58 – Walmart Health Centers Closed, Marijuana Reclassified, South Bans Abortion, Kaiser’s AI

Marcus: [00:00:00] If you’re finding value in our episodes, please pause to give us a rating and leave a review. Your feedback is crucial for helping us connect with more listeners. Thanks for your support.

Vic: Welcome back. Thanks. It’s good to be here. I, uh, you did a great show while I was away. I listened in. I was in the Yucatan and, uh, fishing.

We had a good time. Nice, man. Good to be back. Then I went right to a board meeting on Monday morning in Ohio. And it was incredible. I walked in to the dinner the night before, everyone was talking about Health Further. So we have a bunch of fans in Columbus. I mean, it wasn’t a huge dinner. There maybe were 12 people and like 7 had listened to your show.

They were asking me why I wasn’t on it. This was on Monday night, where it drops Friday or Saturday, I don’t know.

Marcus: Dude, that’s amazing. I’d love to hear that. Um, yeah, I think people don’t know, like, we don’t really know who’s listening to that.

Vic: That’s right, that’s right. I was like, oh wow, good, I’m glad you listened to it.

Marcus: [00:01:00] That’s, that’s great feedback, man. I’ll, I’ll, uh, I’ll take that with pride into the weekend. Um, yeah, look, uh, it was fun to do the show without you only because now I know I can do the show without you. Like, that’s the only reason why it was, it was fun. Not, not because, uh, I enjoyed doing it without you.

I’m glad you’re back.

Vic: We both are going to be gone once in a while, so we have to be able to. Get the news out. There was a lot of stuff going on last week. So for sure. Yeah. I

Marcus: couldn’t miss it, especially like with the Medicaid rule stuff. Like that was just like, yeah, no way we have to, we have to cover that.

Uh, anyway, look, uh, let’s, let’s, let’s dig in. Right. Okay.

So to the fed, this was fed week. Everybody knew based on what’s been happening with, uh, inflation, we were not going to get, um, uh, a fed, a fed rate cut. We knew that. Yeah. So

Vic: yeah, we weren’t going to get cut. You covered it last week. The economy also is. slowing [00:02:00] down pretty dramatically. It’s not a recession, but it was not great.

Um, so I think people were watching to see what Chairman Powell would say.

Marcus: Yeah. And so what did he say?

Vic: He basically said, they’re going to wait and see, and he’s moved, uh, further away from rate cuts. So, I mean, he didn’t really give any clarity other than that, but if last meeting he was 50 50, he’s now You know, further, uh, maybe it’s like 70 20 against doing rate cuts.

Yeah. But they did slow down their quantitative tightening, uh, which is sort of, um, you know, selling off the assets ahead on the balance sheet. It’s the balance sheet, right? Yeah. Yeah, and it actually takes cash out of the economy, so it’s restrictive. They’re slowing that down, which I took as, you know, a good thing they can do that is, you know, A little bit more under the radar.

It’s not the headline news, but at least it’s slightly positive. It’s a

Marcus: tool. It’s one of [00:03:00] the tools they have. Right. Okay, so, I mean, I think the reason why that’s important, right, is because it demonstrates what direction they want to go in, even though they can’t start cutting rates yet.

Vic: Yeah, that’s right.

Is that fair? I think every Fed chairman, including Powell, is very scared of what happened in the late 70s, where like, they thought inflation was over, and they kind of were a little bit more accommodating, and then it took off like crazy again. So, they want to be cautious about that, but they, they see the economy as You know, struggling and there’s a K shape thing we’ve talked about a bunch.

And so they’re trying to find ways to make it better for Americans, but they also need to be cautious about inflation.

Marcus: Yep. Yep. All right. We don’t want to spend too much time on that. Uh, moving on treasury yields. Uh, tell me about this. What’s going on?

Vic: Yeah. So the, the, the treasury is basically front running or, or guessing where the fed is going to go with rates and.

They think that it’s [00:04:00] not, you know, higher for longer or maybe even they would have to raise rates which of course is Driving the yields up which is okay For people that want to get yield, but it’s bad for every other asset, right bad for socks bad for real estate bad for everything Yeah

Marcus: Yeah, so basically that’s it, but like, that’s it.

That’s it. That is a signal that rate cuts are not coming in the near term and therefore the stock market is sour on that. But good for people who have bonds. Yeah. Okay. All right. Uh, all right, moving on why it’s why it’s hard to get hired despite glowing job reports, by the way, if you can’t tell I’m putting Vic to work because yeah, I took a week off.

