How Prescriptive AI is Saving Lives with Trey Sutten of Siftwell Analytics

Jake Aaron Villarreal: I'm Jake Aaron Villarreal, born and raised in Silicon Valley, and here to take you behind the scenes to share what it's like to be a startup founder, the journey they're on, the products they build, the problems they solve in an effort to make our lives better. I'm excited to have with us today Trey Sutten, co-founder and CEO of Siftwell. Trey, welcome to the show.

Trey Sutten: Great to be with you here, Jake. Thanks so much.

Jake Aaron Villarreal: Well, happy to have you. A little bit more about Trey, before we dive in. Trey's motivation for starting Siftwell stems from his firsthand experience of seeing loved ones and patients suffer through conditions that could have been discovered and treated earlier with the same innovative modern technology used in other industries. His mission was to bring this advanced AI technology into the healthcare space to improve and save lives. He's held roles as a CEO and CFO at multi-billion dollar companies and holds an MBA from Duke. Trey, great background. Before we jump in, where are you, where are you calling in from today?  

Trey Sutten: Today I'm calling in from Charlotte, you know, move around quite a bit. We're still kind of in that founder sales mode and so I find myself on the road quite a bit, but it's nice to be home for a few days. We're actually launching a Series A fund raise and so I've kind of locked out my calendar so I can spend time with my co-founder and hopefully get through this raise pretty quickly and get back to business.

Jake Aaron Villarreal: When I started this podcast, I had this vision to go behind the scenes to share what it's like to be a startup founder in Silicon Valley, where I'm born and raised. And weekly, we dive deep in the trenches to find the wins, the losses, and the lessons learned with the hopes that it helps you run a better startup. But here's the thing. If you've gotten any value out of these conversations or been inspired at all, hit the subscribe button. And I get it, your podcast feed's probably overflowing. But to stay up to date what's going on in Silicon Valley, stick with us because at the end of the day, we're all just trying to build something that matters and we're better when we do it together. So, hit that subscribe button and follow us wherever you find your podcasts. Now, let's get back to the show.

There you go. The road show for the raise begins soon. So, it's always an adventure. I'm sure you'll have good success. You know, we'll talk about your company and, you know, this show is about really helping inspire, educate, and entertain. Others are, you know, in the space of building a technology startup. Maybe they're on the sidelines as an engineer looking to do it, but not sure when and how. Or it could be investors just listening for new companies they feel like they want to contribute to that raise. So hopefully we'll capture somebody in the audience that it appeals to. In terms of you, walk us through your origin story a little bit, you know, kind of where did you grow up? How did you how did you get into technology, starting your own company?

Trey Sutten: Yeah, I mean, it's it's been a long windy road. You know, Jake, I come from a public service family. My mom was a teacher, my father was in the service, and and my sister's in the service. And so, for me, you know, that was always an important aspect as I thought about career options. You know, was born actually at West Point at the academy. My dad was teaching at the time. He stayed in for, you know, roughly 34 years and so moved around quite a bit and was really fortunate for that experience, moving around, moving around so much and and seeing different things and learning from different people. My undergraduate was in technology, but I veered pretty far off that course. You know, I tell people I was the worst programmer ever. And so I think you know initially Price Waterhouse thought I was going to do big ERP implementations and they quickly discovered I was much better functionally. So I started fixing processes, then projects and ultimately companies.

And so you know I think the real common thread throughout my career has been the turnaround restructuring work that I've done, you know, working at Fannie Mae and Freddie Mac and LA Unified School District, Detroit Public School districts. And so a lot of the work I did in that area had a public sector component to it. You know, organizations that were very much mission focused. And how do you align all the resources that they have at their fingertips to achieve that mission? And whether that's dollars and teachers and books, or buses to make sure that kids are getting to school on time, that investments are being made in the education of those kids... all the way over to health care. How do you deploy every care manager and every dollar, everybody in your network to really drive improvements in health outcomes at a reduced cost?

