All right, so maybe about a year and a half, two years ago, Jacque came and gave a
standalone presentation. I think it was in Beverly Hills and sat on a panel as
well. I still remember some of his comments because they were so impactful. He's the chairman and chief executive officer of SSB, a diversified US -based healthcare
development and investment firm. And he's had multiple billion-dollar-plus exits,
including a DecaCorn, a $10 billion -plus company's help build. He also has one of
the largest, longest -running LLCs, I believe it is, with over 1 ,000 investors in it
that's scaled all the way up to $1 billion-plus. So it's definitely a founder type
to learn from and investor to learn from and we appreciate you being here today.
What else would you add to your background just so everybody kind of knows where you're coming from? 

Richard, first of all, it's a pleasure to be here. I'm not selling services. I'm not selling a product. I basically am here because I think if I would have had an environment like this 30 years ago when I was starting my family office, it would have helped me significantly. So that's the reason I'm here.

The only Everything I know about is healthcare, I've spent 30 years in healthcare,
but I've invested in almost every sector of healthcare. I'm not sure I could start
my business again today the same way. In fact, I'm sure I couldn't, but that's
probably the lesson to learn. At the end of the day, when you're basically doing
the deals and investments and you're looking at the environments that you're working in, you really have to understand precisely what the limitations are in terms of that investment in some kind of organized way that we could discuss this morning.

- Great, appreciate you being here then. With all the experience you have in
healthcare and life sciences, what areas are you most excited about? Because again, you've got the three decades plus of experience like the last two speakers. - Well,  this is a fascinating time. Healthcare is always fascinating. 

First of all, we're hitting $5 trillion in US healthcare spending for 2025. If you can't make money with $5 dollars changing hands then you ought to just take out a gun and shoot yourself. I don't mean to be overly intense on this but there's just no sector that is so  big someone very very smart much smarter than myself David Jones who founded Humana said to me just find one small fire hydrant and stand in front of it. At the end  of the day right now we've been in kind of a funk in health care since COVID. COVID became the US economy for a period of time that no one basically anticipated. We've come out of that to some degree, but at the end of the day, so many of the advances that really looked very promising have not really been invested in for a whole variety of reasons, and we're now in this political uncertainty environment with RFK potentially in the mix, different kinds of political issues, not necessarily negative. All these different factors, I think, will provide opportunity, but I think there's still challenges in relationship to key areas. But I'm still very bullish on physician practice management. 

I think -- again, I'm probably the only person on the planet who has been involved in $3 billion startups with physician practice management and are still sitting here living to tell it. Number two, I think we're basically going to continue to see wonderful expansion in relationship to mRNA, DNA, and AI -enabled applications. The issue with AI is whether we're gonna come from the top down or from the bottom up, and the point solutions offer significant investment opportunities that we could talk about. 

- Great. Since areas of promise, like in the healthcare space, rarely mature, you know, at the same time, it might be seemingly random from people outside the space, how would you handicap the likelihood of, you know, assets appreciating and doing well and like what milestones or markers you kind of look for. Some aspects of health care are substantially more cyclical than others. I think the PPM industry is actually one that is almost entirely cyclical in relationship to supply and demand. Optum controls the market. 90 billion dollars in physician practice management is really controlled by Optum. So Optum sets the floor in relationship to billion dollar deals in physician practice management. You're not going to go against that trend. You have other major players like Walgreens and CVS and others that we have investments with that are in the five and 10 and 20 billion dollar range, but they're not in the 90 billion dollar range. So what you need to do is you basically need to look at the trends that are basically affecting the industry leaders where there really aren't dominant industry leaders. Where there aren't dominant industry leaders like in AI, you've got specific examples and opportunities that you can focus on in different ways. 

Okay, great. So, yeah, I know you're very focused on healthcare. So, you talk about that and what's separated you from everyone else, like at the beginning, was it physician practice management and tell you just had massive escape velocity, or like can you talk about that focus and how long you had an extreme focus?

