44 – Inflation, Nasdaq, Bitcoin, Change Healthcare, FTC, ViVE, Abridge & Prostate Cancer

Marcus: [00:00:00] Uh, be podcast episode 44. What’s up? Happy leap day leap day. That’s right. I just got a chocolate bar from, uh, from Carly at the front desk for happy leap day. Yeah. She loves you more than me. I didn’t get one. She does love me more than you. For good reason. Well, just Carly. I mean, you know, she’s awesome.

Marcus: Um, so I got back from Charlotte, North Carolina yesterday, last night, and, uh, had an awesome time with a subset of my group of, uh, Aspen Health Innovators Fellows, and also spend time at Atrium Health. So it’s my first time finally on campus at Atrium, Atrium is an LP and Jumpstart Nova, um, and had an amazing time with, with my fellows, but being on Atrium’s campus was really fantastic.

Marcus: Um, we got to tour their mobile medicine center. They actually have the largest mobile medicine center in the country. Um, and. It’s, it’s amazing. It’s like, uh, it’s like a warehouse [00:01:00] slash. Yeah. I don’t know what that means

Vic: really. So, so, so it’s, it’s like, and buses that go,

Marcus: well, it’s, it’s, it’s all the EMS.

Marcus: It’s fleet. Right. And, and it’s all the dispatch and it’s all of the home health. Um, and it’s the hospital at home and it’s making sure people get fed. So it’s like innovations on hospital at home, innovations on home health. Yeah. And it’s massive. It’s a, it’s a huge, huge, huge program and outfit. Um, when we met the leadership team, it was like 10 of them.

Marcus: Um, so it was, it was pretty cool because it just, for me, demonstrated what happens when you get the right group of leaders and they get some leeway to actually. Think about

Vic: what you need to make it better. Right,

Marcus: right. Think about what you need to make it better and then make it better for the patients, but also make it better for the business.

Marcus: And, um, this was a really, really solid group and it showed me what, what home health really could be. I mean, [00:02:00] I’ve had some. Not fantastic experiences in the last 30 days with home health. And, um, it was just kind of cool to see that people are working on it, quite frankly, like, like people are working on it.

Marcus: They’re working on making it, uh, tech enabled, making the infrastructure solid. You know, one of the things that. should be a duh moment, but was not something I really thought a lot about was safety. Um, safety is a really big issue for, uh, the healthcare

Vic: worker when they go into the

Marcus: home. Yeah, correct, correct.

Marcus: Um, it’s a really big issue. Um, and so it was really helpful to sort of understand some of the different situations that have happened. And sometimes they’re by

Vic: themselves. A lot of times they’re by themselves.

Marcus: Yeah, yeah, yeah, yeah. Quite often. Um, and they’re by themselves, um, often, not always, but often females, you know, and going into situations.

Marcus: That could be really dangerous. So, um, just looking

Vic: at it can be like malintent, but it also can be someone has dementia or [00:03:00] they they’re confused about who the person is breaking in. Yeah, we went

Marcus: through that kind of scenario and just hearing the thoughtfulness, hearing about the protocols, hearing about the way that they, um, keep their, their team safe.

Marcus: The alerts, the protocols, the check in, you know, um, frequencies, all of it was just really cool. So I needed a little bit of a boost because I’ve been kind of not that happy with healthcare. Seeing a

Vic: system that’s like really trying and making it better. Yeah. What’s the geography that that creates? Group covers so just like greater

Marcus: charlotte or the entire atrium man, that’s a well, it’s not it’s not the entire atrium footprint So it’s it’s it’s the charlotte region.

Marcus: Yeah, I think it’s probably the right way to put it Um, but it’s something that you know, they definitely stamp out you could do other places. Yeah. Yeah, no question You got the right leadership. Um, you know this or even atrium could do it. I mean they have oh atrium can for sure Yeah, um also atrium is getting really big, you know, they’re like the third largest.

Marcus: Yeah That’s why

Vic: I was asking how broad this is massive

Marcus: You Yeah. Yeah, they’re huge. So, [00:04:00] anyway, um, that was, uh, it was really inspiring. So, thank you to Jen Sullivan, my, my dear friend, for, uh, hosting all of us and, and walking us around and, and, uh, leaving us a little bit more inspired than we were when we got there.

Marcus: Yeah. Alright, with that, uh, let’s dig in.

Marcus: Uh, first thing we’re going to talk about is PCE. As always, we like to talk about the feds metrics and PCE was announced today, Thursday morning, and it went up 0. 4 percent in January, as was expected up for up 2. 8 percent from a year ago.

Vic: Yeah. I think you said it, everyone was expecting 2. 8 on an annual basis.

Vic: And that’s what it came in at. I think really no. No significant change, but Wall Street, was it maybe scared about it or something? Cause immediately after that, even though it was as expected, the stock market went up, maybe a relief [00:05:00] thing. I don’t know. I don’t really think it’s much changed. So

Marcus: I mean, the, the, the stock market is just full steam ahead at this point.

Marcus: Right. I mean, you know, it, it, it’s not. They, they have decided everything is okay and they’re just going to keep running and, uh, man, oh, you know what we were, we put the show together, but there is one thing I want to pull up at some point, which is, uh, a card to email that came in today about, about, uh, the startup economy and, uh, employment in the startup economy and how in 2023, the hires was like half the From the year before and more people departed either through departing or or layoffs than were hired.

Marcus: Last year. And that’s like a first for the last five years. Um, it’s always been somewhere around 60 percent to a full a hundred percent more, um, hires than, than departures. And look, I can’t get over it, man. It’s like every day [00:06:00] there’s more announcements of more, you know, layoffs and we’re, we’re hitting all time highs.

Marcus: And the truth is that the technology wave, certainly AI has some hype cycle, but the technology wave. The automation wave, the streamlining wave, the focus on profitability, as opposed to R and D and growth. All of these things are making the market happy, right? They, they are making the market happy broadly.

Marcus: Um, and so I think this has been. Scott Galloway called it a corporate Ozempic. And I think this has been the strategy that corporate America has used to offset the concerns of the fed funds rate, right. Is we’re just going to get super duper lean, super efficient and be more profitable than ever. And that is going to make equities very attractive and keep capital flowing into [00:07:00] equities.

Marcus: So yeah. And, and

Vic: as a VC, that makes me happy. That’s good. It’s good for my business. It’s good for your business. It’s good for anyone who has a balance sheet with a bunch of equity investments that go up when the stock market goes up. And I think that we talked about it last week. If you don’t have significant assets in the stock market, which is half the population, um, the fed might need to think about another way to measure how, how the economy is doing.

Vic: I don’t think the stock market, um, equals the economy. And it seems like it’s less and less every month. Does it equal it? Because, because of what you’re saying, like it’s companies are able to do more with less people. It’s getting very,

Marcus: it’s getting very disassociated. I think.

Vic: So the Fed has two mandates, full employment and stable prices, or something similar.

Vic: I may not have worded that exactly right. And they’ve been really focused on [00:08:00] getting prices more stable, and they keep talking about the low unemployment rate, which is fair. That’s maybe the best guy, but I get the sense that it’s still, um, it’s not equally distributed. We talk about the K shaped economy and different things, like people that are at the top end.

Vic: It’s easier for them to leverage AI for themselves, their stock portfolio is doing well, their, their houses are going up in value, but if you’re renting and working at a job that is, you know, being, maybe not totally removed by AI, but your negotiating power is being diminished. I think that’s going to be a challenge over time.