And I really learned that side of it on a restructuring project, you know, joined the North Carolina Medicaid Department initially as Interim Budget Director and then, as you mentioned, had the great opportunity to be CFO for for the Medicaid program, and really developed an understanding and and a passion for how important Medicaid was in our country as a cornerstone of of how we care for our fellow Americans. Moving on from there, you know, was the CEO job at a Medicaid managed care organization that really focused on individuals with substance use disorders, intellectual and developmental disabilities, mental health challenges, and some other complex diagnoses. What I discovered in both those two roles, Jake, was that the tool sets that we had available to us, particularly as a single state managed care organization or even regional plans, don't have access to talent and technologies like some of the larger managed care organizations have. And so about three years ago, we started to ideate as a C-suite. And you know, we knew that we were going to merge the prior managed care organization into another. We were all going to move on from or not go with a with an integrated or merged entity. And so we started to ideate and this is what we arrived at: is how do you line up the right resources with the right individual at the right time so that you can drive those better health outcomes and do it at a at a cost that allows you to stay in business and and redeploy those dollars to other members or other programs that are important to the the people that you're responsible for.

Jake Aaron Villarreal: Yeah. Got it. For those that aren't super familiar with the health care industry and the costs and at the end of the day it's about people that are, you know, you're helping save a life or helping them get care because they've got a surgery that's needed and maybe they have the money, maybe they don't or maybe they don't even know they have an issue. Talk about like the concept of what inspired you to say, "Hey, look, we know there's an issue here. We know there's a problem. There's a better way to to help." And what is it that you're actually providing into that space that's becoming innovative and helpful?

Trey Sutten: Yeah, the you know part of the inspiration you know came from my former Chief Medical Officer and former Chief Operating Officer. One is now CMO at GEHA, which is famous for their sponsorship of Kansas City Chiefs, and then Dietrich, my COO who's a Market President for Humana. Um great minds and they, they were, they're the ones that really started to drill into this idea that the tool sets and the technology... I think in in general healthcare lags the world at large in the adoption of technology. But in particular, as you get down to smaller managed care organizations that are responsible for really marginalized communities and complex populations, we knew that there was something better out there.

It was just incredibly fortunate that somebody that's in my network, I was a plus one at his wedding, has been doing machine learning and artificial intelligence most of his career and has been doing it for the likes of Microsoft and Google kind of as a hired gun. And so to take a problem set that I knew very very well—one, you know, I've had these problems, I've owned them and I fixed them, but I fixed them with technology that was outdated to the best of my ability. As the curtain was pulled back for me by our third co-founder Eban and I saw some of these tools that were available in other industries, it was it was like a light went on and it was immediately how do we how do we take these tools that are about really accurate predictions, really really rich contextualization including causal factors for why somebody is going to be non-adherent or their condition is going to worsen... how do we take those and repurpose them specifically for the Medicaid, Medicare marketplace populations?

And that's exactly what we've done. You know, a good example that that we're really proud of and is near and dear to my heart because both my mother and sister are survivors of breast cancer, is a plan asked us to figure out how to improve breast cancer screening rates. So, the first step was to get their claims information. We stitch that information together with about 15,000 data elements that we've got and we run the machine learning which results in really accurate predictions about which women inside of a plan's membership are likely to go or not likely to go. But more importantly, what are the obstacles that every one of those members is facing or what are the challenges or what are the concerns, you know, and so we run the predictions that says here are the 12,000 women, but down to the individual member level, we've got a deep understanding of why they may or may not go. And so you Jake, the the the example I always use is we identified a cohort of roughly 450 women, 80% chance of not going on their own accord. And for that group of 450 women, we were able to identify the fact that that distance was a big issue. All of them lived more than 20 miles from a screening facility. They didn't have transportation. So that was the second challenge. Third was that they were of an age bracket that they might need child care when they went. And then lastly, they belong to a socioeconomic or demographic group that would suggest they might have concerns about price. And so when they started to outreach to those women, they were able to have a highly contextualized conversation to say, "Hey, there's a screening facility. We can get you there. This one in particular has childcare. And by the way, all this is a covered service." And so it allows for plans that have a very different level or very different starting point at least with their members. And in that case, that plan had the highest cancer screening rates ever in history of of the plan. And that's a real example where some of those those cancer tests came back positive. And you know we haven't tracked them longitudinally, but what that would say to me is that not only is the plan doing a better job or a more efficient job by by the input of these insights but but truly impacting people's health.

Jake Aaron Villarreal: So when you have a product like you have and it's really an analytics of the data that you're providing to companies, who is it that you're outreaching to who wants to look at it and say, "I'll test this, I'll try this, I'll pay for this" within, you know, the the broad spectrum of the healthcare industry. Who you selling to?