Vic: Yeah. Um, yeah. So the Wall Street Journal had a story where they interviewed a bunch of job seekers just trying to get below the. We see, uh, these reports of lots of jobs being advertised and [00:05:00] unemployment is, the rates are low. And yet, the gen, like, I have some friends, people, if you have any friends that are looking for a job, it’s not, there aren’t just jobs everywhere out there.

Right. Right. The Wall Street Journal tried to get below the numbers and talked to some actual, both job seekers and recruiters, and they came out with the same thing, that there’s a lot of jobs that are posted that are not, they’re not going to fill. Right. They’re sort of just gathering information or whatever, and they’re being very picky.

There’s many more applicants than needed for a job. So it’s a hard, it’s a hard job environment out there. We’ll get the new jobs report tomorrow. But we don’t have it yet. So,

Marcus: yeah. So I mean, last year was clearly a year of. Uh, as, as they refer to, uh, what meta and Twitter sort of brought about a year of efficiency, right?

We’re going to focus on the bottom line. We’re going to look across all aspects of our [00:06:00] business, see where maybe we overhired, especially during the pandemic, cut that back, focus in on our core lines of business, you know, not just cut down on headcount, but it probably also cut down on initiatives. Right.

Focus are all of our efforts, not just, uh, the people but R and D dollars, just areas of focus. It does feel like in 2024. That’s that effort has kind of settled. And now we’re sort of like, okay, we are where we are. Now we’re trying to maybe. Recover from some of the blow blow back from that, you know, because anytime you do layoffs, it’s not easy internally, there’s a lot of culture stuff that has to sort of settle down, uh, there’s probably things that have to be worked out with your customer base, you know, it’s bad news, you’ve, you’ve, uh, you know, shut down a particular product line.

I think about Google, they, they shut down their jam board, you know, product line, and I hadn’t invested in it, but I was thinking about it and I was really glad that I didn’t as an example. So this year it feels like. Companies are spending that time and energy now kind of, [00:07:00] uh, just resetting themselves under this new reality and not necessarily being really aggressive in any particular direction.

Although later on, we’re gonna talk about some investment stuff, but just internally focused on resettling. Maybe retaining the, the great talent they have, the ones that especially stuck through that, that hard layoff time. Um, but that’s not necessarily a time where you’re going to have a lot of job openings, right?

Where you’re, if we just think about the cycle here, it feels like we’re probably in for at least a year of a tough job market as companies internally kind of reboot themselves and get their act together.

Vic: Yeah, I think that’s right. I’d say we had sort of a tactical. Wave of job reductions and layoffs last year.

It wasn’t like a bad recession Just cut cut 30 of everything because we we can’t we have to do it. That’s right It was much more like we we need to cut here so we can Reorient our business and maybe invest in areas that are growing more, right? And I think that is being [00:08:00] digested as you said, but I I don’t think there is Many companies that are hiring like massive numbers of people and a lot of people People, including me, are trying to figure out, well, what is AI going to be able to do?

And, like, I play with it all the time, but, and, and I think there are some jobs that it can replace, but it’s not clear yet. And so, not a lot of peop not a lot of companies, I think, are hiring massive numbers of folks. It’s just kind of a Uh, slow, I don’t think there’s a lot of job cuts, but I don’t think there’s many job openings either.

Marcus: Yeah. Yeah. And also the other side of that, especially as we think about consumer spending is you cut jobs. Okay. Well, people get a little bit freaked out. Even if they keep their jobs, they spend less because they’re saving more because maybe they get laid off next. Well, that saving and that dropping consumer spending leads to missing the projected GDP growth.

Projected 2. percent end up at 1. 6 percent growth, right? Okay, [00:09:00] well, that’s not great for so many sectors of the economy. So there’s a little bit of cyclical cyclicalness to this, right? Which is layoffs are not just, you know, good for the bottom line only. They could potentially be bad for the top line.

Vic: Yeah. Definitely. And I think it’s also true that, uh, the Biden administration, but across government really since the pandemic, there’s been a lot of government spending a lot. So a lot of the aspects of the economy have been kind of propped up by significant government spending, and I expect that to continue through the election because that’s Something that every government does, but I don’t know if it continues forever, so we may not be able to live on government subsidies forever.

Marcus: Yeah, well, they’re clearly tightening up. I mean, when you look at the rules, uh, they did everything in the, uh, uh, in the IRA. But I think the rules we’re seeing this year are actually much, much tighter, at least from our lens on health care. You know, if you think about how that trickles all the way down, it’s, you know, they’re [00:10:00] allocating more through margin mandates to labor, but they’re not paying at the high level the companies anymore, right?

