Business Model Innovation in Healthcare

Naomi posted some thoughts on changing business models in health care on the USV blog yesterday.

The one that I am personally most excited about is what Naomi calls “change of venue” and within that I like the “virtual primary care” model.

A pure virtual primary model eliminates fixed costs associated with brick and mortar expansion and is able to focus resources on reaching more patients, recruiting more doctors to their platform, and improving the experience for current patients. Payments on a subscription basis allow doctors to get paid more consistently rather than waiting for insurance companies to process claims and paying overhead costs to negotiate reimbursements with their billing offices.

We have portfolio companies executing this model like Nurx and Modern Fertility and we hope to add more.

I value the doctor/patient relationship, but I think there is a lot technology can do to make that relationship less expensive, more engaging, and more convenient (for both parties). And generational changes in doctors and patients are catalyzing and facilitating this transition.

#hacking healthcare

Comments (Archived):

  1. jason wright

    ‘change of venue’ – now where have i heard that before at USV?we’re just as likely to see doctors simply up their charges as we are to see primary healthcare reach more of the people more of the time. there are only so many hours in a career, and a comfortable middle class life does not come cheap.

  2. awaldstein

    Great topic and thanks for surfacing it.I’m obsessed and deep into this category, but I guess it depends how you define healthcare.To me it is the intersection of genomics, nutraceutical innovation (liposomes, B3, molecular miniturizing) and making the data collection devices the channel (wearables) and crossover mindfullness apps like Headspace, the commerce delivery system for supplements.Too fascinating. Too exciting.Too crazy that biohacking merges with wellness and science. That Cannabis innovation touches fire with a host of unheard of new categories of health.

    1. Richard

      Cannabis and healthcare is perhaps the biggest myth perpetuated this year. Look at the explosion of strokes in this user group.

      1. awaldstein

        You are uninformed and not reading my comment carefully.Though entitled to your own views obviously.The amount of health related innovation coming out of states that have legalized cannabis in related items, even CBD from hemp is quite astounding.

        1. Richard

          There are many thing i am, but uninformed is definitely not one of them. I am a scientist first and p values are not horseshoes.

          1. awaldstein

            I said that the advances that are coming from the legalization of cannabis are both funding encouraging a host of innovation.That was the jist of it.That is true.

          2. Richard

            Innovation and cannibas? What are you smoking? Look to where innovation happens, Israel, China and US (scientists). What you will not find is marijaunia.This current meme is as shameful is tobacco. But I suppose that if Fred had spoke of innovation in tobacco in 1959, you would be nodding in agreement there too.

          3. kidmercury

            this is a good beef here. def have to side with richard. marijuana’s benefits may exist for certain sub-populations, but far more will be impacted by negative side effects. i support its legalization because i have a bias towards less legislation and letting people do whatever non-violent stuff they want to do, but its usage is probably a negative for society overall. i say this as a person who used to smoke a lot and still smoke on very rare occasions.

          4. JLM

            .The notion that something – a medicine – that is delivered through hot smoke in one’s lungs is going to be “good” for you defies basic logic.There was a lot of buzz about treating PTSD with cannabis and it boils down to a lot of vets like getting high.When pure, scientific tests of efficacy are run, cannabis is not a top ten drug treatment for anything.This does not mean that there are not outlier examples of relief which are cannabis based, but the notion that cannabis is a medicine for the entire broad spectrum of users is unlikely.I am resigned to the notion that marijuana for recreational use is going to be legalized in the US.JLMwww.themusingsofthebigredca…

          5. LE

            Well as you know I agree with you.But there is one upside to point out. People who smoke pot (by my totally talking out of my ass theory) are more likely to be chill and expect less out of life. Hence they are willing to except lower wages and in fact not be uptight about having less than others. Kind of an Island type chill and you know what I am talking about.Also all the talk about it not be addicting means nothing if people are defacto addicted to using it, right? Sure maybe it’s not a physical addiction but same as food and PETF (defined in my other comment) you probably don’t see many people who enjoy it deciding to stop using it. [1][1] Of course since I don’t hang out with those type of people how would I know.

