24 – Opioid Treatment on the Streets of Philadelphia | 3 Key Announcements from HLTH | Kaiser’s Resolution with Labor

Marcus: [00:00:00] All right. So, uh, take two of episode 24. Wow. Uh, so we’re on the road. We’re in Kansas city. Uh, we are going to be attending the Casey, uh, bio Nexus Casey disrupt annual event, which is pretty cool. And, um, We are, I’m going to be keynoting it and we’re going to be attending a whole bunch of different activities.

So, we’re literally recording from the hotel room. Yeah, we’re on the road. Yeah. On the road, in a hotel room. And hopefully this actually works. Yeah. Um, but, we, we recorded on Monday, lost the audio, so we’re literally going to re record the show. And, uh, you know. Take two, we better. Yeah. We’ll be a lot smarter.

Yeah, yeah, I, I would imagine. So, anyway, to kind of quickly catch everybody up, uh, you know, we missed a full week. Uh, you know, our, my family suffered a loss. We, uh, we lost my, my mother in law, um, about two weeks ago, uh, on Saturday. And, um, you know, it was, uh, an intense [00:01:00] experience. Uh, she was an amazing, amazing woman.

Um, and cancer is brutal. Um, but we had an incredible experience with the healthcare industry just in terms of, uh, the, the, the comfort and the time together that hospice afforded us. Uh, we were at an Ascension Hospice, and so just want to thank everybody, um, at that facility who, you know, really took care of our family and took care of my mother in law, um, through that process, and, um, you know, it’s a club nobody wants to be a part of, but unfortunately We’re all going to be there eventually.

Yeah, it’s a, it’s just sort

Vic: of a reality of life, so, um And then I’ll just mention the hospices. Really helpful. You need to get your directives. I need to work in mind So that you have that you have your wishes met. Yeah,

Marcus: exactly. So so anyway, um, you know just wanted to Thank everybody for everyone who did reach out, you know could kind of tell you know, where I [00:02:00] was last time and You could tell I wasn’t in an awesome place when I just thank you all for reaching out and offering your support.

And with that, we’re going to dig into the show. And so let’s go.

Vic: Yeah.

So we had the CPI report come out last week on Thursday. Uh, we’re showing it here on the screen, but for those that are just listening to audio only, uh, it, it, the last food into the core. Uh, it’s coming down. It’s making improvements. Of course, we all know the peak, really high inflation in 22, early 23, and we’re making improvements.

But I don’t know that we are at the 2%. I’m not sure when we’ll get to 2%. It’s kind of like a good news, bad news. It is coming down, but I’m not sure that the Fed is going to start cutting rates and [00:03:00] coming back because we’re not at 2 percent yet.

Marcus: Yeah, that’s right. And, and, you know, it’s coming down, less food and energy, but of course, You know, unfortunately, and it’s also worth worth mentioning, uh, you know, the world is in turmoil right now.

Um, and you know, our thoughts, uh, and prayers are with everyone who is suffering right now and who has lost someone. I know, I know someone who, who, who lost a sibling, um, in the initial attacks. And, um, you know, it’s just a dreadful situation. Part of that is going to, uh, I think impact the cost of, of energy, uh, and not trying to equate human lives to the cost of gas.

Uh, but in, in the context of how it does impact our economy, you know, global conflict, war, terrorism, they, they do have economic impacts as well.

Vic: Yeah. I mean, it’s bad at all fronts, right? And hopefully some, uh, clearer minds will prevail and we will, we’ll get to a better place, but it’s really bad right now over in the Middle East.

Marcus: Yes. Certainly, [00:04:00] you know, nonstop continued Escalation of aggression without any willingness to discuss the the larger ramifications and and uh, You know, I mean some of the things that are happening now are just no one can stomach. Uh, obviously, but we we we This is a health care show. Um, a hospital being bombed is just yes.

It’s not even you know I mean, I I literally lived in a hospital for a week. I mean, I can’t even imagine. Uh, what what that uh is like so And it really

Vic: doesn’t matter to me where, who did what, like, a lot of people are suffering, a lot of people died. On both sides and, and I really hope that the conflict can at least calm down

Marcus: or, yeah, that, that would, that would be great.

So, um, so, so with that, I mean, I think we’re, we’re heading into a window of unpredictability as it pertains to the CPI, um, you know, global. Uh, turmoil does not bode well for, you know, stable, [00:05:00] uh, prices as it pertains to energy and potentially even food, you know, supply chains are going to be impacted by this.

This is a, it’s, it’s going to be a challenge.

Vic: Yeah. Yeah. So I think we’re going to continue with inflation higher than the Fed wants. I hope they’ll relent and start cutting, but, but I don’t know that I see that in the next several months.