So that’s obviously going to ultimately have a trickle down of restriction on the workers. So, um, all right. Uh, what’s the story here in the Wall Street Journal about you like the journal today? Uh, California fast food chains are now serving sticker shock.

Vic: Yeah. So, um, maybe go down a little bit. The, um, I think the, the tagline I liked was, uh, uh, a hamburger, you know, which is the cheapest item at McDonald’s, it’s like 3.

50 now. Hold on, just the

Marcus: baseline hamburger?

Vic: Baseline hamburger,

Marcus: yeah. We’re not talking about a Big Mac.

Vic: No, no, this is just, just the regular burger. I mean, so, you know, you see 16 for a meal at Chick fil A. That’s just like the spicy chicken sandwich at Chick fil A. Okay. And a little bit further down, I think, is the, um, McDonald’s one.

[00:11:00] Um, so here. McDonald’s hamburgers, 2. 50 each. Big Mac is 5. 40.

Marcus: You know what? So, the last time I ate at McDonald’s regularly, I remember the hamburger was on the dollar menu. Yeah, yeah. Like, that was the whole point. Hamburger

Vic: and cheeseburger were on the dollar menu. I was always surprised that there’s no extra cost for the cheese, because, you know, who cares?

Yeah. But yeah, it’s 2. 50 now. Wow, wow. And so, again, I keep coming back to it, but this K shaped thing, like, there’s a lot of pressure on people that, I mean, some people just love McDonald’s and fast food, but a lot of people are getting their calories there because it’s cheap. Yeah, that’s right. And the prices are going up significantly.

Now, it’s worse in California than the rest of the country because they also institute a minimum wage.

Marcus: They force the fast food worker minimum wage to go up. Right, yeah, exactly.

Vic: Yeah, I mean,

Marcus: look. I feel like inflation like inflation is it’s not just inflation. I [00:12:00] feel like a regular theme when we talk about policy and when policy seeks to mandate things on business, it’s like I don’t understand why they don’t ever price in how that is going to change.

The way that the business acts like the business is never going to take it on the chin without responding to get their PNL back to where they want it to be. Never. Yes, like that’s not how this works, you know, so, um, I think it’s just such an interesting thing that we regularly cover the. Um, the ways that policy makers try to mandate P& L things.

It

Vic: has always, I mean always, often it has unintended and bad consequences. Like this. Probably the workers at these restaurants a lot of times buy food from similar

Marcus: restaurants. Of course. And then, you know, what might be another thing that they might do, they might take away, you know, some level of perks that they [00:13:00] have, right?

I mean, you’re focused totally on the wages. You didn’t focus on the benefits. You didn’t focus on the perks. You know, okay, fine. Well, I’ll just balance it out that way. So anyway, I mean, I’m not saying that these, these different policy initiatives are not effective. Uh, well intended. They just seem to not fully understand how to properly incentivize the, you know, the private market in America to actually pay workers more right that they seem to be very stick oriented.

And I don’t know what the answer is. That’s carrot oriented, but all I’m really saying is, uh, you’re not thinking of this all the way through. Because the business is going to adjust and the worker, the worker and the consumer will get screwed.

Vic: Yeah, I’m more cynical than even that. Like, I think the politicians stop listening after the headline.

Like, yay, we got, uh, fast food workers, a higher minimum wage. Let’s celebrate. And then they move on to the next thing. And they don’t know that this unintended consequence is going to happen, but I don’t think they really care.

Marcus: Like, they’re, they don’t

Vic: care. [00:14:00]

Marcus: They’re

Vic: moving on

Marcus: to a new

Vic: topic.

Marcus: That is certainly cynical.

Yes, yes. All right. Uh, more in the Wall Street Journal. Uh, office loan defaults near historic levels with billions on the line. Okay, so are we nearing kind of this story that we talked a lot about probably 20 episodes ago? Yeah. We kind of gave it a break because we were like, I got tired of it. We

Vic: all got tired of hearing about this pending thing.

Um, 38 billion that are facing loan defaults. You know, I think is a significant everyone knows the real estate office real estate in kind of the big. Cities is a challenge. I’m sort of following it at a low level. Um, but it’s, it’s going to have to get refinanced at some point.

Marcus: Yeah. Yeah. So, okay. So in this, in the picture, in this story, it’s showing the Aon center in Los Angeles says it was recently sold at a huge discount from its price a decade earlier.

Well, When I was in, um, in Chicago, actually, I was in the suburb of [00:15:00] Chicago, um, for an HFMA board meeting probably a year ago now, um, they were pointing out some buildings that were currently on the market about to basically be like sold at a fire sale, you know?

Vic: Yeah.