Richard, I would like to tell you it was because I was so brilliant and I was able to sort out all these enormous complexities of healthcare. It's not true. You know, at the end of the day, if you're not at bat, you're never going to get a hit. So looking at all the different changes that are going on within a $5 trillion industry, even when
that industry 30 years ago was $500 billion, not $5 trillion, it still gave you an
opportunity to look at healthcare adherence, physician practice management, integrated delivery systems, pharmaceuticals, in those days small molecule pharmaceuticals, now biologics and others, and then genomics in a variety of different areas. We are now, I think, in a critical point in time where the same formula that we used 30 years ago is still accurate. You look at the clinical model. If the clinical model doesn't work, you shouldn't be investing in that healthcare environment. That sounds basic as basic can be, but literally that's where most people start and stop their investment's thesis. But it's just not clinical. It's then clinical, then you have to have a business model that pays for it, and then you have to have an operator that can actually operate the company. So the three elements are clinical, business, and operating expertise, and at the end of the day, whoever you're going to invest with needs to defend those three areas of expertise. Okay, what about what Mark was just speaking about on stage about when people tell you something's not possible And then you're able to do it has that happened to you? And if so what helped you kind of achieve the impossible I think every billion dollar exit we've had in multiple sectors of health care people have said it was never going to happen But and here's the key was the clinical model Correct and in quite frankly, we've miscalculated that occasionally. We knew biosimilars were gonna be big. We didn't knowhow long it was gonna take and we didn't know how much we were gonna have to invest, but 50 million dollars turned into 19 billion. That was a biggie. We lost 50 million on cellular regeneration because we totally miscalculated the clinical model. But at the end of the day, again, many of the very, very big exits that we've had could not have been predicted. You might have
predicted they might have a high probability of success, but you could never really predict how big they were going to get. Right. Munger talked about collecting 100 mental models, and I referenced that in my beginning slides. So we talked about Mark Russo's distribution via cruise ships and find our galleries all over the world. 

In your case, was there a strategic distribution access to get access to new doctors for physician management or some sort of distribution platform that once you plugged into everything got supercharged or was it not that way? 

It goes back to what you articulated earlier when you look at doing something and you're doing something that people say you can't do before you have to be clear again with the filters I just talked about. Will the clinical model for that particular and it's usually a subsector, it's not a whole sector, it's a subsector. And what I mean by a subsector, it can be Medicare, it can be Medicaid, it can be commercial, whatever it is, you need to find a solution for that population you're looking for, because you have enough money going through that population to be successful or not be successful. Having said that, find someone who understands that business and then find someone who's operated that business, because if you haven't operated that business, you basically can spend huge amounts of money, quite frankly, not being successful.

Right, right. It connects to like what we heard on the last interview about finding
someone who's done exactly that before. Right. Exactly. And in health care that's
especially difficult because if you're a superstar at running a physician practice
management company for a medicare population, which is, which became very popular in the last several years, and Medicare risk takes a Southern South, which it has, you are basically sitting there with tens of billions of dollars of assets that are underperforming right now. So this is now the time to be invested in Medicare PPMs because they will go up within about an 18 -month to two -year period unless they get fooled around by the U .S. government again. Got it. What would you
say to people looking at returns of 15, 20, 30 percent to 10 to 20 X returns?

What's your advice to investors and founders who are trying to allocate their time
and investments. We always found from a foundational and first of all SSB our family office has a captive fund that has grown over the years with these different exits and for all intents and purposes again we've used much of the philosophy that Richard has articulated which is again why I enjoy being here for these conferences. At the end of the day Most of the investments that we make at this point in time are earlier stage investments. They're usually seven to eight figures. They usually have that 10 to 30x potential. We don't really invest in small percentages. We have wealth managers who do that. Basically, it's for a much bigger return. 

Okay, got it. 

And I remember one quote from a year and a half ago or so on stage is somebody asked from the audience, how do you work with billionaires? How do you get
them to invest with you? And I remember you said, well, I helped make them
billionaires. You added value to them first, like we try to stress here at the
club. Can you speak to that or give an example? So it's very practical to people
in the room and how you pull that off. - One of my guiding principles, and I think
this is important for all of us, whatever stage in life you are, you wanna pay
forward. And when I went into this line of work, being a physician, it was a big
change for me because I trained as an academic cardiologist. I had a wonderful
relationship with my patients, and I left that to really enter the world of business
to try to change healthcare. But I also knew that I had to basically bring people
with me, and I have had the good fortune of building some of these physician
practice management entities. The summit one is probably the best example. The
Government grew from a $20 million initial capitalization of which we put in a fair
chunk of that to almost $9 billion in its last exit about two, three years ago.
We made 1 ,800 physicians, millionaires in that process. Not billionaires,
but millionaires. And some of them became decimillionaires and people got close to several hundred million in some investment positions. So, at the end to the day, I think bringing people along with your clinical, financial, and operating model is
absolutely critical in the professional services environment. In my mind, that's
critical. 