Marcus: Yeah. Um, so we wanted to share a little bit about an experience that I had, um, last week I was with my Aspen health innovators fellows and we were in the, uh, the city of brotherly love.

We were in Philadelphia.

Vic: Yeah.

Marcus: And, uh, one of the things we got to do was go out. Into the city, specifically into the neighborhood of Kensington and, uh, work hand in hand with public health workers, uh, to address people who are suffering from opioid use, uh, uh, disorder. And it was definitely very eye opening for me.

Um, I have not had People in my immediate family who suffer [00:06:00] from, from opioid use disorder. I grew up really in the crack era as it pertains to epidemics from a drug perspective. And so I knew what that looked like in Brooklyn, New York. I knew exactly what that looked like. Uh, and actually, and also I worked out of San Francisco and so I’d seen the tenderloin, you know, it wasn’t my first exposure to, to any of this kind of stuff, but I do have to say the neighborhood of Kensington was another level, uh, in terms of what I had actually experienced.

And also it was my first. Uh, in person experience with, um, you know, with the people, with the communities, you know, walking through the communities, talking to people and, uh, myself and, and, uh, and, and my friend Rachel, who’s also in the fellowship with me, we were walking around the neighborhood with, with a couple of, you know, great gentlemen handing out Narcan, uh, to basically anyone.

It was, it was indiscriminate, you know, whether you

Vic: want it to have for other people or you Um, Wanted to have for yourself. That’s right. You don’t even ask really just you want to give.

Marcus: Yeah Yeah, we were just giving it out to people in the neighborhood. Everyone knew [00:07:00] what it was, right? Everyone knew how to use it.

So, you know, it was a living and breathing reality for them uh, but one thing I wanted to bring up, uh, that was very very new for me was that there is a A relatively new but fast moving drug combination out there, which is a combination of fentanyl, which everyone I think is pretty familiar with, along with a drug called xylosine, which is actually an animal tranquilizer, and on the street, they call it TRANQ, T R A N Q, and they’re mixing these two things, I think, to, to simulate, uh, the, the The, the effect of, of heroin in terms of like the flow of the high, because fentanyl is a very fast acting.

The flow and like how long it lasts, how long it lasts. Yeah. Uh, you know, fentanyl’s very, very fast acting and, but it doesn’t last very long. Yeah. So I think Xylazine is extending the, the experience, let, let’s, let’s call it, by effectively knocking, um, the person out when they’re using it, and then they will.

You know come to and then be ready for the [00:08:00] for the next fix. So this is very very dangerous because this tranquilizer Is it’s not an opioid and so it’s resistant to narcan. So that’s bad, right? We narcan was a lifesaver for the opioid. Um, uh epidemic But now this adding the xylosine is really really dangerous And also it’s got the very dangerous side effect of, um, necropathy.

So, so people’s skin is literally dying and it’s not local to wherever the injection might happen. So that, so that skin dying may happen anywhere in the body. And, um, it was really, really devastating to, you know, see the effects of this combination on people. Um, really, really sad. So I just, for me, this was a little bit of a PSA, you know, we we’ve shared here the link to the, to the DEA public safety alert, but just want people to, to understand that the, um, the, the impact of the, of the drugs is actually escalating, you know, it’s, it’s, these drugs are getting more [00:09:00] powerful, they’re getting combined in, in crazier ways.

And the, the damage that it’s doing to people is really, it’s, it’s getting, uh, it’s just getting so intense.

Vic: Yeah, and we, we, I’ll say that we have an opioid epidemic, but it’s different when you actually see the people there. And we were talking earlier, it’s, it’s someone’s son or daughter. That is experiencing this, and we need to get them help, uh, but it’s a long road, it’s hard to see where we could correct this at any short time, just because there’s so many people suffering from this.

Marcus: Yeah, even down to like where it’s coming from, so one of the things that I learned last week was that, uh, A lot of this stuff is coming in on, on ports, you know, so Philadelphia has a very, very, very active, um, you know, important economic port where tons of, you know, ingress and, and, and, and egress is, is happening and, um, you know, there’s a, there’s a pretty strong belief that a [00:10:00] lot of, uh, fentanyl is coming from, uh, You know, potentially, uh, you know, adversaries, you know, countries that are adversarial with us.

Maybe they’ve had their own experience in the past, uh, with being attacked in this way. And so, you know, you can see how bringing this in through the ports might be a way to, to diminish communities across America. So there, there’s, there’s so many different ways. And then also, you know, keep in mind, uh, I, I happen to know somebody who, They got addicted to, to opioids because they had a sports injury, right?

And then they were prescribed

Vic: Yeah, you start with Oxycontin. Right. And then, um, it’s, it’s highly addictive and then you go to heroin or fentanyl, uh, when it’s difficult to get the next fill of the prescription. And then it’s like this, this really bad slippery slope that you’re just, you’re stuck. Yeah.

