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Our Healthcare 101 crash course is BACK, 9/21 - 10/2
I'll teach you everything you need to know about how healthcare works.
- Jargon to understand
- Business models for all the stakeholders + case studies
- Major laws
- Trends in the space
- Memes to make it all digestible
Healthcare can seem incredibly complex and impossible to understand, but I'll get you caught up quickly
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It's crazy is how wide the variance of contracted prices can be between hospitals AND between payers.
The Turquoise Health team graciously pulled the data so I could show you all just how wide that range is. Especially for C-Sections, where the swing can be $35- 40K between hospitals.
Even WITHIN a hospital you could have the same C-Section costing twice as much depending on which insurance you have (e.g. NYU)!
Obviously you have to layer outcomes on top of this. But damn...you could buy a Honda Civic and still save money if you went to Elmhurst (along with getting some of the best halal cart in the city). And that’s just for the facility component.
Fwiw NYC is a bit of an outlier, most times it’ll look more like $10 - 18K ish in other cities
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It's pretty clear that healthcare costs are going to go up in the near term with the introduction of AI
Three reasons for this. The first is simple - payers are being much more heavily scrutinized for their use of AI in preventing $ going out, while hospitals/companies using AI to bill more have a ton of leeway.
The second is that the current billing rails incentivizes AI use cases that are "add-on" billing line items. Consider the AI second reads of mammograms which are an up charge, the AI diabetic retinopathy screens that bill more than their human counterparts, etc. which are all effectively upcharges.
The third is that more people now have access to a self-diagnosing and triage tool, but also still need to go to the health system to resolve their issue if they need confirmatory labs, screening a prescription, etc. That's going to create more utilization inherently, though how much more than just using Google is TBD.
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Every time technology has been introduced into healthcare it's caused costs to be inflationary. My hope is that AI becomes a tool that makes costs deflationary, but there needs to be a clearer path for that to happen.
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it's surprising how hard it is to find up to date studies on malpractice. A big part of this is data access.
The National Practitioner Data Bank is public but only records paid claims and has no clinical detail which makes it pretty unhelpful. Below is a chart of malpractice claims for $1M+ and $2M+ per year
Malpractice carriers seem to only give researchers access to their internal claims when the industry is going through some kind of crisis.
The 2006 Studdert paper that everyone quotes had 5 malpractice carriers give rawdogged claims access to the researchers, which doesn't really seem to happen ever.
Our current malpractice system creates an added issue that there really isn't a central repository to analyze claims, it's scattered across the carriers.
Other countries collate it all into one place so you can actually use it for safety research + look deeper into doctors/institutions that might have more issues.
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Healthcare needs more engineers
You'll have a real impact and discover some hilarious quirks to working in the space
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Very excited to announce our new FREEEEE course on AI Agents in Healthcare Ops
In partnership with Champ AI, we're going to go through how agents are working and not working in areas like revenue cycle, credentialing, and a lot of things your ops teams are probably dealing with
This course will also help you think about what TYPE of agent to use against what kind of workflow, and will include some fun live demonstrations
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I think we'll see more experiments in college alternatives now especially since
- the employment <> college degree relationship is no longer as strong
- the cost to attend college is extremely high and likely to get higher esp with less international students paying full price
Thrilled to announce our latest incubation: Horowitz Andreessen Academy.
Horowitz Andreessen Academy will be a two-year residential program in San Francisco for 16 to 22 year olds.
My biggest regret from my college experience is how divorced it was from the real world (both practically but also intellectually)
HAA is the opposite. Students will learn from real-world practitioners and intellectuals; including founders (Sam Altman, Brian Armstrong, Jensen Huang), investors (Elad Gil, Daniel Gross), and professors (Agnes Callard, Tyler Cowen), among hundreds of others. The Academy is the educational experience I wish I had.
In 1984, the educational psychologist Benjamin Bloom published a paper about how the average student who received one-on-one tutoring focused on mastery techniques performed better than 98% of the control group. For generations, this was viewed as unrealistic to implement even if it produced the best outcomes.
At the Academy, we will be able to locate any tutor on any topic that a student desires.
Take an aspiring filmmaker or producer. The standard path offers them film theory courses, peer workshops, and the occasional visiting filmmaker; everything past that takes meticulous networking and luck. The very entrepreneurial type will find ways to invite prominent speakers to speak and meticulous networking to reach the right people. At the Academy, they will learn the business from the people who run it and their next creative project will have notes from award-winning filmmakers.
