yeah. That ouch moment just like, well well, everyone's experienced that, whether it's you pinch something in your back or you I don't know. Even even if you took a tumble and you and you you did something with your elbow or something. Right?

Heath Fletcher:

So the first thing you wanna know is, did I break my did I break it? And do I have to go yeah. Do I need to go to the hospital to get a a a break assessed or something more serious? Because that's the first thing you think about. Well, is this serious, or is this something I can I can I can get through?

Heath Fletcher:

Right?

Steve Schutzer:

Exactly.

Heath Fletcher:

To hear, oh, well, you know what? You don't have a break. You just have a sprain, and here's some x here's some exercises you can do, and here's this you can do. We'd fast track and get a person get my get me back on on track and avoid all of that. Yeah.

Steve Schutzer:

We can

Heath Fletcher:

totally see that.

Steve Schutzer:

And and people people have very busy lives. They have kids and great kids, and they don't wanna go to the ER. They don't wanna go to the doctor. Right? They just want an answer to their question.

Steve Schutzer:

So our market, Heath, is mostly self funded employers and on their ecosystem of brokers and consultants and that whole world around self funded employers. And when we look at their data, the the three big categories of buckets of spend is orthopedics, cardiometabolic, and cancer care. And depending on the demographic of the company, maybe one or the other.

Heath Fletcher:

Right.

Steve Schutzer:

But orthopedics, we call MSK, is always one of the top three. Right? And then we look at their data of where are their pain points. Well, it's, again, so much ER use for non ER problems.

Heath Fletcher:

Oh, yeah.

Steve Schutzer:

It is wasted MRI scans for people that didn't need an MRI scan.

Heath Fletcher:

Right.

Steve Schutzer:

It it's the wrong side of an MRI. So if you go to a hospital for MRI scan in this country, $1,802,000, I can get an MRI scan through our third party vendor for $3.50.

Heath Fletcher:

Oh, wow.

Steve Schutzer:

So, I mean, all of these types of things. But it's been it's been slow, and I'm not gonna tell you it's been easy because of the things you brought up from the very beginning. And that is why hasn't it transformed faster?

Heath Fletcher:

Mhmm.

Steve Schutzer:

And it's because of the perverse incentives to a large extent because we have to work through those intermediaries. Mhmm. Every one of them has a piece of it. Right? And and when it comes to the employer, they're not appreciating yet their fiduciary legal responsibility.

Steve Schutzer:

They don't understand it yet despite it's hard to imagine, but a lot of them don't. You talk about the CAA. They go, what's that? And and then it comes to even when they do know about it, they think they've got everything. The box is checked.

Steve Schutzer:

That's not good enough anymore, Heath. They have to look at the outcomes of that box. Is it is it giving value to their members, or is it just a box you're checking?

Heath Fletcher:

Mhmm.

Steve Schutzer:

But health care is brutal, man. It takes a lot of time.

Heath Fletcher:

Yeah. It's a it's a quagmire to manage.

Steve Schutzer:

It's tough, but we'll tell you, you know, every year, we're now approaching $5,000,000,000,000 with horrible outcomes and sicker population every year. Yeah. You know, it it it is it's time for a change.

Heath Fletcher:

Well, it's these kind of ventures that are at least cracking the the door open to to say there's other ways to do this. There's other ways to approach this. So when, tell me, when you started Upswing, the vision obviously, the vision was to to cert to do exactly that, is to streamline the process, give patients quicker access. How did you what was your vision for the company as far as that growth? Like, you say you're it's a little bit slow on the uptake, but what what was the vision for the growth of the

Steve Schutzer:

company? I I love that question because even when we launched and maybe it comes from my primary care background, but a couple of things are in our DNA. One is we've gotta work we've gotta work with primary care organizations, which is why we have relationships with Galileo and Recuro and four direct primary care organizations. Because the pairing of good primary care and good orthopedic management doubles down the value to the purchaser. Right?

Steve Schutzer:

So where I'm going with that is from our perspective, we always intended to be something more than just an orthopedic company. We want to be something part of a bigger organization.

Heath Fletcher:

Mhmm.

Steve Schutzer:

Right? We're probably gonna go out, raise an a round in the fall, and hire more people and keep banging your head against the wall with a bigger

Heath Fletcher:

Bigger facility. Yeah.

Steve Schutzer:

Always looking for something to roll up into

Heath Fletcher:

Right.