But, but I want to go back to the, to the Chinese, I think you’re talking about China [00:11:00] shipping fentanyl and maybe xylosine into our ports because That’s probably true. If it is true, it’s, it’s a national security issue as well as a healthcare. It’s a huge healthcare issue. Um, the British did that to China a hundred years ago.

So I certainly can imagine China feeling like, uh, turn around is fair play and we’re going to do that. But whether they are doing it or it’s some other organization, as our, our country has to get control of this and try to have a plan to stop it or slow it down and treat the people, help the people.

Marcus: Yeah. Yeah. And the sense that I got was that they. You know, it requires tremendous coordination from multiple agencies. So, you know, you just kind of rattle them off, right? The DEA, the Custom Borders Patrol, uh, the Coast Guard, right? There’s this three right there. And then that’s going to be mixed in with your local, uh, you know, for [00:12:00] whatever city, whatever those agencies are, the police, the fire department, the FBI.

So yeah, I mean, yes, we have to get a plan, but it has to be a coordinated plan. And it’s very, very difficult because again, these are. Um, active economic ports and time to, you know, time to market of getting these goods in and to their official destination is a factor as well, right? And so, you know, skimming through all these things and then also you have to sort of make sure that everybody is, that’s working at every point in the chain is legitimate and it’s not actually, you know, a bad actor.

So it’s a very difficult problem. I think, I think the point I’m just trying to get across is this is a very serious problem. It’s a very complicated problem. This is not an easy problem, you know?

Vic: Well, and the, uh, neuropathy people are gonna die from wound wounds and untreated wounds in the on the streets.

They’re not getting care that they need, and it’s gonna be. Really bad. Yeah. Yeah. So

Marcus: this is, let’s go to a [00:13:00] more positive story. Yeah. It’s a good segue. So this Monday it was, it was, uh, covered in CNN Health. Um, the, the headline was Healthcare Game Changer, Feds Boost Care for Homeless Americans. And uh, it’s talking about how there’s, uh, new payment models coming out of CMS to enable community workers to actually work out in the field.

So when you sent this over to me, I was like, Vic, I literally was doing this last Tuesday. I was, I was with. Community workers, people who literally lived and were born and raised in those communities delivering health care, Narcan wound kits in the community, walking around in the community. And, you know, I have to say it was effective, you know, it was effective to get the things distributed.

to empower people to save a life at the right moment and to help people take care of other people. So I was really encouraged to see that where we are looking at payment models that will enable more of this kind of activity as well as, you know, it’s also just a way to sort of address the labor shortage, especially as it pertains to, you know, licensed [00:14:00] credential clinicians that, you know, we’re already struggling with.

Vic: Yeah. So, I mean, they’re delivering healthcare. You were delivering healthcare. Yeah. Yeah. Um, and it’s very effective. What I thought was interesting is that this is a federal rule from CMS. Uh, but it is being led by, uh, Pennsylvania. Maybe because they have this huge problem. Uh, California started it. A couple of years ago, they, they lead a lot of things, uh, around this, these kind of issues.

Um, but just now it’s going to be nationwide. So it’s much more, uh, prevalent if you can get paid and reimbursed for this care, you can do a lot more of it than fully charity only.

Marcus: Exactly. Exactly. So, so this, this was, to me, this was good news, obviously. You know, lots of unintended consequences, lots of bad actors, lots of fraud, waste and abuse will have to watch out for all those things.

But for those people who actually have good intent, who want to grow these programs, who want to be on these communities, I think this is this is a great development. Um, all right, so moving [00:15:00] into cyber security stuff, really bad, uh, uh, cyber security issue with 23 and me. Um, and I think this gets into all things in the in the digital therapeutic personalized medicine world.

Where, um, data was stolen and there’s a lot of lack of clarity about what 23andme is, is willing to confirm in terms of what actually happened with the data breach, how much data was actually breached. Um, you know, what was the method of, of it being breached, but what we know is right now out on the dark web, um, 23andme data is out there available, being, um, peddled, being sold.

And what’s really dangerous about this is it includes, you know, data on our ethnicity. And so, you know, you can see the dark web is already sort of a bastion for, uh, you know, racism and antisemitism and other like really, you know, terrible things. And so having this sort of data out there is, is, is, uh, it’s a nightmare.

Yeah. It’s really bad. I mean, I.

Vic: There’s a lot of stories of, of hacks getting [00:16:00] through and especially healthcare records. Healthcare is probably the biggest, uh, honeypot that people try to attack. But this seemed like a, uh, a new level, like all the genetic data, all the ethnicity data. Um, being out there is, is really bad.