Right. At our last event, we had the founders of Barefoot Wines, which is
the largest wine brand in the world, up on stage. We did a fireside chat just like
this, so if you don't have time to stream all of our past discussion panels, I
know many of you don't, at least look at the fireside chats, but on that one, they
brought up that their mantra was to look at like who gets rich when we get rich
and partner. And I know you've done some big corporate partnerships that really
helped move things up. And I think it might be beneficial for founders here in the
room to hear just an example of one or two, even if you don't use an exact name
if you can't. 

- No, most of this is public. In fact, all everything I'm gonna share
with you is public knowledge. So I'm not gonna get into anything that's proprietary.

But let me suggest things take on a life of their own at times. And this physician
practice management example I gave with Summit is, I don't want to say once in a
lifetime, but it certainly is an example of how a $20 million investment, followed
by another $50 million investment, literally was a $70 million investment that then
went to a $2 .6 billion valuation, that then went to a $9 billion valuation, and now became a partnership which is called, in the financial parlance, a strategic aggregation, which is essentially Walgreens, Village, Summit, and Cigna, $25 billion of private capital because the IPO market was constipated.
And at the end of the day, the IPO market is still constipated. So what I'm
looking forward to is that whether you think the healthcare market is good,
better and different right now, I think the deal market is about ready to open up.
And there is no way a $5 trillion piece of that deal market is not gonna benefit
from that. So that's an example of the strategic partnerships that can grow with the size of the deals that occur. 

- Right, right, yeah, that makes a lot of sense. 

And I wanna point out, like in the mass media, people who are wealthy are typically portrayed as a little bit evil or not so nice of people. You know, Mark was just here saying he likes, he tries to be kind to every person. He's obviously passionate about what he does. Jacque is here, he's not raising money. He doesn't have a fund for you to invest in. He doesn't have a product. He had lunch with me in an Arizona, super helpful. And that's what I generally find with really successful family offices and founders. It might be really busy. This might not reply to every random email they get, but they're generally very helpful. So my last plan question, and then we'll see what else you wanted to share, was what's an unlikely piece of advice that you've learned the hard way that you could share with people here in the room? 

- Just expand your network to the greatest ability you can, hearing from
multiple, multiple different sources. One of the things Richard has asked in
preparation for this talk is, what do you source your deals? And the answer is
everywhere, but it is everywhere. It is the National Association of Corporate
Directors. It is all the universities that I sit on the entrepreneurial boards for.
It is where basically I sit on board of counselors. It is the board of direct, the
five or six companies. I was on a call with Australia till 11 o 'clock last night
'cause they're a day ahead of us. But at the end of the day, you're constantly
being exposed to new and different perspectives in the area that you're focused on. I have approximately 25 ,000 people who follow me on LinkedIn. I don't know why to be honest with you. They follow me to basically see what I'm watching, which is fine. I'm very happy to tell people what I'm watching. And at the end of the day, I try to pay it forward. And that's really why I'm here. 

Awesome. Anything else that I should have asked you that would have been a really smart question you'd like to share with the room? 

Well, I think the real challenge is, what are we going to see in healthcare? And healthcare is so broad at this point in time, I think what we're going to see in the insurance industry was greatly affected by the challenge that we saw in New York City with the head of United Health Care's insurance function. I go back to the origins of United Health Care. I go back to the origins of Humana. We help make those companies very large at different points in time. I won't bore you with the stories, but I think we've got some really serious foundational issues in health care that are going to come back in relationship to complexity, prior authorization, and certain areas. A term that you ill probably not hear other places, this is a term called Evernorth. Evernorth is owned by SIGNA. It is a prior authorization giant in relationship to the Blue Cross plans and other plans. And they are the ones that do pre -certify a lot of care. And they're not very popular right now. And I think they're going to get a lot of scrutiny along with the PBMs. So I wouldn't be jumping to buy PBMs or anything that is a heavy pre-authorization component right now. 

Right. Great. Awesome. Well, I appreciate all those insights. I think everyone in the audience got at least one or two takeaways they could all put into place and remember and remind themselves and act on. So definitely appreciate your time and being so generous with it. Thank you.

My pleasure. Thank you.