Marcus: Yeah. And, and also I think that as PCE has gone up, um, I think the odds of the fed doing a rate cut naturally go down. Right. Um, doesn’t mean that it’s not going to happen this year, but you have to say that the odds go down, that [00:09:00] it’s going to happen this year if inflation is going up. Right. I’ve been saying that

Vic: they’re going to do one after the election, like, you know, late November.

Vic: Do one something like that, but not really jump in front of the election either way because it’s just going to be very politically charged

Marcus: Yeah, so so I think From our perspective in the, um, in the risk capital space, I think that means another hard year of capital allocation. That’s, that’s, that’s my general sense of that.

Marcus: Uh, I think the tech companies are kind of, are going to continue to run away with it. Um, they’ve just got way too much momentum at this point. Uh, the regulatory environment is so, Hemmed up. We’re going to, we’re going to talk about some of the stuff the FTC is working on, but there’s nothing they’re going to be able to do to stop the runaway train.

Marcus: That is, you know, big tech, by the way, big tech is saving the pensions and the endowments. And so, you know, I think, I think all the politicians who are bought by all of those folks are going to say, [00:10:00] let it, let it ride. Um, and, and so look, I mean, we’re, I think this is what it looks like.

Vic: Yeah. Right. I mean, three, 2.

Vic: 8 is pretty close to 3%. It’s not 2%, it starts with a 2 though, but it’s maybe moderately better than it was previously. Right. It’s sort of slowly coming down, nothing has really broken, and there’s no huge issues. And if there is something shows up in commercial real estate or wherever the Fed can try to do something, then they don’t need to proactively do anything.

Vic: They can just wait. Yeah. Yeah. Still hasn’t happened. Right.

Marcus: All right. So let’s, we talked about the stock market. Uh, we’ve talked about the Dow and the S and P have had their all time highs and now the Nasdaq, uh, closes at record highs after the PCE announcement record highs.

Vic: Yeah. I mean, I think there was some concern maybe that the, [00:11:00] Inflation would be much higher or something.

Vic: I don’t really understand because the definition of expectation is the consensus of Wall Street was for 2. 8. And then when it comes out at exactly the expectation, it’s hard for me to understand how that can drive the stock market up, but it did. I think it, what the sense is that was reported I mean, tech don’t care, basically.

Vic: Yeah. Yes. Right? I mean, the, how it was reported is that there’s now a sense that, uh, a Fed rates cut is more likely because inflation is in line and declining. That, that was the story. That seemed to be tied to the NASDAQ going up.

Marcus: Okay. I mean, I think it’s probably that, but it’s also tech don’t care. Tech, tech ran away with all time highs before this announcement.

Marcus: So I think, I think it was mostly just like, we don’t care. And the NASDAQ I think is an [00:12:00] interesting one because we talk about the magnificent seven in the S and P 500, basically making up a little under 50%, but in the NASDAQ, it’s like 60 plus percent, right? The Magnificent Seven plus Berkshire. I mean, I mean, it’s almost all of it.

Marcus: It’s almost all of it Right

Vic: and you can see from the chart They pretty, they track pretty closely with each other, the NASDAQ and S& P 500.

Marcus: Yeah. So anyway, uh, all time highs, uh, everything is fine. And then, uh, and then Bitcoin did not hit all time highs in, in the U S dollar, uh, index, but around the world in China and in India, and I think 28 other countries, Bitcoin, all time highs in different currencies around the world, 61, 000 in, in, in the U S.

Vic: I believe it’s. going to get to an all time high soon. Oh yeah. And it hasn’t even happened yet. When is that? Maybe April? Yeah. Yeah. So for people that are listening that don’t follow it so closely, the amount of, of [00:13:00] bitcoins that get released to miners is going to be cut in half. And that then, of course, a lot of miners sell their, their coins to fund operations.

Vic: And so that traditionally has removed sources of available coins to be bought on the market and made it much tighter. But that’s coming up in April sometime. But the, the ETF, SpotBitcoin ETF, I think, has really driven a lot of new people to be able to buy that couldn’t previously. I mean, even for me, I, I manage some money that I can’t get out of a traditional bank.

Vic: And they, they didn’t have a Bitcoin product before this, and I don’t have a big percentage, but I wanted to put 2 percent in Bitcoin and they’re just like, no. And now I, I was the, I called them like maybe two weeks ago and asked if they’d buy the Fidelity one, but they’re all the same kind of, and they had to figure out how to do it.[00:14:00]

Vic: But they’re going to do it. But they did. Yeah, it took them an hour. Yeah. It’s not hard. Well,

Marcus: Fidelity is now recommending, uh. Fidelity has it in their, in their allocation. In their allocation. Yeah. And it’s one to three percent. Yeah. They’re recommending now. I mean, that’s like, that’s mind blowing. Right?

Marcus: We’re like we’re now at the place where one to three percent you’re being recommended to buy into Bitcoin. I think it’s a great inflation hedge. Honestly, it’s not even a question of whether or not it’s a great inflation. It’s the definition of inflation. It’s just that the traditional finance world or as everyone in crypto would call it, tradfy.

Marcus: Yeah, you know, is. Is now coming around to it. I mean, the institutional money is pouring in and it’s driving up the price. Did you see, do you see the size of the micro strategy by that, that Michael Saylor just put for

Vic: now, but he is a brilliant, he’s brilliant. I mean, I got to give him credit. I mean, he was early and very committed all in and right.

Vic: Yeah. Yeah. And it’s, I mean, he might be in the S P 500 at this [00:15:00] point. He has the market cap. Yeah. To be in the SP 500, uh, whoever controls that, maybe it doesn’t pay. I guess that’s how it gets named. Standard pores can decide if they want to let him in or not, but that’s amazing. Right. From where micro strategy was previously.

Marcus: Well, just as a high level theme, before we move into the next story, I mean, uh, it does feel like we are moving. Into hyper capitalism, right? Like it’s, it’s moving so fast. It’s tech enabled it’s on rails. We now have crypto being legitimized. Stock markets are at all time highs. All the market value is aggregating to a very few.

Marcus: Companies, they all happen to be technology companies. Those technology companies all happen to be AI enabled or AI pushing companies. Um, we’re moving into an entirely new phase, new era that we haven’t yet named. And people are talking about AI, like [00:16:00] it’s a hype cycle. And I’m like, I don’t think these layoffs are a hype cycle.

Marcus: I don’t think that these all time highs are a hype cycle. I don’t think that crypto, you know, uh, hitting, hitting all time highs as a, as a hype cycle. Uh, you know, it, it really just feels like we’re moving into a hyper capitalist because I feel like before we were in this more corporatism era, you know, that, that’s, that’s what it felt like before, but the speed of it and the tech enablement of it at this point, it’s, it’s, uh, it’s just this hyper tech enabled.

Marcus: Capitalism that is going to leave that’s going to necessarily leave so many people behind Um, and also I think as a segue into the next story also Has a lot of real vulnerabilities to it Yeah has a lot of real vulnerabilities to it

Vic: Well, I mean, I think that the um, I don’t totally have this figured out yet but there’s two things I wanted to comment on first of all that the Division of profits between [00:17:00] the capital providers and the labor providers, you know, has been, there’s a hundred percent of profits and they split that up.

Vic: You have to pay human labor to do things. And then you need to attract capital partners to invest in capital assets. That’s been true forever, maybe since the industrial revolution. And it’s been trending more and more towards the capital side. Since the internet and I don’t see it slowing down, I think it’s going to.

Vic: If anything, accelerate and that brings real challenges to like how our society functions and taxation policy and what is right. How do we, how do we manage this? Then the other piece is I think that the corporate power, the tech corporate power. Um, maybe it was already coming, but the Bitcoin thing and, uh, just how powerful NVIDIA is [00:18:00] out of, out of nowhere, I think states are declining in power and, and tech corporations are, are going to

Marcus: be the dominant player.