I, I don’t think there’s any way to really prevent my data from being hacked in all the different, uh, parts of healthcare that I interact with. So, I, I don’t know, I don’t have a good solution for this, but it’s, it’s gonna be an ongoing issue, I think.

Marcus: Yeah, yeah, and I think we’re just trying to bring it up.

I mean, I’ve been talking on Basically every board that I’m on about the ever vigilant, you know, um, investments you have to have from a cybersecurity perspective. And, um, it’s just, and especially in healthcare, right? I mean, I, I think we’re really going to have to start looking at all angles at healthcare providers and the fact that they have to maintain EMRs.

We’re gonna have to stop looking at those as assets solely and really start to explore the liability that’s [00:17:00] there. You know, we talked many, many episodes as we were. reviewing common spirits, quarterly reports about that, that huge, you know, nine figure expense that came from a hack. Uh, you know, the, the, the fact that you have to store this data really at the end of the day as a liability.

I mean, it truly is. You’re not making enough money for the risk you’re managing, uh, you know, by having to store it and maintain it.

Vic: Yeah. I think that’s right. And, and, People, I would like to have control of my own data. I mean, it might be, I mean, there’s been tech companies that have every five years another tech company tries to create a kind of a personal medical record or some different name like that.

It hasn’t really stuck yet, but I think eventually I want to get control of my own health care data and then I bring it to Common Spirit. I bring it to the doctor or whatever I do. Um, and what service I’m looking for, um, and then they don’t have to hold it all. Be the custodian.

Marcus: Right. Yeah. Right. Yeah.

Agree. I mean, I think, uh, distributing the data and [00:18:00] distributing the permission capability of the data is certainly a strategy to, you know, limit the value of the honeypot, as you put it, that’s out there. Um, all right. Into a couple of big, uh, big moves in the venture world. So Main Street Health, this is, uh, you know, Bill Frist and Brad Smith strike again.

Yeah. Yeah. Yeah. Thanks. A couple of episodes ago, we were celebrating them being number one in the Inc 5000 for CareBridge and now Main Street Health, which is another company that they have in the value based care space, uh, was able to get 315 million in 26 states. And, uh, they, they have a lot of payers that have, that have invested in this round.

Vic: Yeah. Oak is their main, um, financial partner, but they brought in Five or six payers to contribute to 315. I think, um, we have, so the health conference in Vegas was a couple weeks ago now, but we’ve chosen three, there were, there were hundreds of announcements at health, just cause it’s a big event and everyone, you know, kind of [00:19:00] queues up there, their new exciting thing.

We’ve chosen three that I think are really meaningful and Main Street raising 300 million from a bunch of payers. Expanded in 26 states. It’s a great service in a rural, rural health. I mean, we, we, we need a lot of support. So I think it’s, um, I’m happy for them. I

Marcus: think it’s good. Uh, second story we want to cover is the announcement that General Catalyst is going to buy a health system.

So, uh, This was shocking. Yeah. I mean,

Vic: um, I am excited to see what, what they buy. And Dr. Mark Harrison was of course at, you know, around, uh, Um, he’s a, he’s a great operator, but I don’t know what, I’ll be interested to see what they buy because there, there aren’t a lot of the, um, really profitable, well kind of.

choreographed markets are already bought up. So they, maybe they’ll buy a nonprofit. Um, but it’ll be interesting to see if they’re able [00:20:00] to drive the change that they, they expect to drive.

Marcus: Well, they, we talked, we talked about the, the big merger that they did with come here. And I think it was Estella’s maybe the name of the company that’s in the revenue cycle management space.

Um, so combining workflow and revenue cycle management, now they’re going to buy. So they, they are certainly talking about, you know, building out of. A full platform. And I do think that there’s an interest to the strategy of we always talk about the value of the payvider model, which totally aligns the payer with the provider insofar as here’s the payment mechanism.

Here’s exactly the data we want, and everything gets co designed together, right? Um, but there’s certainly a ton of inefficiency that happens between, uh, the provider and the technology that the provider has to leverage, right? It’s, it’s very often a hodgepodge. And I think the height of, of integration that we’ve seen over the last five years has been this wave of health systems saying, we’re going all in on Epic and we’re going to make every single, you know, facility [00:21:00] that we have an Epic facility, we’re going to get to level four or level five, whatever that Epic stuff is.

Um, but that really has, I think, been the, the height of true tech hospital integration that we’ve seen out there. Which is pretty pathetic, really. It’s not very good. That’s exactly right. So I think the, the theory here, the general catalyst is, is putting forth is that you really can build an entire health system operating system, right?

And I think they’re going to try to demonstrate that with a, with a single health system, have it operate much, much more efficiently. And then I think use that to sort of prove. That other health systems really should be using their full platform.