          6. sigmaalgebra

            Naw: There will be enough accidents, etc. from people high on pot for some lawyers and insurance companies to pour cold water on it all.There are already plenty of examples of people causing harm from being high on pot.Dirty politicians — that is, nearly all of them — come up with proposals, anything, anything at all, to get some votes and, thus, power for something else, “the hidden agenda”, so make proposals, e.g., legalizing pot.Many of the proposals the politicians come up with are dumb de dumb dumb and obviously were from the beginning, but the US democracy has to let the proposals actually do their serious damage before, later, quietly, we reverse the politicians’ proposal garbage.

          1. LE

            Not into this stuff (never even tried it period) and not defending it but you can always find a ‘white man study’ to support a point of view. Also the above study is not double blind no way they are doing that type of testing.Look at the studies that clearly said ‘wine is good’ or ‘any alcohol in moderation’ is a gain in health and then all the sudden further research took the other point of view.My view on marijuana use (as a generality) is that it’s overall bad not good. Not that there isn’t good for particular groups of people or in tight circumstances. But in general for a state or society overall no way it’s a good thing.Quite clear why there is a big push for it though.Drugs in general we had it right years ago. Nothing good has become out of all of the drug experimentation of the 60’s other than a situation where there are so many people impacted by it and an entire illegal industry set up here and in other countries to produce and distribute drugs.I hope all of you out there who do or did or consider doing drugs stop thinking it is ok simply because it has not had any impact on you personally other than the enjoyment or upside that it gave you. This is like me thinking it’s ok to drive my car on a road at 120mph (boy would I love to do that) and not recognizing that the other guy is not as good of a driver as I am.Separately (tmi time here) as I have stated my wife’s parents were druggies when she was growing up. It had a tremendous impact on her and her siblings at the time. And yes they have and do suffer health problems (which we all pay for) as a result of the abuse.

          2. Richard

            Study aside, this issue is a no brainer. Number of dads who would have a beer with their 16 year old son vs smoke a joint with their 16 year old son. We all know one is harmful and one is essentially harmless

    2. Adam Sher

      Will the researchers embrace neutraceuticals and wearables (and other non-drug areas) so that we get sound research? I heard a fascinating suggestion that the US should create a research opportunity zone where innovators are encouraged to take risks and where subjects can voluntarily go to participate in the research. Essentially, a way to encourage human testing because that would be more expedient that what we do now.

      1. awaldstein

        I like this idea a great deal and agree that the more studies we have the better.

  3. JimHirshfield

    A healthy debate will ensue about this sector not being immune to disruption.

    1. Matt Zagaja


    2. Girish Mehta

      Hmm…it seems that you believe that laughter is the best medicine.

  4. Matt Zagaja

    Instead of going to my normal doctor’s office for a flu shot this year I was able to get one while I was at CVS. I know they’ve been doing this for years but it was a novel experience to me. The key parts to this was for unknown reasons CVS is always located in a convenient place, and they let me do this as a walk-in. Other than the 10 minutes to process my insurance paperwork, it was about as easy as getting a battery replacement at the Apple Store. Models like this are especially valuable in places like Boston where getting a primary care doctor near you can be a bit of a challenge.

    1. awaldstein

      Interesting as the next victim of Amazon will be the drug stores as honestly, the vast percentage of stuff in them is junk and if I can get prescriptions with the same precision as I get other stuff one day or same day, they really don’t have a reason to exist.

      1. Tom Labus

        With the Aetna merger, we’ll be going to see docs at CVS. CVS has mini clinics some already.

        1. awaldstein

          Interested to watch.Just because you have the raw materials though doesn’t mean you can make it work. Aetna is hardly the epitome of understanding the customer!

