you can speak with 24/7, is infinitely patient, and never rushes you
has access to all of the latest medical knowledge and literature
has a superb bedside manner
can communicate with you however and whenever you want: text, voice, or video
knows all about your medical history and doesn't have to ask you the same question twice
has memorized the results of all the medical tests you've had
focuses on keeping you healthy and proactively checks in on you
has breadth and depth - it can be your primary care physician and a specialist
can create a personalized wellness plan that's unique to you and help you stick to it
is free to interact with or as close to free as possible
This is universal healthcare, and it's around the corner. It will be available to everyone.
OpenAI, Anthropic, and Gemini are already better at diagnosing conditions than most doctors. They have better bedside manners, too.
They and Consensus are the doctors I turn to first when I have a medical question for myself or my family.
I feed the results of my lipid panels to them and ask them what I should do to improve my biomarkers, and I get answers that are just as good as those of doctors I know and trust.
The foundational models already have the wisdom and wherewithal to deliver personalized healthcare to everyone with an internet connection. They just need a friendly wrapper and trusted UX (likely one that is heavy on voice). It's time to make it so.
Founders have little to no diversification. They are all in on one idea, company, and mission. It's an insanely high-risk, high-reward endeavor. As founders become increasingly wary of this level of risk concentration, they begin to think about ways to mitigate it. One idea I've heard repeatedly is the notion that a group of founders can self-assemble and contribute a percentage of their equity in their company to a shared pool. That way, if they fail and one of the other founders in the group succeeds, everyone else can benefit to some degree. It's a coordinated equity swap. I've heard this idea many times over, but I have yet to see it work in practice (although I am hopeful that someone can find a way to make this work for founders in either a programmatic or bespoke way).
I have found a solution to this problem, and it has worked marvelously well. Whenever I tell people about it, they think it's batshit crazy. But then they usually come around and see how unique, important, and beautiful it is. I think more people, founder or otherwise, should do it. Here's the story.
Steve Martocci and I have known each other for nearly twenty years. We built GroupMe together and when you found a company with someone you form a bond that stands the test of time. After GroupMe was acquired, our interests diverged. Steve had an idea for a company that would change the music industry, and I wanted to shake up the world of small business lending. But we knew we always wanted to work together and bet on each other no matter what.
I am convinced that the best way to fix the healthcare system is to reinvent it from the outside in. I am hopeful that this is possible and that there are enough entrepreneurs and people disenchanted with the status quo who are ready to create this change. There are certainly tailwinds, many of which we articulated in Healthcare at the Edge. People are fed up with the existing system, they are taking charge of their own health and wellness, we have tools like Supp and Consensus to make our own research-informed decisions, the DeSci movement is pushing science to the edge, and services and products are popping up at the edge of the system that are going direct to consumers.
One thing I have been thinking about lately is the types of structural business models that might emerge to facilitate this transformation. Right now, the way our healthcare system works in the US is insane. For most of the population, our employers pay for our insurance which dictates what doctors or hospitals we can visit and how much we pay for medications. This makes absolutely no sense and is the result of years of bad policy, lobbying, and decisions that were sometimes made with the best of intentions but, when layered upon each other, created a labyrinthine mess of complexity and inefficiency. It also put everyone else's interests at the center of the system and leaves the patient on the periphery. Fuck that.
you can speak with 24/7, is infinitely patient, and never rushes you
has access to all of the latest medical knowledge and literature
has a superb bedside manner
can communicate with you however and whenever you want: text, voice, or video
knows all about your medical history and doesn't have to ask you the same question twice
has memorized the results of all the medical tests you've had
focuses on keeping you healthy and proactively checks in on you
has breadth and depth - it can be your primary care physician and a specialist
can create a personalized wellness plan that's unique to you and help you stick to it
is free to interact with or as close to free as possible
This is universal healthcare, and it's around the corner. It will be available to everyone.
OpenAI, Anthropic, and Gemini are already better at diagnosing conditions than most doctors. They have better bedside manners, too.
They and Consensus are the doctors I turn to first when I have a medical question for myself or my family.
