My investing theses

Hit up ya boi

Jul 12, 2020

Some exciting news, I have a scout fund for some pre-seed/seed investing in healthcare companies! Now I can also say “how can I be helpful?” non-specifically.

If you’re building a healthcare company (especially if it’s in any of the spaces below), please fill out this form and I’ll reach out to you if it’s a good fit!

These are some areas I’m excited about. If you’re a company working on these problems, let me know!

Standardization

Healthcare has largely fallen into the camp that solutions should be customized to their end users. I think there's a big opportunity to create more standardized solutions, which end up becoming a cheaper option thanks to scale and become a valuable distribution avenue because partner solutions can be distributed quickly across customers (no expensive implementations needed).

Three specific places I'm thinking of:

Standardization of scales and measurements that physicians use - There is a huge variance in how physicians measure different scales like PHQ-9, Body Surface Area, etc. Software can do this better, passively, and in a more standard way.

Standardization of processes - Redox (integration), PatientPing (ADT feeds), and CoverMyMeds (prior authorization) were able to coordinate a single function between a ton of different stakeholders because they created a standard where there were once a ton of custom processes. This saved everyone time and created an actual network effect as the network grew.

Standardization of data - Companies like Flatiron were successful IMO because they made highly valuable unstructured data into a structured and standardized form. Registry companies similarly structure and standardize said data for different use cases. Health Catalyst does the same with warehousing solutions + the data hospitals generate. There are lots more opportunities here.

Physician independence + unbundling the hospital

How do we make it easier for physicians to build income independent of a hospital and theoretically start their own practices? How do we carve out certain service lines away from hospitals into a workflow optimized exactly for that service (e.g. maternity). Burnout is at an all time high, physicians hate the tools they use, and hospitals are too consolidated. If we want to make the provider landscape more competitive, how would we do it?

Virtual work making it easier for physicians to work on the side and slowly shift hours away. DocSpace is one company I’m involved with here, which helps physicians build their own virtual practice. I like the company because it generates a new supply of independent physician services from the ground up and lets them choose their own tools and workflows.
Companies that enable independent physicians to see a higher volume of patients or make more money per visit. This can be handling as much non-physician work as possible with home monitoring tools, or give the ability for practices to participate in different reimbursement models (e.g. shared savings plans, collaborative care models, etc.). I'd love to see a new tech-enabled MSO or something akin to this.
Identify high performing physicians. A physician's ability to go independent is dependent on how they get patients, and it's easier for them to get patients if people know they're good at something. Right now referrals and discovery are based more on convenience and relationships than quality for a specific service.
Patient acquisition is one of the hardest parts of being independent. Embedding physicians into places patients already concentrate makes it easier to acquire new patients, reduce the overhead of your practice, and makes it easier for patients when they don’t have to go to a separate clinic. Care delivery being brought to pharmacies/groceries is one example (e.g. VillageMD + Walgreens), but what are others?

Patient-to-patient education and support channels

Using patients to help guide and support other patients is underutilized as a more cost-effective form of patient engagement with people that are knowledgeable, regularly present, and empathetic.

Companies where peer support is a key part of their offering - e.g. building the Alcoholics Anonymous but for other conditions.
Companies that use data from other patients to help guide patients similar to them through their health journey. Cancer navigators have excelled here and show demonstrably positive outcomes and a better experience. What are other versions of this?

Services-as-APIs

There are still a lot of functions that healthcare companies build in-house today that isn't part of their core competency. Creating an outsourced, plug-in service similar to CredSimple, TruePill, Eligible, etc. for other obstacles digital health startups face in their early days is still a huge opportunity.

I’m especially interested in companies building these plug-in services to better enable home health businesses to build on top.

Diagnostics

Patient-initiated diagnostics are flipping the physician-patient relationship since patients are now armed with information, giving them more agency of choice on where to receive their care. Plus thanks to improvements in machine learning and sensors, the types of diagnoses and settings where diagnoses occur has expanded tremendously.

Diagnostics companies have typically avoided any sort of care delivery that's beyond the diagnostic tool itself. There's an opportunity to build new workflows around patient diagnostic tools which looks more like a proactive healthcare system where someone reaches out to the patient, vs. a reactive one where a patient needs to seek care.

Plus, automated and passive diagnostics create more standardization! Double whammy.

Improving Audits + Compliance

I wrote a long thing about how we’re in a golden age of fraud that’s yet to be uncovered. Money is flowing through the system with virtually 0 traceability or understanding how it’s being distributed. Most audits require a physical presence, ad-hoc spot checks, and are generally not scalable relative to the complexity of the system. How can we make audits more scalable and consistent?

This is not just limited to outright fraud, but also better monitoring of behavior to identify waste. As a thought experiment, what would happen if patients wore bodycams as they went through the health system? What behaviors on the care delivery side would change?

Separately, identifying fraud and waste are one aspect but actually collecting owed payments and enforcing the collection is tricky. Are there companies that also help with that process?

I’m definitely not limited to the areas above, just extra excited about them :)

If you or someone you know is building a company in these spaces or thinking about quitting their job to build a company in these spaces, fill out this form and I’ll reach out if it’s a good fit!