          1. Tom Labus

            Walgreens spent huge cash getting ready for Theranos blood centers which they never verified worked.

          2. awaldstein

            My point exactly.On one level, Amazon should be the answer as a prescription in a prescription and the back end order, inventory, sign for stuff, insurance payment stuff they are perfect for.On the other, pharmacists, pick up the phone and call the doctor–my does–and it is the loop of customer give-a-shit between these pieces that touches the medical alert systems where the secret sauce lies.People literally can die with errors or lags.

          3. jason wright

            was does that say about Walgreens? what therefore *is* Walgreens?medicines, pharmaceuticals, healthcare, they’re all financialised sectors, where the money is the focus and the product or service is largely incidental. people, as patients, need to be put at the centre of things.Theranos was a debacle.

        2. JamesHRH

          We have mini clinics in TX in Rx & Grocery stores.

      2. Richard

        The problem with medicine and healthcare is that most users make decisions based on the loop of you don’t know what you don’t know. And the VCs are certainly taking advantage of this. A good pharmacist at CVS can save you hundreds of dolllars per year. For example a 30 day fill for a script can often carries copays of $30-50, while a 90 day fill has a fixed price of $12.

        1. awaldstein

          There are many problems.I see innovation and the funder of this as part of the cycle of making it better.Your example is a good one and doesn’t require human intervention as any good software system built to always give the best price would I think be able to do this.The drug store reason to be has been gone for decades. They have something but i don’t see it as a complete model.

      3. Adam Sher

        Weren’t drug stores already victims of competition from Walgreens, Wal-Mart, etc…? I wonder how Amazon will out compete them.

    2. Adam Sher

      I appreciate being able to get my flu shot at Walgreens (doing so Friday). It’s a great improvement over a Dr. visit and I look forward to more out-of-hospital care. I’ve had good experiences with Urgent Care clinics too.

    3. JLM

      .Twenty-five years ago, my company health insurer used to come to the company and give free flu shots.JLMwww.themusingsofthebigredca…

      1. LE

        Over 30 years ago the ‘gold standard’ best health insurance cost me $65/month for a single and about $130 for a family for Blue Cross Blue Shield and Major Medical. That was all you can eat go anywhere you want w/o referrals. Same plan that I had for myself. Even inflation adjustment it was reasonable like no big deal when I gave it to employees.

  5. William Mougayar

    Are most of these solutions tailor made for the US system, since they start by taking into consideration its own (messy) position?I wonder how applicable this approach would be in other countries? The reality about healthcare systems is that each one is peculiar to, and entrenched in a specific system that is different from one another.I’d love to see healthcare innovation that has no borders and can easily adapt to the multitude of local systems.

    1. awaldstein

      Good question.Health care systems out of the states I can’t speak to.For the pipeline from genomics to nutraceuticals to wellness cross categories this is a global reality, geographically delivered.Am considering participating in one pan European so I know of what I speak in this case.Anything that requires hard goods delivered can have global platformed but needs to be locally determined.

    2. jason wright

      you point out that there are so many different systems, and it’s interesting to contemplate why that might be. one human body is much like another, and so that’s not determining the differences. clearly some healthcare systems are driven not by medical imperatives, but by other imperatives. the more financially capitalistic the society the more clearly the imperatives of financial capital tend to determine the nature of the system. i would say that US healthcare isn’t really about health or care. it’s about money and money moving around the system.the UK’s NHS is a universal safety net system, but the culture of the system is quite deficient. it’s become a monster of an institutional form. far too many managers of the grinding bureaucracy, and far too few doctors and nurses actually serving patients.The French system is so much better.’innovation sans frontier’.

      1. sigmaalgebra

        For the US, look up Hill-Burton hospitals and Community Health Care clinics.

      2. William Mougayar

        Right. The human body is the same more or less, universally- but the health care systems are not.