Take a young founder. Yes, there is endless content online; you can watch a video on any skill. But content is not coaching. The Academy will provide dedicated, experienced coaches and mentors who know your company and psychology. Students can workshop issues with prominent leaders in technology who host sessions on campus. Every generation of entrepreneurs has had mentors in their corner. Ours will too.
Take the technical student focused on research. At the Academy, academics are focused on the frontier. Students will be taught and mentored by AI researchers at frontier labs. They’ll be conducting research and sharing progress, and presenting their work at ICML and ICLR.
The goal of the Academy is to identify the right mentors, the correct bottlenecks, and the right introductions, adjusted continuously around one person and their pursuits.
The education philosophy focuses on co-ops, courses, and pursuits.
Co-ops are the opportunity to work during the year (not just over the summer). It's the chance to work across countless different roles and companies, including getting connected to our 10 founding partners: Anduril, Anthropic, Coinbase, Google, Meta, NVIDIA, OpenAI, Palantir, Replit, and Stripe.
Courses are taught by legendary people: people who have founded unicorns, invested in those unicorn companies, or are on the intellectual frontier.
And most importantly, it's about Pursuits. It's about personal projects, quests, startup ideas, rabbit holes that define the student experience. The Academy will provide dedicated, experienced coaches and mentors who know your work and psychology.
At HAA, the individual education of each student is the whole design. We want to meet you. Applications for the founding class are open.
theacademysf.com
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I think of college as a bundle of a few different things
1) Status/credibility among peers and employers - having a selection process + a company/firm with an existing can do this
2) Community - need people to be in-person for long periods of time around the same phase of life with programming to bring them together
3) Education - People want to learn but might want their education to be way more targeted in what they want OR continuing over longer period of time as they're in the real-world (maybe college shouldn't just be the 4 years but an intensive 1 year + something you come back to after 2 years working)
I'd love to see more experimentation here - in fact I"m surprised more companies don't set up their own direct pipelines (I actually wrote about how we can rethink college like 7 years ago, many of the ideas still hold today)
nikhilkrishnan.com/2019/04/2…
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We just wrapped up our first ever Ship It conference for healthcare software engineers.
80+ really smart engineers from different parts of the industry, all hands-on workshops, with a few fun group activities (very niche trivia, creating new cursed patient intake forms, etc)
I learned a ton from just being in the room. Everything from how people are thinking about evals (basically everyone is making it up as they go) to how people are giving agents a sense of "time".
Thanks again for supporting Out-Of-Pocket and taking a flyer on a brand new conference
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We had some really great sponsors this year that were involved in running workshops, being a part of trivia, etc.
- Ultralight
- R1RCM
- Photon
- KERNEL
- AKASA
- CloudCruise
- Medsender
- Canvas Medical
- MediCircle
- Ro
It was a blast and really excited to do it again! We're already planning Ship It! 2027 in SF 👀 you can sign up here to get notified about it: outofpocket.health/ship-it
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Nikhil Krishnan retweeted
This is where agents could really change healthcare.
So much of the market is fragmented that better matching is a much bigger unlock than it sounds.
Agents can make those connections without everything needing to fit into a perfect taxonomy.
IMO AI enables the creation of new marketplace in healthcare in a few different ways
1) It makes inventory more discoverable - This can be knowing what's in stock at the pharmacy, what appointments are available, if a doctor still takes patients with X insurance, what kinds of patients are in the panel, etc. You can now verify this at scale with things like calls, structuring data in the EHR, etc.
2) Agents can match suppliers and buyers more easily - Agents can take requirements that buyers have match them to sellers even if it's a fuzzier match. Before you're need to create really specific tags to make that match happen, but now you can do it on pretty much anything. This becomes even more complex if the transaction requires 3+ entities.
3) You can bootstrap new networks quickly - If a company isn't in your network, you can automate a fax or call to transmit the same info. Using existing rails that anyone can participate in basically means anyone can be in your network.