Vic: Yeah, I think that’s exactly the strategy and I’m interested to see it roll out.

I think there’s a half I’m half of a mind that it’s going to be really challenging to buy probably a nonprofit health system. I don’t, I don’t know of a for profit that they could buy. Maybe, maybe they’ll surprise me, but buying a nonprofit and then coming in and saying, we have all of [00:22:00] this cool tech.

And putting it on their bureaucracy, maybe they can do it. It’ll, it’ll be fun to watch them do it. I think there’s a lot of, um, there’s a lot of ways that the existing bureaucracy is going to resist that. And notice it, we’ll just see how it, how it evolves. They need to. They need to find the right culture.

And as we talked about with Common Spirit, Common Spirit is intentionally trying to shift their culture. It’s pretty hard to do with a big ship like that.

Marcus: Yeah. Well, you know, look, it’s a pretty good start if you’re going to use a very, very successful health system CEO, you know, as opposed to bringing in some tech CEO or something like that.

That’s right. That’s, that’s probably a good

Vic: start for that kind of strategy. Yeah. He, he’s well positioned to, to bring it, bring all these tools out. And I’ll be interested to see what, I mean, I think it’s 50, 50. I’m excited to see what they do. And

Marcus: then the third story we’re going to bring back from, from health is, uh, my, my friend, who’s, who’s in the Aspen Health Innovators Fellowship, uh, Jen Bushel, she and [00:23:00] her team at Delphi Diagnostics launched a blood based lung cancer screening test.

So, um, this means a lot to me on a lot of levels. Um, I’m. Very, very pro patient sovereignty. I’m very, very pro increase the capability of diagnostics that are out there. I think there are far too many deaths that are happening because of inadequate diagnosis. And, uh, and, and also in effect quickly enough.

That’s right. And also there was a long, Uh, freeze in the blood based testing space because of Theranos, obviously. So, you know, I just want to give a shout out to the Delphi diagnostics team. I know Jen, you know, she is a person of incredible integrity and, uh, I’m really excited about. What they, and really I’m hoping an entire market, uh, you know, start to bring on, which is low cost, you know, high fidelity.

And when I say high fidelity, you know, we’re, we’re not talking 99%, right. You know, we’re talking maybe, you know, [00:24:00] 80%, you know, screening tests, screening tests. That’s exactly

Vic: right. Be producing some of the people that go through the screening tests should get a further test. That’s right. And, but, but I, I, I think it’s exciting that, that we have moved beyond the, the bad actors and now someone’s doing it the right way and bringing a, a, a new screening system to market.

The reason that, um, the blood based screening is really valuable. The reason Theranos tried to do it is it, it’s very common. It’s easy to draw blood. Every health system in the world can quickly draw blood. You can do it on the corner, uh, in a lot of places. And so, if we can get more and more screenings through blood based screening, it’ll be, it’ll be great.

Marcus: And, and I think it needs to be said that a lot of this technology is really based on advances in machine learning and artificial intelligence. And so this is a place where You know, those advances are really exciting, right? You know, we, we talk about where is machine learning really going to help in, in healthcare.

I mean, diagnostics is a [00:25:00] no brainer, right? Like more of this, please. So anyway, congrats, congrats to the Delphi diagnostics team. And, uh, we’re just going to stop. Actually, I want to bring up one other thing. Um, and, uh, I don’t have the link here, but just going back to the general catalyst thing, and then we’ll go for a break, go back to the general catalyst thing.

Um, Um, you know, you found, uh, this week that, uh, a local venture capital firm in Nashville, Claritas, um, is, is, is putting together an offer to take Sharecare, a company that’s publicly traded and that they own about 10 percent of to take it private. And we were talking over breakfast about, you know, just kind of connecting the dots that, you know, LifePoint Health was taken private by Apollo and, you know, Ardent is, is owned by EGI and, you know, now, you know, those were private equity firms.

Now we have General Catalyst. And, and, uh, you know, Clara toss, we have VC firms, right? Looking to take these assets public. And I think there’s an overall trend there. We’re going to have to take the private, sorry. I think there’s an overall trend there about. In this new Fed, you [00:26:00] know, increased interest rate market, um, and also all the capital that’s, that’s still under management at the, you know, growth and private equity stage.

Um, there may be a lot of taking things private. There may be a lot of taking things private and not just from private equity firms, but from VCs.

Vic: Yeah, yeah, that’s what I mean. We know the Claritas guys, they’re in Nashville, good guys. And it’s pretty exciting to see VCs, General Catalysts, Claritas moving into this space.

I think there’s a lot, just, there’s a lot of capital out there. Lot of wealthy individuals, institutional investors. That are trying to find a place to invest. And the public markets have been, except for like the five or six tech companies have been really crushed. And so there’s an opportunity to bring share care at a pretty reasonable price.