Marcus: Well, it’s, it’s, it’s, it’s because governance has been hijacked for ideology. See exhibit Alabama. From last week. Um, I mean, it’s, it’s, it’s straight up hijacked for ideology. What, I, what, whether you agree with it or you don’t, the, the chief justice of the Supreme Court is a Christian ideologue. Like, self, self proclaimed.

Marcus: He, he’s on record. Saying that there’s a, there’s a great holy war going on and that he’s being prepared to do something that’s going to be very unpopular, right? This is the kind of stuff we have going on in, in governance that can’t fly in a globally competitive world, right? That’s so of course, states are declining in power.

Marcus: They’re declining because we have. We’ve, we’ve allowed politics to devolve, to devolve to [00:19:00] lowest common denominator in exchange for voting block power, right? To be able to control higher order things. So what, what do I mean by that? What do I mean by that? I mean, there are many, many Republicans who are not like hardcore, uh, right wing Christian ideologues, like many, many, many.

Marcus: They’re mostly just free market capitalists, right? Like they, they, they want their low taxes, but to aggregate enough power to me, to be able to maintain that they’ve had to, you know, pander and, and add in as core elements of their party’s agenda. These. Ideological things that that are popular to a whole lot of people that actually don’t even care about the low taxes stuff, right?

Marcus: But but it aggregates enough power for them to keep those types of types of things in play

Vic: Well, I mean, I I agree that that is bad But I don’t think that that has resulted in corporate power rising versus [00:20:00] government power Republicans are Not good for humanity. And I think Democrats also are challenged for humanity.

Vic: What I see is that, um, corporations have gained power because a lot of the money, money can be moved electronically, right? So you can move and, and the tech companies are leaders in this. They orient their business and move money pricings to avoid taxes. Of course, that’s their job to do that. And then they move the products digitally.

Vic: And so the government control over commerce and the ability to tax is diminished. They don’t have the same ability to tax like they did before everything was electronic.

Marcus: Yeah, but that’s a, that’s a byproduct of government not doing it. Um, and the government created much of the technology that the corporates have built all their power on.

Marcus: I mean, you know, see, exhibit, internet. [00:21:00] So, so again, it’s, it’s a, to me, it’s a, it’s a leadership issue. I, I understand sort of the operational reality that you just presented. I get that. But why isn’t the government just as efficient, right? Why, why isn’t, and not, not for reasons that government can’t be as efficient as the free market.

Marcus: It’s way out of balance now, right? You know what I mean? The difference in efficiency between corporate America and the government is, you can’t even compare the two at this point, right? It’s just, it’s so bad. Yeah.

Vic: I mean, we have two parties. I don’t like either party. Yeah. We have two candidates. I don’t like either one.

Vic: I’m not lining up for one party or another. We need to blow up the whole thing. That seems pretty hard to do. And every day. NVIDIA, Microsoft, Google, Facebook, everyone, they’re just running. They’re just running. Yeah. And they’re not either party. They’re, you know, yes. Now, the thing that I want to get to is they rely on the U S government for military defense.

Vic: [00:22:00] Yes.

Marcus: A lot more than that. Utilities roads. I mean, keep going.

Vic: A lot of, a lot of stuff, so many things, water, right. And I, and I think. I, for one, and I, I know people in time, we, we all take it for granted. Yeah. That’s right. Because we don’t, we don’t see what it would be like. Right. I’m self made, but I’m within this, uh, warm, like incubating space of Nashville, Tennessee.

Vic: Right. Um, and then I think the cyber sort of attacks are sort of other people around the, the country sort of, I mean, on the world trying to get their share and, and they, they don’t view it as they are. Terrible criminals, they view, they’re like Robin Hood and stealing from rich folks that have plenty of money anyway.

Vic: And [00:23:00] I don’t know, I don’t see that. That’s another trend that I don’t see going, going down.

Marcus: Well, it, it, it does have, I mean, look, Bitcoin as of yet has not been brought down by a cyber security

Vic: attack. Made me think about this whole,

Marcus: this whole, well, I mean, I think that’s the point, right? I mean, that’s, that’s why.

Marcus: I think on this show, you and I are going to start talking more regularly about Yeah,

Vic: I think we have to. About blockchains.

Marcus: Like, we have to start talking about it because the next story is about change healthcare. And, look, I mean, this is, this is really close to home, right? Nashville company. Um, It’s hard to get more close to home for us than change health care.

Marcus: And an amazingly important part of the infrastructure of the United States health care system. Okay, they were attacked. And we’ve been talking about attacks largely on hospitals. Yeah. Um, but the Change [00:24:00] Healthcare Network has been attacked. It’s still down. It’s been down

Vic: nine, I think eight or nine days.

Vic: And And there’s no, I don’t, either they know what’s going on and they’re not saying anything, Chan the Change Optum crew, or they don’t know what’s going on. Either way,

Marcus: pretty scary. It’s, it’s, it’s super scary. And the, and here’s, here’s the thing I want to make sure we, we don’t do. Um, I don’t want to, I don’t want to pile on change healthcare anymore.

Marcus: They want to pile on these hospitals. We need to make sure that people understand the impossibility of securing these systems. Yes. Like, there’s a reason why this is happening over and over and over again. These centralized networks that have all sorts of vectors of attack, because they are open [00:25:00] on the internet, they have corporate agents touching them from a million different endpoints.

Marcus: It’s code that’s been, you know, written and cycled over decades at this point. Yes. Yes. You can’t secure it with, with all of the security happening inside of one company, like something that important has to have the eyes of quite frankly, the world on it to secure it well. It’s almost or it shouldn’t

Vic: be in that kind of it’s almost

Marcus: it’s a honeypot.

Marcus: It’s almost impossible to expect that a group of the top security experts in the world from inside of an organization can stop cyber attacks from the rest of the world, right? If they want to get to it, it’s kind of the old adage. Like if someone wants to get you, you’re got. You know what I mean? Like, if someone really wants to get [00:26:00] you, you’re God.

Vic: I think the only answer is to make it Less valuable to get the honey and more expensive to do it. Yeah, to distribute it and encrypt it. And it’s not that useful. And then try to do what you can to make barriers.

Marcus: And you better believe nine days in, they’re having these conversations that change right now.

Marcus: Like they’re, you know, they’re saying around the clock, they’re working. People are not getting any sleep. Right. It’s, it’s, it’s mayhem, right? Inside of the organization right now, trying to figure out how they’re going to navigate this. But also the pre postmortem. There’s like, we have got to break up our points of failure.

Marcus: We’ve got to break up our points of failure. I remember when AWS went down and I don’t know if it was a cyber attack or not, but I remember when AWS went down, it was the, it was the entire Eastern region. Uh, and it was probably 2000, I don’t know, maybe 11. Uh, because Moontoast [00:27:00] had just moved to it and it went down for like 48 to 72 hours.

Marcus: Damn thing took down the whole damn internet, man. I mean, Twitter was down for like three days. So our clients were like, you guys are down and we were like, Twitter’s down. So they were like, okay. You know what I mean? But it’s just like understanding these centralized corporate, um, networks. These centralized corporate networks.

Marcus: They’re gonna go down. This is, you know. Yeah. And

Vic: the rumor. They’re gone. The rumor. I think it’s been confirmed by a few media sources, but I don’t know if it’s true or not, but it’s a group called Black Cat. They’ve been fighting with the, the big guys for years, right? The FBI, CIA, someone in the UK had a big win with them in December.