    3. Matt A. Myers

      The most efficient model will takeover the status quo, assuming resources are managed well and accountability is held – efficiency therefore including qualitative improvements and not merely quantitative (Genuine Progress Index vs. GDP).The only way to know this for sure is having apples-to-apples cost and systems comparisons, which must come from transparency and accountability as a foundation – and then can compare exact match of services to see who is able to offer better value for less, e.g. efficiency.It’s planning for and designing the system that should exist – and not worrying about the status quo, and then contrasting it with other systems as a learning process and as a way to educate the general population. There’s a lot of unnecessary built-in complexity which leads to confusion, among other things. The status quo, in Canada too, is fighting adopting newer, better technology, so the older indoctrinated systems and professions aren’t made obsolete – so they can keep their skillset relevant and keep their jobs, at the expense to people not having access to more effective and cheaper solutions; it’s pretty sick in itself and opposite to their pledges of “do no harm.” It’s amazing what ego and ignorance can allow one to justify.Understanding where the ecosystem(s) currently stand (it’s good we have a variety of examples to compare), how much stagnancy and friction they have – and where it’s at and why – will lead to the design of the most competitive product, ecosystem.

      1. William Mougayar

        But there are regulations, governments or complex insurance systems behind any health care system. And that’s the reality and head winds for change.

        1. Matt A. Myers

          Indeed, there is a path of least resistance however.

  6. Pointsandfigures

    In a Medicaid type doctor patient relationship, the relationship is a commodity.

    1. JLM

      .Not all the time. I have Medicare. I go to the same doctors I did before I had Medicare.The toughest thing is to find a good doctor and practice.I go to a regional clinic (Austin Regional Clinic) which has every specialty in house, has a state-of-the-art digital medical records system, in-house lab, and which is highly accessible 24/7.I could get an appointment this afternoon for this afternoon — might not be with my regular doctor.There is a desperate need for “execution advantage” in health care.JLMwww.themusingsofthebigredca…

  7. PhilipSugar

    Disclosure: My wife is a Nurse Practitioner and put her way through Penn Nursing School as the aid to the very famous Claire Fagin who took her under her wing, and paid for her education.Penn named a 165,000sft building in her honor: https://www.facilities.upen…She would say why take a limousine to NYC when you can drive a Camary? Not that there is anything wrong with the limo. But there is a cost.My college roomate who literally sailed around the world http://www.notallthosewhowanderare…Was so appalled when he realized how the rest of the world viewed healthcare he started a company that simply informed people about all of the warnings of the drugs they were taking and what exactly the said efficacy of the drug.So much of this is crazy. My wife acts as my father’s confidant to manage his medical care. There might be a business there. He fainted at my house, as the ambulance came they asked what medications he was taking……13 different ones.Nobody can tell me you know the interactions of 13 factorial.Famously the head of Mount Sinai hospital said, we will not have people on more than 6 medications. He was pilloried by the drug companies who of course want you to take more.