Steve Schutzer:

To be part of a larger organization. I'll tell you, I'm a you probably don't know professor Porter or Kaplan, but they really are the architects of the value based health care agenda. Right? Porter's seminal book 02/2006, maybe 02/2006, called redefining health care is iconic now by Porter and Tysberg. Anyway, he spoke about organ no.

Steve Schutzer:

This is now seventeen, eighteen years ago. Talk about organizing health care by conditions. What he meant by that, he called it an integrated practice unit. So forty five percent of our patients at Upswing are obese. I bet you half of them have behavioral health issues Mhmm.

Steve Schutzer:

Diabetes, heart disease. Why do we have to have one off solutions for every one of these companies? Right? Somebody's gotta roll us up into one big happy family Yeah. And address it based on the condition.

Steve Schutzer:

Yeah. And we're hearing a little bit of this because you see, you can say which condition should be the IP? Should it be MSK in all of our wraparound? Mhmm. Probably should be obesity or diabetes management, and then wraparound all of these other services into this more holistic integrated.

Steve Schutzer:

Now think about for the patient. Beautiful. Yeah. Think about for the purchaser, even more beautiful.

Heath Fletcher:

Yeah.

Steve Schutzer:

They don't wanna have 18 different free contracts, right, with every little solution. Yeah. So our our vision is to roll up into something. It's not out there yet, and we're looking and thinking either something horizontally where we can be part of a of an integrated practice unit focused on maybe obesity or behavioral health or roll up vertically into something like an advanced primary care company or something like that. So that that that's our in our three to five year radar or less.

Steve Schutzer:

We don't

Heath Fletcher:

That's yeah. If it could be less, that'd be great. Yeah. That's interesting because then you've got you you can have all these sort of almost like their intake funnels, you know, oh, I gotta sort back. So they would go to a particular upswing, for example.

Heath Fletcher:

Or I'm I'm experiencing a heartburn. I don't know why. So they go see another one. We're in this era now of of all this access to information, all this data. And we but it's all it's all fragmented.

Heath Fletcher:

We everyone's collecting all this data, but it's not connected. So I can go through Upswing or I could go through UberDocs or I could go through any of these, portals to get access to some some sort of health care. But because my my profile is each one. I have a profile on each on each system, but there's no connection to all of my conditions or all of my reports where there's one place to say and now with the age of AI to say to have AI reviewing my my health report to say, oh, this person is, is in in in risk of heart disease due to their weight, or this person's at risk because of their they they are a smoker. And so there's no real centralized information hub where all the patients can be assessed and and their and their diagnosis or their treatment plan or their recovery plan or whatever.

Heath Fletcher:

It can be seen by all health care workers.

Steve Schutzer:

Yeah. If your questions are so prescient, they're really excellent because that that's nirvana. It's called interoperability. So let's say you had this integrated practice unit. Interoperability.

Steve Schutzer:

Like Interoperability. But let's say you had this integrated practice unit focused on the condition known as obesity, and you had obesity medicine, orthopedics, diabetes medicine, behavioral health, it wouldn't matter which portal the patient came in. They may come

Heath Fletcher:

up

Steve Schutzer:

with an orthopedic problem first. Right? Yeah. But then all of these solutions are connected. Right?

Steve Schutzer:

That makes me so happy just even visualizing that.

Heath Fletcher:

The deck.

Steve Schutzer:

Positive. All been patients before you've had families. No one knows about no one talks to anybody.

Heath Fletcher:

Mhmm.

Steve Schutzer:

And and I hope that somebody from private equity will listen to this podcast and say, Steve had a great idea with his suggestion. We can go into business together.

Heath Fletcher:

Okay. Sounds good.

Steve Schutzer:

That would be nirvana. Yeah. And it would be a roll up amongst roll ups that employer will crush it. Yeah. So so you asked a great question, and it really is about that inter interoperability, about focus on the patient, the data.

Steve Schutzer:

Imagine a better world under those conditions. Yeah. Yeah. I just always I'm always looking for the best. You know, I really do care for patients a lot, as all physicians do.

Steve Schutzer:

And I I feel for them when they're on these horrible, disparate journeys, and they're dysfunctional, and they get bounced from one doctor to another. And it's just wrong, and it's just it it it is hard to change. But, again, there are some areas of inspiration, and I hopefully, upswing will be part of that. We're working we have a small but mighty team. You know, startup world, as you know, is is not for the faint of heart.

Steve Schutzer:

It's a it's a seven day a week gig. And, you know, at least in my brick and mortar world, I understood the players. Yeah. Understood the challenges, the obstacles. Right?