Trey Sutten: Yeah. the the folks that we tend to work with, Jake, usually fall under the Chief Medical Officer's vertical or functional area. It could be also the Chief Operating Officer if they've got clinical operations as part of their responsibilities. You know, from there it tends to go down to like an EVP or an SVP of population health or care management on the pop health or emerging risk use case. Quality, it tends to be, you know, there's usually a Head of Quality within a plan that reports up to the CMO. We also do some work in member retention. And so, why is it that somebody might leave a plan being satisfied? And, you know, we've done some good work in different campaigns to drive stickiness. The motivation being there, you know, if you've got a different time horizon for how long a member is going to stay with your plan, you might be able to make different decisions about the care investments that you make if you're going to hold on to them longer. And so, you know, again, all this kind of ties back to the mission. You know, we like to work with clients that care about their members and want to do a better job.

Jake Aaron Villarreal: Yeah. you know, it's there has been some different models that have come out and I know that we talked about this recently that you know I last year... a couple years back was using Oscar and you know they're pretty good at giving you those early, early, I don't know if they're early warnings, but just "hey you know you have an annual checkup coming up you know make sure you attend" or you know "you haven't checked this recently, why don't you go get that checked out if you have some time and it's covered by us" or whatever it happens to be. It's there's this this outreach team that that we hadn't seen and maybe it's because I'm older now. They're like, "Okay, I'm identified as like I'm in a different, more high-risk bracket or whatever it is." But the user experience was kind of cool and it was great. It felt like there was a human aspect that it's not just a, you know, provider I'm paying for, but they actually are interested in like my health and you know, maybe there is going to be early detection of something that will save my life. Where does your technology fit into those, that, those teams?

Trey Sutten: That's exactly what part of what we do, Jake. That's exactly part of what we do. You know, the the other thing that I would say is a slight difference in how we think about it or what happens behind the scenes is these aren't plan-wide campaigns that they're running necessarily. This is very targeted for Trey, you know, and I'll use the example where we've done some work around social determinants of health. You know, for Trey, it's transportation, social connectedness, and meal delivery. For Jake, what he needs is he needs to be assigned to a PCP. He might also need meal delivery, but those are the two priority items to make sure to get him connected to. And so for us, it is exactly that targeted outreach for the prevention of worsening conditions or or spending on unnecessary avoidable care costs so those dollars can be redeployed. Nobody nobody wants to be in the emergency department. The plan doesn't want you there. You don't want to be there. Certainly, your loved ones don't want you sitting in an emergency department. And so how do we how do we pre-identify folks that are more likely to to end up in those types of settings, or in just by way of certain supports and services that that really can drive changes in some of that activity. So that's exactly what we're up to.

Jake Aaron Villarreal: Very cool. You've raised some capital, you're going for your Series A now. When you started with this vision of what you what you built, have you had any incremental or major pivots from where you started of "here's where we want to go and here's where we want to attack the market" versus where you're at today?

Trey Sutten: I don't think any major pivots, Jake. You know, the vision from the start was, you know, improving member health, rooting out unnecessary avoidable cost by way of technology. Now what I will say is, you know, our clients have made us a lot smarter over the last two and a half years just about what really they need and how they can use it. I I think what distinguishes us and something our clients talk about as being valuable to them is we don't just take analytics and kind of throw them over the wall and hope they find a home. We we stay with them and we're going to help them organize the campaigns and run the campaigns and and we do that in a way that contemplates what they're already good at and what they're already capable at. So I would say the you know there hasn't been any sort of major pivot since the start, just refinements and us getting smarter.

You you mentioned the raise. I think you know for the, for the potential founders out there who were founders, you know, something that was really helpful to us is you know we only raised money as we got more and more comfortable with the product, you know, initially it was my money, co-founders' money and then as we got some really good results, there's a benchmark, a risk stratification benchmark and we significantly outperformed that benchmark and then turned a pro bono client into a paying one, and only at that point did we pivot from a fundraising standpoint and say, "All right, now we're comfortable taking friends and family money." And then when we got some more paying clients, then we said, "All right, we're going to go out to institutionals." And we're grateful for all of our first round friends and family. I mean, literally family, you know, I mean, my co-founder's mother-in-law is one of our investors. So, if that won't keep you focused, I don't know what will. But from there it was, you know, moving to institutionals, and we're we're super grateful that AlleyCorp led that round, Ardent Digital, and then obviously TAU out out in your your backyard. So we've been really lucky for the investors that we've gotten so far.