Vic: And I didn’t follow it, I’d just been learning about the last couple of days what changed. And took down a bunch of their sites that they use to do pirating stuff [00:28:00] and arrested a few people. And instead of Most criminals sort of cower and run away. They, they threatened back to the FBI, like, okay, we’re gonna come get you and make you pay and Supposedly, they’ve been attacking lots of places and they’re claiming credit for this.

Vic: But their, their methodology is they pay people to pose as employees. Oh, okay. No, it’s, it’s social engineering and they pay you to come as an employee and, or whatever, maybe, yeah, it’s espionage, espionage, or you meet one of the low help desk people at a bar and pick them up and sleep with them and steal their, steal their ID.

Vic: I mean, it’s, it’s espionage. How do you secure against that? You can’t. That’s, that’s, that’s the, that’s the number of employees that change. I don’t know how many have, but more than, than you can secure.

Marcus: It’s, it’s such a sticky problem. It’s [00:29:00] such a sticky problem. And, and as we get more tech enabled and more dependent on these corporate networks, you know, and this is why this ties, this ties into this hyper capitalism thing I’m talking about.

Marcus: Right. It’s like, as you know, stock market’s going up, it’s consolidating into fewer companies. These companies are all these centralized corporate networks. They have all of our data. They control everything. It’s like, we’re, there is a massive vulnerability in that, right? There’s a massive vulnerability in that.

Marcus: And people who don’t understand technology and networks and network security don’t understand why, um, the more that we move in this direction, the more that we put ourselves in positions like this. Um, so let’s, let’s, yeah, so it’s

Vic: having an impact now.

Marcus: Yeah. So, so you, you’ve, you found this, uh, this, this tweet, uh, at J M line burger.

Marcus: He has this nice little infographic here that says the change healthcare cyber attack means no electronic claims process since two 2024 every day. They outage continues means a larger [00:30:00] cashflow impact downstream in days, weeks. How are providers preparing, preparing? Yeah. Um, we’ve already had conversations inside of.

Marcus: Some of our portfolio companies who file claims, who we’ve talked about the fact that those claims are going to be delayed. Okay. We’ve, we’ve, we’ve had those conversations and we’re running small companies, like huge companies. Right. But this is the dependence that, that we have, right. This is the dependence that we have in the scale.

Vic: I mean, not everyone’s watching it, so let’s just read through some of the

Marcus: a million physicians 700 laboratories, 6, 000 hospitals and health systems, one in four U. S. patient records, 125, 000 dentists, 39, 000 pharmacies, 2, 400 payer connections, 15 billion healthcare transactions, 1. 5 trillion in healthcare claims, all 50 states and 90 percent of the counties in the United States.

Vic: Yeah, so you rattled through all of those. Let’s just pick one. 6, 000 health systems. How many are there? 6, 000. 6, 000. It’s all of them. Maybe there’s one that’s not in there, but it’s all the health systems. Um, [00:31:00] it is, it’s a really important, uh, infrastructure asset for the entire healthcare system. Hackers have successfully taken it down for nine days.

Vic: And that’s scary to me. I don’t blame anyone at Change Healthcare. I don’t mean to do that. Just understand like the repercussions are significant.

Marcus: They are significant and change the name of the company. They were going to happen. It’s the centralized nature of what, of what this means, right? The bigger

Vic: you are, the more you have a target on your back.

Vic: You’re a massive target. That’s

Marcus: just, it just is what it is, right? Yeah. Um, and then, and then you pointed out, This, uh, this, this letter from the American Health Care Association and the National Center for Assisted Living writing a letter to HHS. Yeah, today. Yeah, basically saying, hey, the payment delays we’re getting, they’re already on thin margins, right?

Marcus: Yeah. The payment delays we’re getting, we’re like, we, you’re going to have to backstop us, you know? And look, are they wrong? Are they wrong? [00:32:00] Because the government has, Has enabled a, a, a for profit healthcare industry to rely on a corporation in what, in what easily amounts to a utility to not go to the government and say, Hey, like, we’re not going to be able to care for us citizens.

Marcus: You need to like You need to float this. You know, until you get it fixed, you need to float this. Are they wrong? No, I, I think They’re not wrong!

Vic: I think we have to, we have to support, I mean, it’s, it’s 1, 400 LTACs and post acute facilities. I don’t know how many there are, but that’s a lot. That’s a significant percentage in this, in this trade group, and they quote, um, the Medicare financial management manual, chapter three, section 150.

Vic: I don’t have that memorized. [00:33:00] They’re claiming that this is a situation that is referred to in that manual as a, Basically a national emergency and HHS has to has to help them advance payments. Yeah, and the the money is Depending on how what the what the cyber attack is the money should be there Change typically is is the rails that it runs over so They can’t get the money to the right place.

Vic: Yeah, the claims aren’t processing. But HHS should, should help them. Just like the Federal Reserve would step in and help some bank that needed a 30 day temporary amount with a cyber attack or anything else. The Federal Government has to step in and, because there’s a lot of people that aren’t going to get paid.

Vic: And there’s patients, I mean, long term acute care, and it’s, it might be too personal for you, but there, there’s patients there that need to be cared for, the, the nurses just can’t walk away.

Marcus: No, no, no, and they’re not, and here’s the deal, and they’re not, they’re not [00:34:00] walking away. This is why these organizations are saying we need payments now, because we are continuing to deliver care without payment at this moment, right?

Marcus: Um, and, and not because the payers don’t want to pay. By the way. Right. Yes. This is not a pay or provider issue. There’s no question about

Vic: whether it’s being done or not. That’s right. This is

Marcus: not a pay or provider issue. This is a technology rails issue. Yes. Right. Um, so just honestly, just a really sad situation.

Marcus: Um, sad for the people that change healthcare, uh, good people. Doing important work being attacked at basically like, you know, as a proxy for our nation state. Yes,

Vic: you know, I mean, that’s what

Marcus: that’s what’s

Vic: going on. Cat is mad at the FBI. Yeah, and the FBI is doing it. I mean, they’re pursuing criminals.

Vic: That’s what they’re supposed to do. Um, but yeah, change. Healthcare was not engaged. I’ll accept their huge target. Yeah. And it’s, it’s sad. It’s [00:35:00] also scary because a month ago, I didn’t realize that we had this fragility. But it’s where we are fragile because we have too few processing groups.

Marcus: Yeah. Um, okay.

Marcus: And then kind of continuing on with our, our, our FTC stuff. Yeah, it was a hard week for, uh, ESG. Yeah. Continuing on. I think this is

Vic: unrelated. But it’s, it’s,

Marcus: it’s, it’s unrelated. It’s unrelated. And not only is it unrelated, you know, you could have waited a week or something like that. Can’t wait till we get to the other side of this.

Marcus: But, you know, the FTC has their agenda. So they, uh, they are scrutinizing UHG. This is not the first time. Now, is it FTC or DOJ? I think it’s DOJ. Is it DOJ? Okay. So the DOJ is scrutinizing UHG for antitrust practices. Um, Obviously, you know, United Health Group, uh, acquired Change Healthcare, so this, this, uh, falls into, you know, sort of a, a tough week, um, for, for United, um.

Marcus: Yeah, I

Vic: don’t think it’s related to the Change [00:36:00] power in the market right now. No,

Marcus: I, I, I, I think, I think it has much more to do with, um, the, the fact that they’re the largest, uh. It’s Optum. Uh, yeah, their largest employer of providers and they also do a lot of business between Optum and UHC. So, I mean, but here’s the thing, like, to me, I’m just like, okay, what are you going to do now?