Take it private, do some work, try to fix it up. Um, I think healthcare, [00:27:00] obviously we’re biased, but healthcare is a place where you can, you can make a real difference, whether General Catalog succeeds or not, that they know what they want to put in place. They will, if they can get it pushed through, they will deliver much better efficiencies, better care, lower, lower spend, more profitable.

And Claritas will do the same. They’re really good. They can, they can redo sharecare. I kind of get it more efficient, more organized. And then you can monetize it by bringing it back to the public markets. When maybe the fed relents and it’s a friendlier time. So it’s pretty exciting.

Marcus: Yeah. And we’ve, we’ve also been talking recently about how we’re, we’re basically at the end of this model of the healthcare industry.

And I don’t think the public markets are a great place for most companies, you know, a UHG excluded, right. You know, uh, but I don’t think it’s a great place for most companies to evolve. to whatever the next version of the healthcare industry is going to be. I think they really do need to be private where they’re not beholden to, you know, quarterly analyst calls and, and, and things [00:28:00] like that, where they can really reinvent themselves, leverage technology, you know, rethink the overall business models, you know, take advantage of massive changes that are happening at the CMS level.

Um, it’s going to be difficult, I think, for especially a lot of provider organizations to do that when they’re publicly traded. Yeah. You, you

Vic: can’t do a big strategic. Initiative re reorganizing the entire business in a 90 day cycle when you have to have it all done. In the next quarter. Right. So you need a little more time and going, going private is the way to do that.

Marcus: Yeah. All right. So we’re going to take a break here and let Doug share a little bit about Jumpstart Foundry, and then we’ll be back to talk about Kaiser.

Doug Edwards: Thanks guys. For the opportunity to talk about our pre seed fund Jumpstart Foundry. My name is Doug Edwards, CEO of Jumpstart Health Investors, the parent company of Jumpstart Foundry.

We’re so excited to be able to talk about, uh, early stage venture investing, certainly the need for us to change the crazy world of healthcare in the United States. We are spending 20 percent of our [00:29:00] GDP north of 4 trillion a year on healthcare with suboptimal outcomes. Jumpstart Foundry exists to help us find and identify and invest in innovative companies that are going to make a difference in healthcare in our country.

Every year, Jumpstart Foundry invests a fund, raises a fund, and deploys that across 30, 40, 50 assets every year, allowing ease of access for our limited partners. to invest to help us make something better in health care. Some of the benefits of Jumpstart Foundry is there’s no management fees. We deploy all the capital that’s raised every year in the fund.

We find the best and brightest typically around single digit percentage of companies that apply for funding from Jumpstart. And we invest in the most incredible, robust, innovative solutions and founders in the United States. Over the last nine years, Jumpstart Foundry has invested in nearly 200 early stage, pre seed stage companies in the country.

Through those most innovative solutions the Jumpstart [00:30:00] Foundry invests in, we also provide great returns and a great experience for our limited partners. We partner with AngelList to administer the fund, making that ease of access, not only with low minimums, but the ease of investing in venture much better.

We all know that healthcare is broken. Everyone deserves better. Come alongside us with Jumpstart Foundry, invest in making the future of healthcare better and make something better in healthcare. Thank you guys. Now back to the show.

Marcus: All right. We’re back. So, um, I think anyone who. Actually looked at this situation, especially comparing it to other union, uh, you know, strikes that were happening could see that the, you, the, the, the Kaiser union was going to be very successful here.

We talked

Vic: about it last, last week. Yeah. The union did really good job and they, they won. Yeah. I mean, there was a negotiation, but they, they, they basically won. They got 21 percent raise over, over four years. Um, and I’m happy for them. I mean, as you had [00:31:00] your experience, we’ve all experienced healthcare. The nurses and support people are critical.

I mean, we need them, and we need them to be paid a fair amount.

Marcus: And Kaiser had it. I mean, they were doing well enough to do it. So, you know, I mean, I think it probably I can empathize with health systems, especially coming out of the pandemic, feeling like they need to have a surplus. They need to be, you know, they need to really focus on the, you know, the cash on hand.

I can empathize with that. You know, it was a it’s been a brutal one. You know, three or four years for health systems, but at the same time, it’s been a brutal, you know, three or four years for, for health care workers and for individuals just with the rate of inflation and the cost of, you know, goods and services and energy and food.

And so. Look, I mean, we’re, we’re all going to have to get through this together and, and in the case where, um, the employer is in a strong financial position, which is not true in so many of these, you know, actions, but in the, in the case when the employer is in a strong [00:32:00] financial position, I do think the union actions right now are making sense and, and also I’m glad this one didn’t drag out, right?