Jake Aaron Villarreal: Yeah. Yeah. Mother-in-laws will keep you on your toes, that's for sure. So got to succeed. You know, AI has really changed almost every sector and industry. And for some companies, it's just layered in a little bit. In other words, it's really their core, you know, focus of what they're bringing to market, which is AI in a different way. What's the biggest breakthrough you've seen so far for your company on the technology side?

Trey Sutten: The work that we're doing around next best action for data twins is is really cool and fascinating. The the shorthand version of this or a possible mental model for your listeners is we're essentially going back in time and studying three or five years depending on how much data we've got. And what we're looking for is two people that look identical in every meaningful way, but one of them got a support or service like transportation or meal delivery or care manager, and the other person that looked identical to them, again in every meaningful way, didn't get that thing like the care manager assignment or PCP. And what we can do with that is it almost behaves like a a simulated case-control study where we can determine the impact of the introduction of that support, service or program on two people that looked identical. You take that pattern study forward in time and you look for all their triplets in the membership that's exhibiting the first, say, trimester of that study period or the first 12 months, 18 months, whatever it is. And you can make very confident assertions about how effective that support, service, or program is on the individual by way of their historic data twins. We do all kinds of sensitivity analysis around that. We also introduce things like synthetic variables to to really assess the the causal relationship between that support, service, or program and what assertions we're making. So there's all kinds of safety checks in this work. But that's one of the cooler breakthroughs that we're working on and is already taking root at several of our clients.

Jake Aaron Villarreal: Yeah, that's really cool. You know, there's breakthroughs in technology. There's also breakthroughs in people. You've led companies that have had thousands of employees and now you're leading a company who has less than that. What's been a breakthrough for you as a startup founder?

Trey Sutten: I tell you, it's a lot easier to go up the ladder than it is to come back down. And I would I would warn anybody that's moving out of a C-level position into a startup founder position. It's been really rewarding though. You know, the immediately previous company, our team was about 950. I'm including, you know, I had an excellent chief of staff. I'll forever be grateful to Molly. And I also had an executive assistant. So things, you know, I would say things or I would ask for things and automatically they would happen. And and I was grateful for that type of infrastructure. Moving from that to, you know, just me and my co-founder doing spreadsheets, putting together presentations, writing statements of work or proposals was... it really took me back to my early years as an associate at Pricewaterhouse, and I'm grateful for my experience there. But that was a tough adjustment. And you just saw through it and you know, now I'm still in the trenches, still doing that work, and I've relearned how to model. I'm back in Excel and I've learned some of my shortcuts and I'm back doing PowerPoint presentations, but I wouldn't trade it for the world. This is the best job I've ever had. And you know, I was just talking to my old CFO and I said, you know, "I feel like the luckiest guy on the planet" and I truly mean it. You know, it's a cool thing to do and I I would suggest to anybody out there that's contemplating it, do it. I would definitely recommend it. You know, for me, I heard somewhere along the lines that to start a company successfully or at least to give yourself the best opportunity, you need a good network, you need really good experience in the field, and you need money. And if you've got two of those three things, do it. And for me, I had all three. And so there is absolutely no reason, no excuse for myself not to. But it's just been a blast ever since.

Jake Aaron Villarreal: Yeah, that's great. You know, when you talk about having a chief of staff or an executive assistant or both, and then you go to doing it yourself, there are technologies out there today, you know, AI that can help, you know, streamline maybe your day or calendaring. Have you found any tools that have been helpful that are close to a match of a chief of staff or anyone that, anything that's really helped you there?