Marcus: The whole, the whole payer world is moving to this model. Like, I, to me, I think this is a bit of a red herring. Like, I, I don’t see this actually getting to the other side because you’re going to break them up. Then you’re going to break up Elevange. You’re going to break up Cigna Evernorth. You’re going to, like, you’re going to break up Kaiser.

Marcus: Like, what are you? What are you going to do? This is, this is the, it’s, it’s the dominant model. If you could have acted on this a long time ago. Oh, like if you didn’t like this, what was building here. Waiting until 2024 doesn’t make a whole lot of sense to me. So yeah, it’s

Vic: interesting. So I, I was at Vive just, you know, networking around and, and, um, met a guy who had been at [00:37:00] UCHI when they created Optum.

Vic: Um, and he, he’s in his third job now, but because of all this, I was just like much more curious than maybe I would have been chatting with him at lunch. Um, and he had a really interesting take. He said that, um, Hemsley and the leadership, uh, really came out of Arthur Anderson. And so they were accounting finance people.

Vic: Um, whereas all the other, so this is like in 2000, 2002, somewhere in there. Cause it was early two thousands

Marcus: when

Vic: they, uh, where all the other payers were led by physicians or healthcare. Now as his, this is the third part. So they started really thinking about how can we have all this overhead. Purely from an accounting point of view, how can we try to not have to have so much of our margin sucked up into overhead?

Vic: Mm hmm. And pre Obamacare, because I was asking about, like, [00:38:00] Obamacare, like, the way I thought about it, Obamacare fixed the MLR, fixed the gross margin, basically, and in response, Optum was created to have a place where they could grow more profitably. Yeah, right. And he corrected me, he said, no, that’s not right.

Vic: We created it before that as a way to offload some of our overhead to other payers. And so they started their different pieces, Um, like the technology services and the, they hadn’t have changed healthcare, but their early like payment processing, selling kind of shared services to other, to other payers, um, called Optum.

Vic: And so they really were, it was a financial engineering play. That predated any of that, but then once Obamacare came out, then it already was in place, and it just made sense. They had the entity. They had the entity, right. And then they expanded into delivery of care then, but they already had it in [00:39:00] place, they had trust with all the other payers.

Vic: Right. Because I’ve been surprised about why, you know, why would, Etna be working with them so closely. And I think it all dates back to like they did it before anyone was trying to do it. So, I think they still are going to be criticized and, you know, called to the carpet by DOJ. Yeah, they’re number one.

Marcus: That, that, that, I mean that comes with being number one.

Vic: If we get to that scale, I don’t know how you run your business without making various healthcare providers upset. I mean, they have, they have direct competitors are on both sides, but they run it really well. The patients are happy and look, and

Marcus: look at the financial performance.

Marcus: I mean, like that, that’s the real thing, right? I mean, like, yes, they’ve got, they’ve got both sides of the ledger kind of going. They’ve been growing it for, you know, 20 plus years at this point. The, the [00:40:00] results.

Vic: The results might argue the DOJ side, though. No, that’s my point. Yeah, that’s why they’re the target.

Vic: That’s my point.

Marcus: Like, they’re a target because, you know, the stock is unbelievable. Right. You know, as, as, as far as healthcare stocks go, it’s an unbelievable stock. Um, okay. And then one more, one more regulatory story. Uh, the FTC is challenging Kroger’s, uh, merger with Albertsons. It’s, it’s positioned as a merger.

Marcus: Um, I, I thought it was more of an acquisition. Kroger bought Albertsons. Yeah, yeah. I thought it was more of an acquisition, um, than, than, than a, than a merger. But, I mean, look. You, you were, you, you presented the story and said, Hey, should we actually tell? And I was like, listen, these are massive pharmacies.

Marcus: These are, these are healthcare companies, right? Between food is medicine. They’re, they’re a urgent care business and their pharmacy business. They’re, they’re effectively healthcare companies, you know? Um, so yeah, I think it’s, it’s a, it’s a really important thing for us to, for us to cover. Um, what do you think about.[00:41:00]

Marcus: Challenging the merger of major groceries. Like feels to me like these businesses are generally. You know, struggling. Uh, I don’t, I’m not saying Kroger and Albertsons are struggling, but just generally speaking, the space is kind of struggling Kroger and Albertsons probably is going to make it even harder for regional and, and, and, you know, smaller grocers to compete with them.

Marcus: Um, you’re going to have to be sort of at the scale of Publix. We, we learned probably more than we ever wanted to know about, uh, the grocery business through our friend Patrick Speer when he was running GMTC. Um, and you know, Kroger and Albertsons would like, you know, Barely show up to these meetings, but you know, you kind of really got a sense that it was a tale of two cities where the massive, you know, multi regional slash national grocers, uh, just had all the leverage, all the, um, capital, all the pricing power, all the white label ability, um, all the tech ability and the, the smaller [00:42:00] grocers were just flailing, you know, couldn’t really get their act together from an innovation perspective.

Marcus: So, I mean, I think there’s probably something here to say, okay, you guys were already beating everybody up, you know, when you were separate and now you’re together and it’s just, there’s going to be no, no ability for any other grocers. Maybe, maybe with the exception of Publix, uh, to reasonably compete.

Vic: Yeah, maybe. I mean, I think that is a legitimate worry. I mean, let’s. That’s what happened. It would change health care and payments. So, we don’t want to have only one grocery store in the United States, for instance. But I think there are niches where, um, like Sprouts, for instance, I think is a pretty good platform.

Vic: Roach Brothers. They’re small. They’re regional. Yeah. Or maybe they’re super regional, where like Sprouts is on the west coast and they have one store here in Nashville. Um, I think Aldi. You know, it’s pretty big from, from Europe and coming [00:43:00] in. They’re doing well. They’re very different. I mean, it’s not the same as Kroger, they’re, they’re cheap, like one peanut butter.

Vic: And if you want a certain brand peanut butter, you got to go somewhere else, but it’s much less expensive,

Marcus: but, but isn’t there. So I think there’s some good, I, I agree with you on Sprout. I agree with you on Aldi. Those are actually two very good call outs. I agree with you. And obviously we could have thrown Whole Foods in there, but that’s Amazon.

Marcus: Right. So that’s really a massive company, massive platform. Um, but really don’t you view those as like really big companies at the end of the day? Right. Like they’re, they’re really big competitors. I’m thinking more about. But what I’m saying is that there’s going to

Vic: be reasonable competition because of those Big competitors.

Vic: Well, now maybe we’re trying to protect the local grocery that’s been in someone’s family for 50 years in a suburb of Nashville. I

Marcus: think that’s more what we’re talking about. I think we’re more talking about anything from single grocers [00:44:00] to, you know, maybe you’ve got a chain of 20. Okay. Um, but, and there’s a fair number of those.

Marcus: There’s a fair number of those still out there.

Vic: If they, if they don’t have loyal customers and make money. I don’t care about them. I mean, they have to have something that the customers really want. Well, we don’t just protect for profit businesses in the United States because. We feel bad for them. I mean, that’s creative destruction.

Vic: That’s the whole point.

Marcus: I understand. And, uh, I think the FTC is saying if we don’t have the ability for those grocers to compete, that once they’re wiped out, Kroger’s going to run the prices up.

Vic: That’s right. If Sprouts and Roach Brothers and Aldi and Whole Foods weren’t there.

Marcus: Oh, okay. So Sprouts and Whole Foods are [00:45:00] niche.

Marcus: More expensive options than Kroger. Yeah, Target, Walmart, Aldi. Aldi is the only one of those they do, Walmart, Walmart. They

Vic: sell the most groceries to anyone.