I feed the results of my lipid panels to them and ask them what I should do to improve my biomarkers, and I get answers that are just as good as those of doctors I know and trust.
The foundational models already have the wisdom and wherewithal to deliver personalized healthcare to everyone with an internet connection. They just need a friendly wrapper and trusted UX (likely one that is heavy on voice). It's time to make it so.
Founders have little to no diversification. They are all in on one idea, company, and mission. It's an insanely high-risk, high-reward endeavor. As founders become increasingly wary of this level of risk concentration, they begin to think about ways to mitigate it. One idea I've heard repeatedly is the notion that a group of founders can self-assemble and contribute a percentage of their equity in their company to a shared pool. That way, if they fail and one of the other founders in the group succeeds, everyone else can benefit to some degree. It's a coordinated equity swap. I've heard this idea many times over, but I have yet to see it work in practice (although I am hopeful that someone can find a way to make this work for founders in either a programmatic or bespoke way).
I have found a solution to this problem, and it has worked marvelously well. Whenever I tell people about it, they think it's batshit crazy. But then they usually come around and see how unique, important, and beautiful it is. I think more people, founder or otherwise, should do it. Here's the story.
Steve Martocci and I have known each other for nearly twenty years. We built GroupMe together and when you found a company with someone you form a bond that stands the test of time. After GroupMe was acquired, our interests diverged. Steve had an idea for a company that would change the music industry, and I wanted to shake up the world of small business lending. But we knew we always wanted to work together and bet on each other no matter what.
I am convinced that the best way to fix the healthcare system is to reinvent it from the outside in. I am hopeful that this is possible and that there are enough entrepreneurs and people disenchanted with the status quo who are ready to create this change. There are certainly tailwinds, many of which we articulated in Healthcare at the Edge. People are fed up with the existing system, they are taking charge of their own health and wellness, we have tools like Supp and Consensus to make our own research-informed decisions, the DeSci movement is pushing science to the edge, and services and products are popping up at the edge of the system that are going direct to consumers.
One thing I have been thinking about lately is the types of structural business models that might emerge to facilitate this transformation. Right now, the way our healthcare system works in the US is insane. For most of the population, our employers pay for our insurance which dictates what doctors or hospitals we can visit and how much we pay for medications. This makes absolutely no sense and is the result of years of bad policy, lobbying, and decisions that were sometimes made with the best of intentions but, when layered upon each other, created a labyrinthine mess of complexity and inefficiency. It also put everyone else's interests at the center of the system and leaves the patient on the periphery. Fuck that.
Ride It to the Sky
Ride It to the Sky
So we made an agreement. We would do all of our investing and company building together, even if we wanted to do totally different things. For every company I would start, Steve would own a meaningful piece of my equity/carry (e.g. ~15%), and vice versa. And for every investment we wanted to do, we'd always bring it to each other and offer to split it evenly. It has worked out, and we have been able to make concentrated bets with our time over the years building companies and now doing venture capital while diversifying risk.
The neat thing about this agreement is that nothing is papered. It's just a code we live by. I feel very lucky to have this deep sense of trust and respect with a partner like Steve. I acknowledge how rare it is. And I think more founders should try to find something similar. In the short term it might feel strange, but over the long term it's extremely powerful economically, psychologically, and emotionally. This concept doesn't just have to apply to founders, it could apply to anyone. Making bets and investments in people you admire and work well with produces returns that cannot be measured in cents or dollars.
Insurance, in every other industry, is used to hedge risk in the event of a catastrophic event. Imagine if your home insurance had final approval on how you could furnish or paint your house. Or if your car insurance only let you fill your gas tank at certain stations they cut deals with. Insurance is a product we buy so we can have assistance in times of dire need. So why does our health insurance dictate what doctors we can see, what drugs we can buy, what procedures or tests we can have done, and how the people who are supposed to care for us behave? It should be there for us if we suffer from a medical emergency. It should not dictate how we interact with the health system in between emergencies.