For the benefit of the people who, uh, you know, Go trust and rely on Kaiser as a health system for their healthcare needs. I’m glad they didn’t have to have the anxiety of wondering whether or not they were going to get the care they need, you know, for more than a week.

Vic: Yeah. Yeah. That’s right. And I think this was a real, the workers went on strike and then they quickly came to the negotiating table and worked out a deal.

Yeah. What I think is really interesting is that. We were talking last week about, okay, Kaiser’s probably gonna have to pay up something, and then how will that impact them compared relative to other health systems in their markets? Um, and what’s really interesting is that the, the U. S. Department of Labor was involved in this negotiation, and then Gavin Newsom, the governor of California, came out.

On the same day, providing a new set of rules, I think it’s a set of rules or, or minimum, [00:33:00] uh, minimum wage at 25 an hour, which matches the Kaiser. Right. So, so I mean, I think they, they had the money, they were probably worried about the competitive dynamics and California wants to make sure everyone is paid as I’ve done with fast food and other things.

And so, um, it’s really interesting to see what I think I see is that the, The labor department was involved in the negotiations and worked out a kind of a settlement.

Marcus: Yep. No, I, it’s, it’s, uh, I’m glad you brought up the fast food, you know, uh, minimum wage, uh, action that California, uh, uh, put in place. You know, California’s gonna continue to be an actor, I think, for, uh, for, for workers benefits.

Yeah. And, but it’s going to be interesting because the, you know, America’s becoming very bipolar, uh, you know, in terms of, You know, blue trifectas versus red trifectas. And, um, you know, what a state like California is going to put in place versus let’s say a state like Texas or Tennessee. Um, and so Kaiser having a huge concentration in California, you [00:34:00] know, that, that sort of makes sense.

But as, as we know, you know, from, from being in Nashville and knowing basically the general locations where Nashville based health systems have their Yeah. Um, you know, have, have the United States, not unionized states generally. Right. And so I think this is going to create even more of a distinction between the nonprofit and the for profit space as you know, the for profits tend to be very, very selective about the markets they enter, um, and the dynamics as it pertains to unions and, and, and Medicare and Medicaid policies and things of that nature.

So. We could see even more of a tale of two different, you know, states, if you will, as the political divide continues to push in opposite directions.

Vic: Yeah, I think we probably will. Um, I also think that the, the separation where a health system is kind of working on its own and then there’s a payer, or you know, that adjudicates the claims, that’s, that’s over.

And so, I think it is going to be a tale of two [00:35:00] different, uh, kind of environments around the country for a short amount of time. Then hopefully we’ll have integrated, uh, I’d like them to take on longer risks than one year at a time. And then if they take care of the people, they benefit from that. Um, And of course they need to pay their workers.

I think it’s interesting going back to our earlier story, California led the homeless, Reimbursement for homeless care outside the hospital. They’re leading here with the nurses and support staff wages So there are some things that I mean, I don’t care what state you’re in My opinion is we should do street health care and pay people could it because it’s better medicine It’s it’s less expensive.

We don’t want them to go to the ER and be you know, really in trouble It’s much better to bring them care

Marcus: Yeah. I mean, we’re meeting people where they are. Right. So, so it’s, I think it’s just going to be a situation where we’re going to have to watch activity in different States and understand that it’s, it’s, uh, it’s playing out at the financial level at the [00:36:00] for profit versus nonprofit.

And just one caveat to your point about, um, the days of payers and providers not being, you know, uh, aligned and integrated. Uh, the only caveat I’ll just put to that is, except for those, uh, Uh, providers that have tremendous scale and are in great markets and operate, you know, their asses off. So like HCA, uh, HCA is not going anywhere.

And I don’t envision HCA, I don’t see HCA getting a embedded payer anytime soon. I think they’re, they’re just, you know, strong enough that they can maintain really good relationships with, you know, the UHGs and the blues of the world and they’re just going to be fine.

Vic: They’ve chosen their markets in such a way to have strong negotiating leverage with the payers.

Over 30 years, right? That’s right. And so that they are really strong and if someone set out to do that today It would be hard. That’s that’s that’s what I think general catalysts has Um, i’m not sure where they’re headed. But yes, I mean hca has assembled a really A really smart set of markets where [00:37:00] it’s population growth and they have enough Enough of a presence that they have significant negotiating power Yeah,

Marcus: well, it’s it’s really like, you know, the market dynamics and your operational competency Determine whether or not your, your, your fundamental lever in making money is driving volume or being more efficient and saving money overall, right?

It’s sort of two different paths. There are very few that are going to be able to do the HCA path as we go into the future. Very, very few. HCA will be able to continue to do it, but very few will be able to do that path.

Vic: Yeah,

Marcus: I think that’s

Vic: right.