Examples of new marketplaces I'm personally invested in:
Photon - better marketplace for providers, pharmacies, and patients by making pharmacy shoppable
Turquoise Health - better marketplace between payers, providers, and employers by turning negotiated rate contracts into something more modifiable + able to be transacted on top of
Double Blind Bio - better marketplace between sites and sponsors so they can find each other based on their needs
I think there are many more to be built here
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IMO AI enables the creation of new marketplace in healthcare in a few different ways
1) It makes inventory more discoverable - This can be knowing what's in stock at the pharmacy, what appointments are available, if a doctor still takes patients with X insurance, what kinds of patients are in the panel, etc. You can now verify this at scale with things like calls, structuring data in the EHR, etc.
2) Agents can match suppliers and buyers more easily - Agents can take requirements that buyers have match them to sellers even if it's a fuzzier match. Before you're need to create really specific tags to make that match happen, but now you can do it on pretty much anything. This becomes even more complex if the transaction requires 3+ entities.
3) You can bootstrap new networks quickly - If a company isn't in your network, you can automate a fax or call to transmit the same info. Using existing rails that anyone can participate in basically means anyone can be in your network.
Examples of new marketplaces I'm personally invested in:
Photon - better marketplace for providers, pharmacies, and patients by making pharmacy shoppable
Turquoise Health - better marketplace between payers, providers, and employers by turning negotiated rate contracts into something more modifiable + able to be transacted on top of
Double Blind Bio - better marketplace between sites and sponsors so they can find each other based on their needs
I think there are many more to be built here
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Nikhil Krishnan retweeted
Malpractice reform needs to be part of any discussion on healthcare cost control. The data is all over the place, but it’s undeniable that doctors spend more on defensive medicine.
I’m thankful to @nikillinit for letting me vent my ideas.
outofpocket.health/p/copy-ne…
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One quirk of the US malpractice system is that it combines payment to the patient WITH demonstrating legal fault
This generally means that malpractice lawyers focus efforts on cases with high potential compensation.
This creates a system incentivizing nuclear verdicts for enormous amounts while also leaving a long tail of patients where mistakes were made but don't get any compensation
Today is guest post from from @DrDiGiorgio on how the US can take a page from New Zealand and move to a different malpractice system that separates patient compensation from a legal definition of harm
(image source: Niskanen Center)
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full post is here, it's an interesting proposal and sent me down a few rabbitholes around how research on malpractice is actually done:
outofpocket.health/p/copy-ne…
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Nikhil Krishnan retweeted
Spoiler: I like no fault compensation models.
Works for New Zealand. Works for vaccine manufacturers. Works for OB in Florida.
A couple months ago I wrote a post about how medical malpractice would need to change in responses to AI and a fracturing standard of care
I thought it would be interesting to get a doctor's point of view - in tomorrow's post @DrDiGiorgio talks about the predicament that malpractice places a doctor in
AND suggests a way we could change how malpractice works that might be better for patients and doctors (but potentially worse for lawyers)
you can sign up below to get it
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A couple months ago I wrote a post about how medical malpractice would need to change in responses to AI and a fracturing standard of care
I thought it would be interesting to get a doctor's point of view - in tomorrow's post @DrDiGiorgio talks about the predicament that malpractice places a doctor in
AND suggests a way we could change how malpractice works that might be better for patients and doctors (but potentially worse for lawyers)
you can sign up below to get it
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As someone who knows healthcare pretty intimately, even I have no idea how Natera does their billing
My wife and I both used Natera to see if there were any potential hereditary diseases we should look out for when having a baby.
But the billing for this was more confusing than trying to actually read my own genetic code. I got a bill for $13K+ that I was told to pay because insurance denied it.
What?? That doesn’t seem right. So I emailed the OB’s office and they said “oh yeah don’t worry, we’ll ask them to adjust it”. Then suddenly it became a cash pay price of $649? Even more confusing is my wife somehow negotiated a price of $349? Everything is made up ahhhh why does this feel like I’m haggling in a wet market.
To this day I still don’t know what happened here. But talking to other parents in the OOP slack group and perusing the Better Business Bureau complaints it’s clear this is relatively common. Try billing insurance, leave the patient with the full bill if the plan denies the test, then offer a much cheaper cash-pay price which seems like a great deal.
It’s clear that OB’s know this is an issue since they knew exactly what to do when I got the egregious bill. In general this was probably the only truly negative billing experience through our pregnancy, and it also just goes to show how strange the shenanigans around lab billing are.
Feels like the providers or Natera should really be checking your insurance eligibility for the tests before ordering them. But why do something that makes sense! It’s healthcare!
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We walked through all the bills we got during the pregnancy and birth here
outofpocket.health/p/pregnan…
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