The best way to build things at the edge of the healthcare system is to work directly with patients and individuals. There are two primary and obvious business models here that stand out: the patient (customer) pays directly, or the product is free and someone else pays (eg an advertiser) is the equal or primary customer.
On the former, I keep hearing about the "Tesla model." Entrepreneurs start with a high-end service (like the concierge doctor I pay for out of pocket) that is only affordable to a small subset of the population. Over time, they can deliver a lower-cost product to a mass market audience because of AI, operational improvements, economies of scale, etc. This was the Tesla strategy - start high-end and work your way down the affordability spectrum over time.
The latter model is closer to what we experience with social media. You can use products for free, but your data is used to target you with contextually relevant offers (eg pharmaceutical advertising, full-body MRI scans, etc.). I would like to see a lot more in this category, and I hope we will. Free products that help people, even with an ad-supported model, are a net good when the core offering helps people.
I think both of these models are perfectly acceptable and should be broadly embraced. If there is enough demand for these products that operate at the edge of the system, maybe things will change at the center of it. Perhaps we will find new ways to create insurance programs or models to fund drug development and for patients to pay for their medications. Perhaps insurance won't dictate so many things about our own health and wellness decisions. I am excited for these changes to happen, but they rely on the proliferation of new business models and products and services that consumers will embrace. I am eager to see more of them emerge and for creative people to develop new business model opportunities here that we haven't yet imagined.
So we made an agreement. We would do all of our investing and company building together, even if we wanted to do totally different things. For every company I would start, Steve would own a meaningful piece of my equity/carry (e.g. ~15%), and vice versa. And for every investment we wanted to do, we'd always bring it to each other and offer to split it evenly. It has worked out, and we have been able to make concentrated bets with our time over the years building companies and now doing venture capital while diversifying risk.
The neat thing about this agreement is that nothing is papered. It's just a code we live by. I feel very lucky to have this deep sense of trust and respect with a partner like Steve. I acknowledge how rare it is. And I think more founders should try to find something similar. In the short term it might feel strange, but over the long term it's extremely powerful economically, psychologically, and emotionally. This concept doesn't just have to apply to founders, it could apply to anyone. Making bets and investments in people you admire and work well with produces returns that cannot be measured in cents or dollars.
Insurance, in every other industry, is used to hedge risk in the event of a catastrophic event. Imagine if your home insurance had final approval on how you could furnish or paint your house. Or if your car insurance only let you fill your gas tank at certain stations they cut deals with. Insurance is a product we buy so we can have assistance in times of dire need. So why does our health insurance dictate what doctors we can see, what drugs we can buy, what procedures or tests we can have done, and how the people who are supposed to care for us behave? It should be there for us if we suffer from a medical emergency. It should not dictate how we interact with the health system in between emergencies.
The best way to build things at the edge of the healthcare system is to work directly with patients and individuals. There are two primary and obvious business models here that stand out: the patient (customer) pays directly, or the product is free and someone else pays (eg an advertiser) is the equal or primary customer.
On the former, I keep hearing about the "Tesla model." Entrepreneurs start with a high-end service (like the concierge doctor I pay for out of pocket) that is only affordable to a small subset of the population. Over time, they can deliver a lower-cost product to a mass market audience because of AI, operational improvements, economies of scale, etc. This was the Tesla strategy - start high-end and work your way down the affordability spectrum over time.
The latter model is closer to what we experience with social media. You can use products for free, but your data is used to target you with contextually relevant offers (eg pharmaceutical advertising, full-body MRI scans, etc.). I would like to see a lot more in this category, and I hope we will. Free products that help people, even with an ad-supported model, are a net good when the core offering helps people.
I think both of these models are perfectly acceptable and should be broadly embraced. If there is enough demand for these products that operate at the edge of the system, maybe things will change at the center of it. Perhaps we will find new ways to create insurance programs or models to fund drug development and for patients to pay for their medications. Perhaps insurance won't dictate so many things about our own health and wellness decisions. I am excited for these changes to happen, but they rely on the proliferation of new business models and products and services that consumers will embrace. I am eager to see more of them emerge and for creative people to develop new business model opportunities here that we haven't yet imagined.