Marcus: All right. Final story. Uh, we’re, we’re circling back to the, to the GLP one, um, uh, drugs.

And so, you know, no, no vo Nordis is out of huge hit on their hands, uh, with, um, Ozempic is theirs. So they’ve got a huge hit on their hands with this thing. Uh, they, they just smashed a, a clinical trial from a, from a kidney failure perspective. Um, so they’re adding more and more, uh, Uh, you know, use cases to it, which I think is [00:38:00] going to increasingly justify the value of what they want to sell the drug for as it continues to take more and more, um, you know, uh, chronic, uh, issues down in its, in its, uh, ability to, to lower, uh, it’s a little overall weight and it’s not only, you know, increasing their value and their, and their market cap, uh, but it’s also impacting other, uh, markets such as, uh, the, uh, Right.

Vic: Yeah. So just to sort of go back to the trial that they ran a trial to see if their GLP 1 weight loss, uh, technology could help with chronic kidney disease. And it, and it can, and it was so powerful that they were able to stop the trial. They didn’t need to go any further. Why should we give people a placebo when we know it’s clearly working and we have this huge statistical thing.

And so they stopped the trial and it’s, it’s really incredible. So. It’s, maybe I should have, [00:39:00] maybe I should have known, but, um, loss of weight is, is, is really powerful. And so it’s about 15, 000 for a year of this, this treatment. And, If you are in sort of a chronic kidney disease, but not in dialysis yet, that probably makes economic sense to go ahead and pay the 15, 000 and now I’m not going to have a bad standard of life.

I’m not going to be in dialysis. And I think you save dollars. Like, so the payers will save. Because they won’t have to pay for dialysis. And as you said, uh, um, pretty immediately when the report came out, DaVitaSoc was down, and I mean, Fresenius was down, and then all the other, um, sort of peripheral companies that, that sort of do various, uh, uh, robotic surgery, other things in kidney disease.

We’re down. And that’s a wonderful, I feel bad for their shareholders, but [00:40:00] it’s wonderful for the rest of us. Cause what it means is we can have a lower, um, kind of less invasive treatment and people can get on with their life, uh, by losing weight, which is incredible.

Marcus: Yeah. A couple of years ago you came to me and you said, you know, one of your big, you know, theses for innovation in healthcare was that, um, innovation in the pharmacological area was going to eliminate service lines.

Yeah. You know, as, as we got stronger with, uh, you know, cell therapies, uh, gene editing, uh, you know, and just, just generally as we advance more things in the biotech realm, we were going to just eliminate whole service lines. And this is, I think, an indication of, of that, that coming to, to reality.

Vic: Yeah, I think that’s right.

There are, um, contributors to chronic disease. Weight is, is probably the biggest. I think behavioral health is maybe a little bit of a nebulous term, but behavioral health [00:41:00] is the other one that I think is huge. Massive opportunity there. And if we can, if we can sort of get at that foundational health, uh, with some kind of drug, it, the only thing that is keeping me from, like, jumping up and down on, um, the GLP 1s is they’re, they’re injected.

So it’s a little bit hard to scale it, I think, um, but there’s lots of things coming out. And I think, yes, it’s, we’re going to have this coming together of the health systems, the payers and the, and the pharma companies all sort of working in the same. It’s a health market. Right.

Marcus: Um, all right. We managed to knock this show out in time to move to the next event we have here in Kansas city.

So now that we’re mobile, we can be reporting from the field all over the place. Yeah. Yeah. I’m so excited about that. I literally don’t want to travel again this year. I’m so tired of being on planes.

Vic: I just want to mention this is our 24th episode. Yes. We have, obviously, the 25th next week. And so I think I’d like to talk with you about some of the trends we’re seeing, [00:42:00] uh, over the first 25 shows, what have we seen, and, uh, try to give a summary, maybe a little bit higher level view to the audience.

After 25 shows.

Marcus: Yeah, for sure. I mean, we definitely have seen, uh, different storylines. We’ve in and out. And I think we’ve come to our own conclusions about things. And I think it’s a good, it’s a good milestone 25 shows to stop and sort of say, what do we think we’ve, we’ve picked up, you know, in talking about the healthcare and health innovation landscape.

Over 24 shows. So I think that’s a good idea. Okay. Uh, well, we will see you all next week. We hope you are safe and healthy and, um, again, you know, our, our, our thoughts and prayers are with all of those suffering in the Middle East and all of those who are related to people, uh, who are in that region right now.

Um, you know, war is is just a, it’s a terrible thing. And, and, uh, it, I think it. It, it puts everything in perspective, you know, about how, how lucky we are when we are in times of peace. [00:43:00] And so, you know, may those times of peace return and, um, you know, until next week.