Trey Sutten: Not particularly in that vein, Jake. It's a great question and if you come across it or if any of your listeners do I'm easy to get a hold of so please do. I'd love to see that technology. What I will say though is you know at Siftwell we're ground up AI inside, AI outside. So everything from Ashby on the recruiting side to help manage some of that. We're using Perplexity for marketing intel. All the LLMs you know, whichever one is the latest and greatest we're using for job postings and and marketing work. We, you know, some of our tools are are plugged into the presentation layer. We're plugged into several Gen AI tools that I won't be specific about, but for the presentation layer, we're doing that. Superhuman on the email side. So, everywhere we can adopt this tech, even Otter for calls that are summarizing meetings. So everywhere we can lever this technology, we are. I think this is the maybe the greatest time in human history to be able to build a company where you can snap together an HR system like Gusto and Gusto has things built in, and then you can layer on top of it all these other tools that now have native AI inside of them. You know, we've got 10 digital employees right now working on various jobs for us and and they work, you know, 24/7. So we'll see. Maybe maybe agents will eventually form a union of some sort on their own, but right now we're benefiting greatly from the advancements in some of these technologies.

Jake Aaron Villarreal: Yeah, they say agentic AI is not far away. And pretty soon you're going to be hiring companies that you know they're going to bring a workforce of customer support agents and sales agents and HR agents and sales agents, and it's just a question of which ones integrate best and help really tackle the problems you're trying to solve within your company. You know, one person, billion dollar startups and all sorts of you know big ideas that are that you know might not be too far away. What do you know now that you wished you would have before you started the company that you can share with us?

Trey Sutten: It's a great question, Jake, and I'm not sure I have a a great answer. The the thing that I've appreciated from this journey is the opportunity to relearn or learn. You know there, when you get in the mix, particularly when you take other people's money, you feel such a great sense of responsibility or accountability or both I suppose, to make sure that the endeavor is successful. And for me how that's translated and for my co-founders as well is becoming students again. You know, I could show you the stack of books that that I bought, everything from Jobs to be Done to the Magic Paradigm, or the Magic Box Paradigm rather, things I'm unqualified for as a sales leader, you know. So, I've got I've got a brand new library that I didn't have two and a half years ago. And that's not even talking about all the conversations I've had with other founders, Chief Revenue Officers. The list just goes on and on and on. It's such an opportunity to learn. And I I can't really point back to one thing and say that was the thing I wish I would have known because I've enjoyed learning all of it.

The thing I would say maybe for potential founders out there is, you know, for me, venture capital was a big black box. You know, it was like, "I'm going to put together a great business. I'm going to demonstrate some results and then I'm going to go knock on some doors and people are going to give me money." And that's not at all how it unfolds. And so, one thing that is more, maybe a little bit more tangible for your listeners Jake, is if you're raising money, really do your research. There's companies that have very specific thesis that invest in very specific industry verticals, invest in very specific stages, whether it's seed, A, B, growth, whatever it is. That was something I learned quickly, but I didn't have any line of sight. And it sounds obvious and almost silly to say out loud at this point, Jake, but for folks raising money, there's a pathway to success and that looks a lot like really doing your homework. And it's something that we did and eventually you know obviously we had a very successful series seed and hopefully A will go equally as well. But if there's something I could give people, particularly potential founders, that's concrete: do your research. Definitely do your research.

Jake Aaron Villarreal: Yeah, we've heard so many founders on this show talk about their strategy and you know some, you know, pulled together a list of 2,000 companies and they just got on the phones and started making calls and getting appointments and you know, they just had no success. And made one little switch and you know I guess maybe some of the the secret sauce that I pulled out of listening you know a couple of them were... one was you know they just stopped trying to present what they thought they wanted, what they thought the investors wanted to hear, and just got real about who they were and what they were saying and what they wanted to do. And they took the suit off and put the t-shirt and the board shorts on and walked into, you know, meetings and said, "This is who we are. This is what we're doing. If you like it, great. If you don't, totally understand." And they got four term sheets like, you know, right after that. So I think there's like a mental mindset that you shift into too when you go through a bunch of nos and then you start building up to where, "okay be real, be focused, and also just be yourself," and I think things come that way.

Trey Sutten: Completely agree. You know, don't sell something that you're not, you know, because ultimately those folks are going to end up as a at minimum an advisor, at most a board member, and what you don't want to have is any sort of daylight between your personal vision and what you sold to those individuals because it will only lead to friction. And so I think the point that you're making is absolutely right. I don't know about the board shorts and the t-shirt. You know, it sounds like my uniform uniform at University of Arizona, but so those were the good old days. But I agree certainly with the authenticity part. It's always a good rule to adhere to.