Marcus: Yeah, yeah, fair point, fair point. I

Vic: mean,

Marcus: if you’re looking for, I think there are less expensive options. Walmart is a very fair point, I concede that point.

Vic: What I, I guess what I don’t like about how DOJ’s Uh, or FTC is positioning this is it’s not going to be fair to the workers in union.

Marcus: Yeah, yeah, yeah, yeah, yeah.

Vic: I don’t care about that. Like, that’s, I don’t think the FTC should weigh in and stop a merger because it’s going to hurt a union. That’s not what I want my government to be doing.

Vic: If it was the case that there were not going to be good options, In some part of the market, on the low end, on the high end, wherever, some region, maybe there, there could be a [00:46:00] region where there’s concern. And, In the past, they have, and this could happen, they file a suit and they stop it and then they make them sell off another piece or do different, something different, so that, that might be a way to make it

Marcus: work.

Marcus: Here’s a question, do you think they’ve sort of run the numbers and the, and the scale of the workforce that is going to be lost is from an administration perspective, there’s a job loss? Uh, sort of prediction here that’s pretty scary and they just don’t like the, the, the optics. Maybe, but that’s not the FTC’s job.

Marcus: No, but it’s part of the administration. I’m just trying to, like, I’m just trying to come up with rationale for why they would want to stop it, right? I mean, if they are projecting, you know, meaningful job loss as a result of this, um, that could be, that could be a reason to, to stick the FTC on them.

Vic: Yeah, I mean it could be the, the union don’t, don’t need a lot of money, it could be that they’re worried about significant job loss, it could be a lot of things, but it’s, I don’t think it is that they’re [00:47:00] worried that there won’t be a competitive market for food.

Vic: Now, maybe, there might be situations where I’m not correct in, in a particular region or something, um, I don’t know, I feel bad if a family has run a grocery for a long time, and Piggly Wiggly, that I love the name, but I don’t shop there, I think going out of business, right? Right by Vanderbilt? Oh yeah, oh

Marcus: yeah.

Marcus: Well, this is what I’m talking about. I mean, like, we’ve seen But to be honest, I haven’t shopped there in 20 years. No, I get that. But we have But there are neighbors there, you know, that live there that do shop there. That’s their local grocery store, right? I mean, all the people who live around Centennial Park.

Marcus: Anyway, look, the point just being Uh, I think, I concede, Walmart is a, is a fantastic thing to hold up as a key competitor. Well, I don’t, I

Vic: don’t

Marcus: want to be conceded, it’s just more different takes. I don’t want it to be win and loss. Well, no, I, I think, I think you, I think you made a good point. Um, look, we, we, no one liked the Kroger folks, [00:48:00] so I mean.

Marcus: Yeah, yeah, Mark, I don’t

Vic: care.

Marcus: Yeah. So, but yeah. All right. Let’s take a break. Uh, we’ll let Doug share a little bit about Jumpstart Foundry. When we get back, uh, you were at Vive this week, so we’re going to get the, the, the Vicato.

Vic: It was great and, uh, tiring.

Marcus: Yeah. The Vicato Vive rundown, uh, after this break.

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.

Doug Edwards: We are spending 20 percent of our 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 [00:49:00] 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 healthcare.

Doug Edwards: 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 Dumpstart and we invest in the most incredible, robust.

Doug Edwards: Innovative solutions and founders in the United States. Over the last nine years, Jumpstart Foundry has invested in nearly 200 early stage preceded stage companies in the country. Through those most innovative solutions that Jumpstart Foundry invest in, we also provide great returns and a great experience for our limited partners.

Doug Edwards: 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 [00:50:00] alongside us with Jumpstart Foundry, invest in making the future of healthcare better and make something better in healthcare.

Doug Edwards: Thank you guys. Now back to the show.

Marcus: All right. Tell me about Vive, man. I was not there.

Marcus: I’m kind of glad I wasn’t there. I got to say, man, you know, I’m not in the conference mood at the moment.

Vic: I mean, I tell you, I got there Sunday afternoon and Sunday night and Monday evening, I was super energized and loved it. Met a bunch of people. I saw, I don’t know what, like 15 different talks. Um, there’s a lot of cool stuff, a lot of exciting stories, lot a narrative.

Vic: It’s like a carnival, right? I mean, we’ve run these events and we’ve been to vibe and health and, um, there’s a lot of energy. They intentionally make it. Energetic. Um, and so it’s great. And then, uh, no, I went to a Nova party. So you threw a party. Jumpstart [00:51:00] Nova and Wavemaker 360 health. I think that’s how you say it.

Vic: Did you enjoy it? It was a good party. Yeah, it was, it was the best party by far.

Marcus: Oh, nice. Lots

Vic: of really talented entrepreneurs, several jumpstart, uh, former entrepreneurs were there, some current portfolio companies were there. It was good. Um, and then Tuesday was pretty good. Uh, but by Wednesday, I was like fried.

Vic: And so the poor people that had to speak Wednesday, Um, I feel bad for, but, um, I came away with like a different, I mean, so it was in Nashville last year. Yeah. And last year I just felt like, um, it was kind of sad, honestly, like all the startups were there and pitching and I was down on the financial markets and yeah, last year was rough.

Vic: Pilots were all not showing any results. And it just was. It was kind of sad. It was

Marcus: also post, [00:52:00] uh, SVB. It was

Vic: post SVB. You know, we had a school shooting on Monday. Yeah, that was, that was terrible. It was a hard event last year. Yes. Um, and this year, even though it was tiring by the end, I felt very, very different.

Vic: The, the technology capabilities, let’s leave generative AI to the side, um, are real. The tech, tech can really make a difference in healthcare. And there were three or four talks where people gave. Results, evidence, like, um, and they’re talking about hard dollar ROI in this department and distinguishing hard dollar in this department versus hard dollar across the organization versus soft dollar, which I don’t think is ROI, where like present TM is and stupid stuff like that.

Vic: In past years, that level of detail and kind of strength has not been there. I mean, they talk about a [00:53:00] vague. you know, better outcomes, but not like you spent a million dollars and we delivered you one five in 18 months. Um, and so that, that was great to see and it’s, um, not being utilized. By many health systems, right?

Vic: So that there’s this like dichotomy that a few systems are doing product design and kind of new workforce design using first principles like from the ground up talking to. So this woman, uh, Terri Coates, hopefully I got the name right, from the Guthrie Center. She was talking about her experience, and they, they wanted to prevent, have fewer falls.

Vic: Mm hmm. They have, you know, when there’s a fall arrest, someone sits in the room and just watches the patient rest. Um, and that’s cost a lot of money. And so she is head of, [00:54:00] digital transformation or something. But instead of just like throwing some fancy AI at it, she went and interviewed all the people sitting there, the nurses, the patients, you know, did a full looking into it.

Vic: And she then set up fixed cameras, just like the camera I use for my Zoom meetings. Um, and a little bit fancier microphone, so you could talk and hear both ways. But it’s not cutting edge tech. I mean, it’s, it’s 20 year old tech. Right. Um, and then she set up an off site place where, kind of a central location, someone can see all the rooms.

Vic: And she brought her cost of fall prevention down by 15x. Because one person can be watching 15 room cameras. And, you know, most of the day you don’t do anything. When the person tries to get up, you stop them and call someone in to help. [00:55:00] And then from that, then she started talking to the nurses about what else they’re frustrated with, but not like trying to force something.

Vic: It’s much more of like a servant leader, like, what can I do to make your job easier? And the next thing that she came up with was, uh, they have trouble getting the second sign off for medication approvals. The nurse thinks it needs to be changed, but she can’t do that without someone else agreeing. And in some of their floors, it might take 20, 30 minutes to go find someone else.