    1. LE

      I definitely remember Claire Fagin from Penn as head of the nursing school. She is roughly (now) the same age as my mother. She grew up during the depression. So the Camry concept has to be taken in context. I will point this out because it’s always important to factor various ‘wisdom’ in context. As an example (once again my mom the same age as Claire is now approx.) told me that she wanted to take me out for my birthday with sisters and relatives etc. So I decided we would go to the same restaurant that we went to before which is located on the ‘Main Line’ (which of course you know what I mean by that). My sister lives there and I like the area just in general. So I tell this to my mom and she says ‘oh there are 14 people I have to see how much money it is first’. And acts all worried like an old biddie who has to scrimp and save. I said ‘Mom we were there just a few months ago you know the place! No big deal!’. She says ‘yes but I didn’t pay your sister did and I want to know!’. Now keep in mind my mom as zero money problems and the cost is for sure not a factor. She actually just gave us all some nice tax free gifts. No issues with money. But yet she wants to make sure it’s not ‘to much money’. This thinking actually held back my Dad in business. He would have to hide deals from her and told me not to buy real estate with my wife’s name on it. (I will always top you in TMI btw for the sake of the community here.)So what do (possibly this is just a stab i the dark) Claire, My mom and maybe even Fred have in common? They flip the reward system. In certain (but not all cases) they get pleasure from being thrifty (even when not needed) instead of pleasure from luxury or spending. You in a way do this to with that truck you drive. Not that you don’t spend money in other areas. But part of the allure of that truck relates to how beat up it is. It’s a flip of a traditional reward system. Also both Claire and my mom don’t care about transportation. My mom drives a Subaru and she gets zero pleasure out of cars. She gets no positive feedback from a nice car so sure a Subaru is fine for her. Personally I don’t like limos either. I like to drive myself.Back to health care. It’s the opposite. The idea is everyone gets (even people here that shouldn’t be here) the best and most expensive health care because well it’s health care and how can you deny it. That is what is going to bankrupt our country. The herculean effort that we put into keeping people alive (who have abused themselves).

      1. PhilipSugar

        Claire Fagin’s point is you can’t just spend unlimited amounts on everything. And yes when that building got dedicated we went. And yes she probably got more joy from helping a poor abandoned girl getting her Master’s at Penn than any fancy dinner or accoutrements she had as the Dean of Penn Nursing and even the Interim Dean of all of Penn.My point is going to be antithetical to many people here. I think the way people manage by “the numbers” is what keeps drug companies in business.Doctors are complicit.It’s so much easier to squeeze in 20 appointments in an hour and get reimbursement and just placate people by dispensing drugs like they come out a pez dispenser than talking to people.It’s much easier to say your XYZ is high take this. Much easier to say to a 90 year old: You should take a blood thinner that costs $2k a month rather than how do we make your life as best we can now.They reel at the fact that somebody would put a 90 year old on blood thinner.

        1. LE

          Well that is true. Also the other thing that is literally never discussed is the food industrial complex. People eating things they shouldn’t and eating more than they should. And you know this very well. All of that eating tasty foods (what I from now on will call PETF – People Eating Tasty Foods’) is a large part the culprit. When I was growing up my mother never made things that tasted so good that you wanted to eat more than you needed to. Steamed green beans. No butter etc. Nothing fancy. Nothing that tasted super good. Going to McDonalds was like a drug. Luckily back then you didn’t go (or even have Pizza) unless a special occasion.Look at our culture now? Sure Joanne and Fred have control but most people don’t.So now we have the fact that foods taste good and people want to eat that food and they over eat. And then they take medicine to take care of the problems that the food gives them. And you know this is the case. Just walk around Walmart. See what people are buying at Wawa. See all the junk food they sell different versions of macaroni and cheese with various toppings. All fatty food. All filled with things you shouldn’t be eating (and this is important) on a regular basis.Growing up in the 60’s and 70’s these people didn’t exist. My guess is if you dig up pictures back at that time (and before) you wouldn’t see people like that other than people who were genetically heavy or some big outliers who just ate a great deal.Also stress in life adds to overeating. And what happens? Take drugs and see doctors for the fix so you can eat more. My father in law an example. Takes diabetes meds but doesn’t have the will power to not eat cake if it’s in front of him.Note that this very little to do with whether you are going extreme and eating generally healthy non prepared foods. The point is most people the average person (where we get socked with healthcare costs) does not have the will power. They are not me. Even my wife is not me.One other thing. All of the advances in medicine keep people living longer whereby we then pay for their healthcare costs. These are people that would have died off back in the day but haven’t.Small example look at this page which I tripped on yesterday. ‘dolls for dementia’. Those people are barely functioning and apparently don’t even know it’s a doll? This is really sad. Imagine the cost of this type of care.