Steve Schutzer:

Even when we're big, I knew how to get through them. Yeah. In this world of intermediaries between the patient, and the and the employer, the people paying, there are so many intermediaries that and they're all again, they all have very perverse incentives that it's hard to conquer that. You don't even know what they are, let alone try to fix them.

Heath Fletcher:

Right. Right. But Couple more questions about upswing too. So as a as an individual, so I I noticed you you you know, you have individuals and for employers to find information. But as an individual, so I I I have a I have an ouch.

Heath Fletcher:

I sign up. I I pick my plan, which is, yeah, really well priced, actually. And then, does it matter where I am? Like, is it geographically restricted? Or and or is or is all my assessments done online?

Heath Fletcher:

Does it really matter, or is there is there some tie in with where I'm actually Oh, okay. In The United States, for sure.

Steve Schutzer:

But Yeah. I know. That's really important. So when you launch a national company, the first thing you have to do is set up the the corporate infrastructure in each state. Yeah.

Steve Schutzer:

You need a PC and MSO in in every state. PC is a clinical arm. MSO is a business. Right. And there are a couple of at what's they they call it foreign qualified.

Steve Schutzer:

There are a couple of states that'll foreign qualify a number of other states. Oh, okay. Consortium. Mhmm. So we have the corporate infrastructure now in 48 states, and we have physicians in about 35.

Steve Schutzer:

So both the physicians and the athletic trainers have to be licensed in that state to see a member.

Heath Fletcher:

Right.

Steve Schutzer:

So there you may ask, what about the last 15? We just haven't had any business in those states.

Heath Fletcher:

Right.

Steve Schutzer:

So for us to stand up

Heath Fletcher:

Supply and demand. Right. Yeah.

Steve Schutzer:

Pay them for any business doesn't make any sense.

Heath Fletcher:

Right.

Steve Schutzer:

Yeah. So they would come on. We would adjudicate what state they're in and make sure that our coaches and physicians are licensed in that state.

Heath Fletcher:

Right. So 2017, you kicked this off, and now it's full swing. I mean, COVID must have been a great experiment for you. It was a great test drive shortly after launching. Did it did you see a big uptake in during COVID?

Steve Schutzer:

Yeah. And and, you know, although although if you look online, it says we launched in 2017. We actually were a different company then.

Heath Fletcher:

Oh, I see. Okay. It was

Steve Schutzer:

a different model, and I won't go into that. But it really became upswing actually just before COVID in about January 2020.

Heath Fletcher:

Oh, okay.

Steve Schutzer:

But, yeah, no, we we had a good bounce during COVID, and then, you know, things gradually go back to status quo. Right. But we're we're we're we're getting there. It we're getting there. You know, there's that diffusion of innovation principle where you work, you work, you work, you work, you get a couple of early adopters, and, you know, you get to that inflection point around 16%.

Steve Schutzer:

We're out now for another capital raise because you always need to kinda raise money. You know, technology is expensive. We have developed

Heath Fletcher:

No kidding.

Steve Schutzer:

So, you know, we're always raising a little more capital, but I think we're in a good a good position. I'm not gonna kid you. It's been the most difficult of all the challenges I've taken on, but this is by far the the the most difficult.

Heath Fletcher:

Is that right?

Steve Schutzer:

But I love it. You know, you get these calls with people that instantly click, and they go, my god. So my

Heath Fletcher:

why I do this.

Steve Schutzer:

Yeah. We instantly click, and then let let's do business. Yeah. And and then you get some of the others with other stakeholders where it's, yeah, we'll call you back and, you know, know where that's going.

Heath Fletcher:

So, I mean, the the best case scenario is that you you're bringing on employers because they bring multiple people under their fold. But individuals too, you so you'll have a combination of chronic people with chronic pain who need ongoing support. But then you have that acute sort of one time pain, that ouch moment where so the so there's a revolving door of those types and then maybe some with more chronic that are regular regular users. But the employers is that's the sweet spot. Right?

Steve Schutzer:

Yeah. Yeah. No. That's, that's very it's very interesting looking at our data. I'll tell you honestly that seventy percent of our patients would call their condition chronic.

Steve Schutzer:

They just can't get an answer. They can't see an orthopedic surgeon. Yeah. Seventy percent.

Heath Fletcher:

Wow.

Steve Schutzer:

So it's we were designed as an acute care company, but people just love to get an answer to their, to their problem. And, you know, we have a we have various pricing models, but because we're virtual, the unit economics work very well. We can be very inexpensive Yeah. Which is another reason why it's shocking that all employers don't say we all want upswing because of price points. You know, we we did some data.