Jake Aaron Villarreal: Yeah. Cool. You know, you're in a space where you're using AI and a lot of companies in the healthcare space, we're just seeing a lot of companies pop up that are carving out their own little niches. As a company, what's the moat that you're building around your company that's fending off the competition, or is it just, you know, speed to market? You're there earlier than others. What's working for you there?

Trey Sutten: I think speed has a lot to do with it. I I think that there's also a lot of hyperbole out there, Jake, about AI and you know, we've seen a lot of folks that have been around for a while slap AI on their name. I think that there's inherent moats born out of the realness of what you're building. And so I think that's an really important part of what we're doing is we're doing the real version of all of this. We're doing it fast. We're doing it a way that is highly informed by the business context. You know, I remember it was supposedly a leaked memo from somebody over at Google and you know, the title was something like "We don't have a moat or they don't have a moat and neither do we." And it talked about the difference between development and deployment of AI solutions. And I think part of our moat emerges out of the deployment side of that that snippet.

And what I mean more specifically is we know these case studies. We know these problem sets because we've owned them and we've fixed them before. And for us, it's that really important part of this is blending that managed care health care expertise with these technologies and delivering them in a way that people understand and are exactly dialed into the problem sets that they're trying to fix. And so, you know, we're staying ahead by way of relationship, quality delivery, real product, and domain expertise.

Jake Aaron Villarreal: Yeah, that's great. I want to shift gears here as we close. You know, when you're building a company, it's not just about the technology, it's the people behind the technology and also the mindset you have as a leader and as an employee. What do you do to stay positive in the roller coaster ride of a startup? And how do you inspire your employees and your your co-founders to keep a level head when you're going through the ups and downs?

Trey Sutten: This is something that I've had to remind myself quite a bit over the journey here, Jake, that you can't let... and I'd heard it plenty of times and I I guess I experienced less exaggerated versions of it earlier in my career, but you just, you simply cannot let the highs be too high or the lows be too lows. And how that becomes so poignant or relevant in a startup world is everything is of consequence. And so every time you have a great sales meeting, it feels like you're on cloud nine. And every time something stalls or doesn't get signed, it's absolutely heartbreaking. And so, you know, figuring out how not to allow yourself the deep isolations between those two emotional states is really important. And and I work at it. I think we all do.

You know, the the other thing that's helpful is I'm, you know, the eternal optimist. I think a lot of other members on the team have a lot more and healthier level of realism. You know, I I think that anything's possible and my co-founder grounds me, but is still optimistic. I think having the unified vision is really important. Taking time to look back and take stock of accomplishments has been really important. I mean, I just, you know, over these last two and a half years or even three, if you go back to the paper, just having paperwork kind of days and experimenting, I've just been incredibly lucky to have become part of a team of people that are just so motivated, so accomplished, so experienced, and and so much history working together. I mean, Chuck and I are not only co-founders, but very dear friends. Same thing with Eban, our CTO and co-founder. You know, Andy, our Head of Product, started a company with Head of Engineering. Connor, those guys built a company and sold it to Sword Health. You know, Eban and Brad have worked together. So, so there's a lot of history. We've been through a lot together. And so, this is easy to stay motivated for, Jake. We're making the world a better place. We're doing it with people that we love spending time with.

Jake Aaron Villarreal: Yeah, we've got it all. It sounds like going in the right direction.

Trey Sutten: Yeah.

Jake Aaron Villarreal: Well, if anybody wants to find Siftwell Analytics, where do they go? And if they want to find you, where where do they go?

Trey Sutten: Super easy. trey@siftwell.ai. siftwell.ai is our website. We weren't able to get sift.com. It's a farming machinery company or something else. So, I'm not sure exactly what it was intended for, but yeah, you can find us at siftwell.ai. And I'm easy to find. Just trey@siftwell.ai.

Jake Aaron Villarreal: Perfect. Trey, thanks so much for coming on. Really appreciate you having the courage to share your story. And for the listeners for listening, it means a lot to me you spent your time with us today. I'm your host Jake Aaron Villarreal signing off for now. We can't wait to catch up with you all on the next episode. Until then, Trey, the world, take care. If you like what we're doing, don't forget to subscribe, leave a review on Apple Podcasts or wherever you listen, and follow us on YouTube where we go behind the scenes to learn what it takes to be a startup founder.

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