        2. LE

          Reason doctors do that is health insurers and the doctors employers don’t allow them to take more time. Not because the doctors don’t want to do it (generally at least).Example (and not unique in any way) years ago I dated a Radiologist who literally lost her job because the boss guys wanted her to stop spending so much time with patients. Literally read her the riot act. She was expected to read 60 studies a day. And she had to sign those studies after dictation. She used to do those at home on Friday night would totally piss me off. Anyway if she didn’t sign them in time the bosses would just login and sign off to clear them from the system. Point being the pressure and the evil came from above the doctors to keep costs down. So if you drop reimbursements that shit happens.Drug seeking? My sister in law who does honestly not need to lose weight that much asked my wife to prescribe her a weigh loss drug. My wife told her ‘nope it’s scheduled forget it’. Same day her sister just gets an appointment at (what she called, not us) a ‘sheister weight loss clinic’. Doctor prescribes her the drug and she gets it filled at the office. So she has to come back.In my office complex there is a few weight loss doctors. They started renting a few years ago and did well enough they now have their own office.

        3. sigmaalgebra

          > You should take a blood thinner that costs $2k a month rather than how do we make your life as best we can now.That blood thinner might be Plavix.There’s an alternative, a miracle medication, called Acetylsalicylic acid, ‎C9H8O4, a.k.a. aspirin. Commonly baby aspirin, 81 mg per day, is enough.Commonly generic house brands of aspirin are close to dirt cheap.

    2. LE

      New startup who I have done some work for:https://www.herohealth.comThe idea was based on a need founder’s own mother had (she was a Physician who became ill and was on a dozen meds).Noting the device only holds 10 meds so!

    3. sigmaalgebra

      If A is a set and |A| is the number of elements in set A, then the number of subsets of set A is2^|A| = |{ B | B is a subset of A }|For some cute notation there is the set of all subsets of A2^A = { B | B is a subset of A }So we have for the number of subsets of set A|2^A| = 2^|A|I will omit connections with Sterling’s formula and the uses of factorial, e.g., |A|!

  8. JoeK

    “Cost is driven down through technology and healthcare is made simpler through new unbundled business models, streamlined payments, and better user experiences.” I doubt that there is a topic more plagued by the Dunning–Kruger effect than the issue of healthcare in the United States.

    1. Dan T

      I’m not sure I agree, but now I know what the Dunning-Kruger effect is – excited about that 🙂

  9. Richard

    The double speak from VCs is on show. Not a single VC speaks “up and to” millennials to purchase insurance and to do so because it’s the responsible (adult) thing to do.

  10. Justin M

    I think a key point to mention is that this could have drastic improvements on the notorious wait times in doctors’ offices. In a virtual environment, you could get pinged/push notifications when the doctor is ready. Rather than sitting in the waiting room for hours, wasting time away.

  11. Matt A. Myers

    It then shifts the burden onto the Landlord Rental Complex, where they then have to reduce how much they charge for rent – and likewise, then how much rent their employees need to pay.That whole complex is of course propping itself up, which applies a constant negative pressure on the quality of life of everyone by extracting as much value as possible from them via buying up and renting space in areas of demand, however it hasn’t collapsed yet – so will it?People just move to new areas to benefit from lower costs, at an indirect higher travel cost, etc – or they wait for businesses they can rent to who become more efficient, to be able to extract more profit from other systems, to then feed into the Landlord Rental Complex.It’s a beast.

    1. Richard

      The real estate market needs a new tax approach. Both commercial and residential markets skimm too much out of society.

      1. Matt A. Myers

        That’s one approach – it’ll be hard to get those laws passed though. The status quo is the status quo for a reason..