Steve Schutzer:

We the largest client we have, which is a big one, is a state of Connecticut health plan. We're we're based in Connecticut. And it's a whole another story how we got this gig, but we earned it. We did a free pilot for fifteen months. Free to them, not free to us.

Steve Schutzer:

Right. It was expensive. But we got some good data, and and we knew we would get good data. And that data then got us the full contract. And then we got some real data, not pilot data.

Steve Schutzer:

But the real data, which was amazingly statistically significant, where this third party vendor created statistical twins in upswing users versus upswing nonusers. How did they do that? They had a one year preclaim history so that they were there was no selection bias.

Heath Fletcher:

Right.

Steve Schutzer:

And then and then they had a one year claim run out. Right? So and then they matched them for six different things. So they created statistical twins. And within that statistical twins, they found that those users save the state 53%.

Heath Fletcher:

Wow.

Steve Schutzer:

53% on their orthopedic spend.

Heath Fletcher:

Wow.

Steve Schutzer:

It reduced their it reduced their PMPM per member per month by a $189 per member per month. We had no use of the ER. Zero. Wow. We saved yeah.

Steve Schutzer:

Mean, on and on

Heath Fletcher:

and case study is enough to to to sell to anybody, really. Yeah.

Steve Schutzer:

Well, it became a big sales tool.

Heath Fletcher:

Yeah. I bet.

Steve Schutzer:

People have to listen to it. You know, we published this data. Yeah. Yeah. It's it is a bit frustrating that people will say, oh my god.

Steve Schutzer:

50 What do

Heath Fletcher:

you what's the biggest pushback that you find?

Steve Schutzer:

Well, it's getting to the decision makers. Right? And you don't just call the employer. They'll say talk to my broker. You know, you just and and, also, we can't build a business one employer at it.

Steve Schutzer:

This is why we need the brokers.

Heath Fletcher:

Yeah.

Steve Schutzer:

We can't keep knocking on doors one employer at a time. I mean, we'll be long gone. So you need the brokers who have these employer relationships.

Heath Fletcher:

Mhmm.

Steve Schutzer:

So but there are different types of brokers really quick. There are those that are aligned with the BUCA, you know, with the BUCA acronym, Blue Cross, United Signet, Aetna.

Heath Fletcher:

Oh, right. Yeah.

Steve Schutzer:

And then there are the independent fee based brokers. They are certified by the Health Rosetta. I don't if you've heard about the Health Rosetta. Yep. Again, that they're really important.

Steve Schutzer:

And they're fee based. You know? They don't get commissions. They made a piece of the savings Right. Which is the way it should be.

Steve Schutzer:

Yeah. So the the the the that's those are kind of our our buddies, you know, finding those independent baker that are nonconflicted.

Heath Fletcher:

So that's the kind of the core of your marketing is is targeting those people and trying to find the decision makers in that area. Steve, thank you so much for your time today. I really appreciate you, and and your story is fascinating. I could go on for another hour here listening to you and then having this conversation. So thank you for your time.

Heath Fletcher:

Do you any any closing remarks or anything you'd wanna say before we wrap it up?

Steve Schutzer:

Yeah. No. I first, I appreciate you again having on. It's I enjoy telling the story. And I hope it is really meant to inspire young entrepreneurs, find a problem and go fix it and stay with it and just follow your passion.

Steve Schutzer:

And and like my mentor told me, right, you gotta leave it better than you found it. I think that's a great message for all of us.

Heath Fletcher:

I mean, for all of us. Leave everything better than you found Absolutely. Thank you so much.

Steve Schutzer:

Thank you, Heath. Appreciate your time.

Heath Fletcher:

Fantastic conversation with doctor Schutzer. I really enjoyed listening to him explain how upswing is adding so much more value to orthopedic care and sort of easy access or early access. There's so many solutions popping up now with the the digital technology, AI, and and all these sort of really inspired visionaries who see that there there can be change, that change is possible, and that it just requires, some visionary thinkers to to bond together and and build these startups. It's inspiring to hear about, Steve's entrepreneurial journey. That spirit for him is essential for addressing these challenges in health care, but effective communication is is the key.

Heath Fletcher:

And as Steve says, the startup journey in health care is challenging, but definitely rewarding. So great advice. You can, find doctor Schutzer on LinkedIn, or you can visit the website upswinghealth.com. Thank you again for listening to another episode of the healthy enterprise, and we will talk again soon. Bye for now.