Vic: And then you got to go back. And so they now do that virtually with the nurse in the central location. And it went from like 25 minutes or something to like three minutes. And so now she’s building like some confidence, some financial results. And she won. She was on stage cause she won the chime. Which is an acronym stands for something in I.

Vic: T. [00:56:00] Healthcare I. T. membership. Something. Yeah, it’s the HEMS competitor. Yeah. Yeah. She, she won the CHIME 2023 Innovation of the Year or something. Oh, cool. And what I liked about it is it’s not tech forward. No. But, but the, the tech forward things where you just like keep a, workflow that doesn’t really work well for the patients, the nurses, the doctors, or anyone.

Vic: And then you try to add technology in. Now you just have a much more efficient shitty workflow. That’s right. As opposed to what Guthrie did, which is like, just to start first principles, what do we want to happen? And then what’s the, What’s the tech that can enable that? Right. And so it felt hopeful.

Vic: There, there are not a lot of stories. I mean, three or four out of several hundred. Um, but I think it was, I was optimistic about it and, and it’s, it’s really a behavior change or leadership approach that any health system can do. You don’t need a lot of money. Guthrie’s [00:57:00] not that big. They don’t, they didn’t put a lot of money in it.

Vic: Right. It’s just more of like a mindset and a willingness to say, okay, the way that we delivered care in 1980. Maybe let’s re look at that. Right. It doesn’t mean it was bad in 1980, but It’s 40 years later, 50 years later.

Marcus: So I love that story. Um, it reminds me of the, you know, the conversation we had with, with with TK at Virtua?

Marcus: Yeah, yeah. Um, Torun Kaur, right? Who actually, did you see his, I didn’t know you by tk. Yeah, yeah. Did, did you see his video on LinkedIn? No. So, so dude’s gonna be a star. His, he’s got like a really funny, uh, video we did on LinkedIn. But anyway, the, the, the point I’m just trying to make is to solve healthcare, you gotta start with the culture.

Marcus: And the workflow and the protocol and then and then introduce the tech like it’s, it’s not the other way around, right? It’s not tech gonna fix culture, protocol and workflow, right? That if you do it that way, it’s gonna [00:58:00] work. The tech is

Vic: ready.

Marcus: Yeah. Oh, there’s tech everywhere.

Vic: The tech is not going to be the like bottleneck.

Vic: No, no, of course not. But trying to like not talk to the people doing the job and just giving them a tech tool and expecting that to work does not have a good chance of success. Um, and then I also was excited. I met a bunch of entrepreneurs, you know, because. If you have a VC badge, you meet a lot of entrepreneurs.

Vic: And uh, they are using AI well, and they’re like not hiring a lot of people and they can, they can do their, you know, MVP and prototype. And, and I think it’s, um, It’s going to really be much faster durations, much faster, kind of go to market, learn faster. So I think the entrepreneurs are really Lower burn.

Vic: Yes, right. So I came away pretty excited about that. It’s going to be a lot of behavior change. change [00:59:00] management and leadership to like get their head around it. Vive does a great thing by showing off, you know, some success stories, lots of buzzy stuff too. Yeah.

Marcus: Yeah. And Vive is super like tech focused.

Marcus: Did you, did you see, um, kind of tech enabled services, uh, being, being featured in any meaningful way? You know, just, you know, new, new entrance, rivaling the way that care has been delivered in the past. Like, was that something thematically that you felt was,

Vic: yeah,

Marcus: I

Vic: think

Marcus: that,

Vic: um, Care moving outside the acute care hospital into the, into telehealth or into the home has been a trend for a long time.

Vic: I think almost every health system has multiple programs and working on that. And I think it’s, but it seems like it’s not slowing down. Like the adoption curve is increasing. And then I think that the um, the non [01:00:00] FDA regulated wearables and the FDA regulated diagnostic tools are also um, tech enabling almost uh, this consumer health thing.

Vic: They had a program called DIY, do it yourself preventative medicine. And it was all about that in three or four companies up there. One of the things I don’t like about Vive. But it’s just, it’s just the way you do these conferences, and part of the reason I don’t want to do them anymore, is every, every talk has like four panelists and a moderator and someone introducing.

Vic: Yeah. And it’s 25 minutes. And so like you, you get a, everyone gets, you get a little, you get a little touch on lots of stuff, but not deep on anything. Yeah.

Marcus: Well, you got to get

Vic: everyone

Marcus: on stage.

Vic: Yeah. Everyone’s got to be a speaker. They all buy tickets and they all whatever. Yeah, yeah, yeah.

Marcus: Blah, blah, blah.

Marcus: All right, cool. Uh, anything else? No. All right. Good rundown. Thanks for going, uh, saving me the, save me the trip. Uh, okay. So [01:01:00] Chamath Palihapitiya, we talk about him every once in a while here, CEO of Social Capital, one of the four, uh, besties on the All In podcast. Uh, Yesterday posted on LinkedIn, um, his, his firm, social capital.

Marcus: They do these like kind of breakdowns on different industries. And he posted a 29 page deck on the business model of healthcare. And so I was really excited to like, open it up and see what are they talking about? And I have to admit, I was kind of upset because, um, damn it, they have very simply explained how healthcare works in these beautiful slides, kind of one graph, every other slide, uh, some of the slides have one sentence just sort of making a point clear.

Marcus: They were able to frame it in a global sense and then put a microscope down onto the United States, demonstrate the magnitude, get down into the different sectors. Talk about the ridiculous triangular business model with payers, patients, and, and, uh, and providers. It’s just, [01:02:00] to me, it was one of those like key moments where you see, we actually have to get outsiders in this space.

Marcus: Right. Um, And he also starts the post talking about his father dying from cardiac arrest, um, you know, and, and talks about, you know, all the, the, the decades of, of different, you know, pharmaceutical treatments he was on ending with, with 10 years on dialysis. And it just kind of reminds you who gets to say who’s an insider, right?

Marcus: Yeah. I mean, when we’re all have to like live with this thing and deal with this thing, who gets to say who’s an insider? I mean, it’s, it’s. Turn my life upside down for a year now, you know, uh, and, and, and that would be true whether I was doing healthcare VC or not doing healthcare VC. Right. I mean, it would have the same impact.

Marcus: So anyway, I don’t know. I just, just, just had tip to Chamath and the team at Social Capital. We’ll put a link in the show notes, but definitely encourage people to look at this deck because from, for an outsider, I think he does a [01:03:00] marvelous job of pretty simply explaining how healthcare works. Thanks.

Vic: Yeah, I, I agree.

Vic: I think, um, we need outsiders. I mean, the, my takeaway from Vive is we have to go to first principles and figure out what, what do the patients need, and let’s try to figure out how to orient our health system to, to get them that. And then everything else is, is, either noise or needs to be sort of brought to bear for that impact.

Vic: And what I really liked about Jamal, sort of what you’re saying is he didn’t lead with, um, his successes at Facebook and in a hundred other places. We talked about it last week, doing a new chip thing. It wasn’t like grandiose, uh, bragging. I’m going to ride in and fix this. He did kind of the opposite of that.

Vic: [01:04:00] Like he made it. much more like why it matters to him and why this is important to him and might be important to the reader, to me. And I think that’s really powerful. And we could learn a lot from Chamath, and honestly from everyone in Silicon Valley, and New York, and in Asia, and Europe, as long as they come at it with that sort of approach.

Vic: It’s, when my kind of hackles get up is when they come in and say like, We get out of the way, we’ll fix this. We, we know how to innovate better than any of you. We have done this with Uber, just to pick one randomly. Um, and that attitude, I think, doesn’t work with the patients or the caregivers that are going to have to be there delivering care after you leave.