      2. JLM

        .Real estate generates ordinary income – rents – which is taxed at ordinary income rates.The two meaningful deductions are interest on the mortgage and depreciation which is taxed (expensed) identically to other industries.When real estate is sold, the profit (selling price minus cost basis) is a capital gain which is taxed at capital gain rates.The cost basis of the property is the original cost minus the accumulated depreciation deduction (depreciation recapture).Why does that require a new tax approach? It is quite rational and simple.JLMwww.themusingsofthebigredca…

        1. Richard

          Holly Softballs!1031 exchangeDepreciation on an appreciting assetCarrying lossesDebt forgiveness not counted as incomeDouble step up basisBankruptcyBorrowing against home equityHome mortgage interest deductionReal estate income tax deductionRental property step up basisTravel cost deductionsBut hey you could have just come clean and made the list yourself,Should I go on?Homestead lawsState Caps on real estate taxessolar panel deductionsWind farm deductionsFarm use tax deductionsCrop price floors….

  12. Matt A. Myers

    I’m writing a book on this in parallel to moving my business projects and related research forward; it’s part of my educational and marketing plan, relationship and trust-building.There are many battles going on relating to health, of the old fighting the new from being adopted – whether purely due to indoctrination or perhaps in part a negotiation with greed.Most people don’t touch on the more holistic challenges – like accountability – with which without it then businesses can take advantage of people, and people are left hurt and without a path to justice – or causing change/improvement, except in the most extreme cases. How do you know exactly what care you will get and how much it will cost? How do you know the care you’re getting is good compared to another?Simply requiring transparency and removing the games played by insurance companies and hospitals in the US would probably be more dramatic of a benefit to reduce healthcare costs.I’m curious too how the negotiations for pay in Canada’s healthcare system goes as well, for what the government is willing to pay for different services. I imagine it goes something like “X now costs $Y, so you need to give us more for this,” yet there’s no built-in accountability to efficiency, nor knowing if a doctor or professional’s level of “success” helping people is merely at a level or efficiency of chance – or worse. In Canada, we also still don’t calculate indirect costs – of say a person having to wait 2-4+ months for an MRI and how that impacts a person’s life – and those surrounding them. They’ve adopted and settled into a system of attempting to delay when money is spent as a means to manage a budget and delay future diagnostics or treatments further, even though they’re not addressing the larger holistic problems – like increasing efficiency, with which would provide/free up a lot more resources/money all by itself to be redistributed into other areas. There’s a lot of stagnancy that’s made their way into these systems due to indoctrination, ego and self-survival, and the education process being flawed.I don’t know if it’s mainly businesses who are VC-funded that don’t want transparency for businesses in their portfolio, as if they’re showing real costs for the consumer to see. A turning point will be – if it gets there – when it’s required for all costs to be public. We might end up having truly not-for-profit organizations, which is essentially what competition is meant to lead to. Likewise, the VC model expects a certain return and therefore will only sell their offering at a certain profit to get their expected return (attempted to be passed onto the consumer) – or the companies disband and the technology, effort, and organization is lost; what waste. Perhaps a new model must arise where companies release everything they’ve created into the public domain as part of their mission, supported by their VCs – think it will get any traction? Perhaps that would be a competitive advantage then, too.There is a lot of innovation happening, however the easy stuff with existing knowledge and technology – the 80% – still doesn’t efficiently get to people because of a variety of reasons. There’s a lot of technology that’s not necessary either – and is more of a distraction or treating a symptom or acting as even entertainment. If we look back the last 100,000 years, humans did quite well without any of this. We of course have polluted the environment in many ways from its natural state, and this leads to health issues and dis-ease states. What the tools like computers and the internet has allowed however, is rapid deployment of information, education, and for any individual to share their vision and path in the most transparent way possible.There’s going to be a lot of fun and excitement in the near future for how rapidly change is going to come. What Elon is doing with Tesla and SpaceX is perhaps just the tip of the iceberg, likewise Jeff and Amazon’s efforts to reduce costs with autonomous systems and AI. There are many other large systems that are ripe for disruption, and these companies are all highlighting – bringing to the forefront of our awareness – deeply important issues that will start rattling people to the core to wake them up, and bring into conversation again what is true security and safety – what does peace and justice look like, and how do we actively engage and participate in holding the line.A model can be created that can scale more efficiently than any other, and that will then feed the world, provide a high quality of life including healthcare and education, and provide rapid security services to all areas. This is what I am working on.

  13. JLM

    .There are a great number of simple business principles which can be employed in regard to medicine.Let me give you two with which I have personal experience:1. Competitive pricing of servicesI need a ruptured Achilles tendon repair. It is totally ruptured and the pain is now gone, so I have as much time as I want to have it repaired. I will have to have a cadaver tendon sewn in. [I am holding out for a cadaver with a 40″ vertical leap or a 180 IQ.]The doc I selected does orthopedic work for the Univ of Texas athletes and is considered one of the top guys in the US for this operation.I got prices from several surgery clinics – including the Surgery Center of Oklahoma.My guy wanted $10K and I got a best price of $5,700. He agreed to match the price and, in fact, will do it for $5,000 if he can do it on a certain date.I have Medicare, so I pay nothing anyway. I contributed to Medicare since it was invented, so I am just getting the insurance I bought years ago.2. Competitive prices for medicationsI take four medicines – two are getting ready to go away and the others will shortly.These medicines cost more than $1500 every three months in the USA.I buy them in Canada. I pay 22% of US prices for the exact same medicines by the same manufacturers. But, I buy them from Canadian pharmacies. The Canadian pharmacies all price match the lowest price. Sometimes the prices vary incredibly.I had all of them submitted to a lab and they came back right on spec. Cost me less than $100 to have this done.http://themusingsofthebigre…I have been helping people do this as noted in the above information. It is as easy as pie.My doctor and the medical clinic are totally fine with this arrangement and take and receive calls on the prescriptions.American medicine can do these things right now.JLMwww.themusingsofthebigredca…

  14. JLM

    .Fred’s blog post focuses on delivery and the business model, but there is an entire flood of new products which are VC or angel backed and coming from medical professionals who are marrying their medical expertise and the innovation ecosystem.As I was reading this blog, this deal literally materialized on my computer. I knew it was coming as I had asked to see the deck. It is typical of the level of product innovation out there.…JLMwww.themusingsofthebigredca…

  15. bfeld

    I’m a big fan of this as a patient.My doctor uses SteadyMD – – my care has been more immediate and better in the past year than it has been the balance of my life. I pay him a monthly fee. Done …

  16. TedHoward

    I applaud and encourage all efforts to fix US healthcare and more importantly improve worldwide healthcare. I see no resolution until health insurance is gone. And I think a basic understanding of the business dynamics is lacking.Imagine entering a Starbucks. You have no choice but you think you pay nothing ever. The cashier tells you what you are ordering and he/she has no idea what it will cost. After you enjoy your beverage, some other person is told the price ($20). That payer simply say “Nope” and tells Starbucks what they will pay for your beverage ($2). They’ll pay you at some future point, hopefully within a year. Starbucks can either get 0 dollars or what they were told they would be paid someday, hopefully. Either way they already paid for the beverage(*).Imagine being that customer and getting a $10 bill for a latte you had 6 months ago. You didn’t ask for a latte. No one said anything about a price for something someone else chose for you. If you knew it was a $10 latte, you never would have bought it.You apparently “bought” it. You thought someone else was buying drinks for you. They found some way that they shouldn’t pay and you should pay.I see two inherent pricing flaws in healthcare. One is that prices are unknown and in fact unknowable (I believe Brad Feld’s dad has a rant regarding price transparency). The other is inherent in health insurance in that price transparency is broken when someone else claims to be paying something someday … eventually.psMy wife is an ER MD. My father was a Psych MD who ran a psych hospital and private practice. I’ve seen this evil fester for decades. Corporations win and humans suffer. A government “for the people” should help the latter but it helps the former instead.

  17. Terry J Leach

    Very exciting!! I think future will have many innovative business models is to eliminate the waste in the middle and bring back more person to person contact.