Vic: Um, [01:05:00] but he, he went the opposite way. And I think that’s, it’s really encouraging and hopefully other, other successful tech entrepreneurs and investors will sort of join in. I mean, we want everyone.

Marcus: It’s a deck I wish we had made. Yes. Let me, I’ll just say it like that. It’s a deck I wish we had made. And, uh, The next best thing we can do is share the link, uh, you know, with everybody and it’s a really nice way to, um, share effective ways that we in the healthcare industry can communicate, you know, because that’s the, that’s the thing about Vive, right?

Marcus: It’s like, it’s a room full of insiders talking to each other, talking in acronyms and shorthand and, uh, you know.

Vic: Yeah, but I’m not doing the conference anymore. We, that’s why we started the conference at first. Well, yeah, I mean, the

Marcus: podcast I

Vic: think is better. Yes, yes, much, much easier.

Marcus: All right. And, uh, now to, to wrap up with some, some, some tech stuff.

Vic: Yeah.

Marcus: Um, a bridge, which is, uh, one of [01:06:00] these automated, uh, documentation, gen AI, um, model companies announced 150 million series B this week led by Lightspeed. Yeah. They’re raising a lot of money very quickly.

Vic: Yeah, yeah, and they, um, I’m kind of excited about this. I mean, they have a partnership with Epic.

Vic: And they are starting with documentation, but that’s not what Lightspeed invested in. What Lightspeed invested in is taking my entire, any patient’s entire medical record and continuously looking for ways to, new research is coming out, advising you and your doctor, sort of empowering the patient, and so it’s, it’s sort of quasi, I mean, they have a partnership with Epic, so they understand the need there, but they’re also bringing AI to help patients.

Vic: Have more optionality. And I don’t know if it’ll work or not, but I think it’s a, it’s a really interesting thing to follow.

Marcus: Well, I, [01:07:00] I, I think that when you look at what we’re all living through right now with, with change healthcare, you look at the legitimacy of crypto. You look at the rise of AI. Um, I, I realize it’s still likely a little ways off, but it also feels like we’ve never been so close to actually having sovereignty over our data and, and having the ability to.

Marcus: You know, leverage the collective intelligence via gen AI models across on our own data and be able to, um, you know, opt into different clinical trials or different research projects. It seems like we are getting there and certainly getting pretty close. Um, well, and

Vic: that’s, I think that’s going to be a really important debate over the next five or 10 years is like, do I want my doctor to use AI to give me the best care possible?

Vic: Or do I want to use AI and work with multiple doctors to get the best care possible? Yeah, well, you know, I don’t know.

Marcus: Well, you know, I think there’s going to be [01:08:00] a sort of legal limitation from a doctor shopping perspective, right? Um, but meaning like, hey, my AI told me I need this med. Are you going to give me this med?

Marcus: Okay, I’m going to go to another doctor to try to get this man. Like, I think that’s going to be kind of a problem and you’re not going to really do that.

Vic: And you won’t,

Marcus: No, no, I don’t think that’s going to work, but I think getting, you know, working with a doctor or maybe multiple doctors in, in sort of a collaborative research model around your data.

Marcus: is interesting, right? And, and, and sort of looking at how you might experiment with different, uh, fitness or nutrition protocols or even pharmacological ones that are, that, that they actually approve, you know, that are evidence based, right? Um, could, could be, it could be really interesting, you know?

Vic: Yeah.

Vic: The, the question is how far will the empowerment of the [01:09:00] patient go? Right? So before, before the internet. You walked in and usually the man in the white coat told you what to do and then Dr. Google now gives people a lot of insight. Yeah, and I think they’re more informed patients. It’s kind of a hassle to doctors a little bit.

Vic: But net net, I think it’s better, it’s better health care, broadly.

Marcus: Yeah, and, and, you’re, you’re sort of circling around something that I think we are going to start talking about more on this show, which is the longevity movement. Um, you know, which I think is getting more and more real by the, by the day, right?

Marcus: There’s a guy named Brian Johnson that, uh, if, if the listeners haven’t heard of him, His movement is called Don’t Die, uh, and and he’s making the point that we are entering an era sort of at the at the dawn of the of the age of A. I. where we are going to have so many breakthroughs that the fundamental foundation of knowledge as we [01:10:00] understand it today is going to be.

Marcus: Sort of obliterated, um, and, and we really don’t know anything. Right. And so His whole model is don’t die. And he, and just, just so you know, like this is a, he’s a pretty rich guy. He created, I think it was brain tree. Um, the, the, the payments company. Yeah. Uh, yeah. And, and sold that for 800 million. And so he’s then taken like the last two or so years and just plumbed a ton of money into making himself a human experiment, driving all of his biomarkers down to like 18 year old status.

Marcus: And he’s in his. Forties, maybe late forties, I think. Um, and, and he’s basically tested and tried out a million different things. And he’s, he’s finding a bunch of hacks now, obviously, you know, how, how scalable is that to, to the average person? You know, look, I mean, maybe not that scalable, however, however, uh, We are at the beginning of some massive breakthroughs and they’re going to kind of fundamentally change, uh, things that we thought we [01:11:00] were destined to die from.

Marcus: And this is not the first time in the history of medicine that this has happened, right? I mean, you know, we’ve had these major, major breakthroughs. Penicillin! You know, we’ve had these major, major breakthroughs in the past where we create something and it fails. Fundamentally changes life expectancy. Um, so I do think that we are headed into that era and you found this, uh, our final story, which is a up note to end our podcast.

Vic: I am hopeful that we will cure cancer in the next 10 years. That’s one of the places where I think. This research, not just AI, but, but CAR T and all kinds of research,

Marcus: combining AI with, with

Vic: biotech. Um, I think cancer is not one thing. I think there’s, it’s a set of symptoms caused by a variety of things, maybe.

Vic: Um, but the story today, or yeah, today, is that AI now has recognized there are two [01:12:00] different, uh, variants, maybe. Maybe. I don’t know what the right word is, of prostate cancer. So there’s not just prostate cancer, there’s two different types. And they have different pathways, and they behave and grow differently, and they now are publishing this and then starting to look at how can we attack and treat prostate cancer, and it’s very likely going to be different for the different types.

Vic: Um, we’ve known for a long time that, uh, some tumors you can take, I think breast cancer, you can take the tumor and, and, um, Get the the genetic makeup of the cancer and then kind of titrate different chemotherapy to it But this is the first time I’ve seen an entire class that has you know, two big ones so anyway, it’s just interesting and sort of on that same thread that Hopefully we’ll start to [01:13:00] check off more and more Ways you die and then eventually maybe you don’t die.

Vic: Amazing world we’re in. Yeah. Um, we’ll be coming to you on episode, you know, 40,000 and ,

Marcus: three at once a week. Um, and, uh, and you, you, uh, you did bring us back an interview from Vibe too, right? Yes,

Vic: yes. Uh, I have a great interview. Uh, Dr. Medel Briggs. Hawthorne talks about health equity. Okay. She leads that for UCLA and incredible.

Vic: And so we will package that up. I learned a ton. She’s really a great person and helped me kind of understand it, but it was really, really insightful. She’s great.

Marcus: So next week, we’re going to put out two episodes on health equity. Jay bought from Deloitte that episode you just recorded. Uh, and then we’ll be back with, uh, with our episode next week.

Vic: Yeah. It’ll be good to have the two different perspectives.

Marcus: Yeah. Yeah. Awesome. All right. Until next [01:14:00] week.