Marcus: Um. Um. So I think the thing is, this is kind of quietly happening.

No one’s necessarily paying attention to it, but, uh, the keys are changing hands, uh, in some pretty big recaps of these buildings. And, um, you know, maybe that’s what happens, right? Maybe there’s just, we, I think we covered, there was sort of some, some Japanese funds that were sort of

Vic: New York. They bought a New York asset.

Right, exactly.

Marcus: So, so maybe what ends up happening here is not so much, um, kind of like a massive sky is falling fallout kind of thing. But maybe it’s just a transfer of wealth. Maybe it’s just a bunch of folks, you know, are caught with their pants down because they got caught in the middle of the, you know, the rate hike and there’s new capital that’s gonna come in.

It’s going to, you know, take on the liability, but it’s gonna reprice everything. Um, and they’re just gonna buy it at a much, at [00:16:00] a, at a much lower discount. People are gonna be willing to get out of the, of the asset at the, at the discount, you know, kind of take their losses and Yeah. And, and go home. And maybe that’s how this all plays out, you know, not like.

That’s the best of all possible scenarios.

Vic: That’s, that’s what the market should do.

Marcus: Well, there’s a lot of capital sitting on the sidelines right now. So I mean, that might be what ends up happening here. And then, and then, and then these people who are buying these buildings, they have the job of trying to figure out, okay, well, now what are we going to do with them?

Right. Because they’re not going to be office. That’s, that’s not going to happen. So maybe you turn them into a bunch of residential. I mean, we need a lot more affordable housing in these city centers. So. You know, if you can retrofit a lot of these, these buildings to be dwellings for people at lower, you know, at affordable cost, that’s probably, it’s probably a good thing.

Vic: Yeah, that would be great. I think a lot of the layout and architecture is challenging to move to residential. [00:17:00] It may be challenging, but But maybe they’ll have to figure it out. Yeah,

Marcus: it may be challenging, but I bet, you know, maybe it’s challenging from a current perspective. Um, you know, zoning, best practices, perspective, and, you know, cities that need affordable housing solutions will probably have to evolve and adapt and, you know, leverage some, some new technologies to, to figure out how to support people who want to buy these buildings, you know, because these are also sort of problems for the cities, right?

I mean, you can’t just have abandoned, unmanaged buildings. In your city. That’s not it.

Vic: Yeah, it’s not terrible. Yeah,

Marcus: you can’t have that. So you need someone who’s actually going to take on the building who’s going to support the building. It’s certainly a win if you can fill it with people, um, and house people.

So,

Vic: yeah, I mean, that works. Well, the problem comes if they, um, so the equity investors, uh, will lose their money, but if it goes below the debt, that is difficult on the banks, right? Right. So that’s what we’re watching

Marcus: for. Yep. [00:18:00] All right. Continuing on. Uh, all right. AI startup core. We’ve nearly triples valuation to 19 billion in five months.

Okay. So the only reason why I won’t totally think this is a joke is because NVIDIA backed it. However, We’ve already seen NVIDIA backed companies lose their founder and CEO to Microsoft. So, I mean, just because NVIDIA is

Vic: NVIDIA is, in my opinion, backing a lot of AI. Well, they got the balance sheet to do it.

Marcus: The market’s paying them to do whatever they want right now.

Vic: Yeah. So, CoreWeave, uh, sort of rents out, Either racks or parts of racks to companies to help them use AI. Uh, so the data center data center rack. So it works pretty closely with NVIDIA, I think. Um, but 19 billion and growing, was it five X or six X or something in, in five months is, is crazy.

Yeah. I mean,

Marcus: that’s, that’s crazy. Just [00:19:00] so, so CO2 led the 1. 1 billion funding round and code Lord knows CO2 needs a win.

Vic: Yeah, but may not be the best. Way to get a win to chase a huge valuation, but that’s maybe

Marcus: well. So, so, but, but they’ve grown five X in, in, in five months. Is that what you just said? The valuation has grown five X.

No, the valuation grew three X. Triple triples. Yeah, the valuation triple. What about the actual business? Have they reported about how the business has actually grown or is this just all hype cycle? It’s all hype cycle. Okay. Yeah. So, uh, the only thing to say here is that there is. You know, mark these words, there is rational exuberance in 2024 in the AI space when it comes to funding and, and by the way, the growth equity funds, they got to place their capital someplace and they got to write big checks and they’re not going to get in trouble for backing an NVIDIA backed company that’s integrated and has strategic partnership, right?

Probably just back up the truck to that one and then, you know, hope it actually plays out. It’s at least an allocation strategy. I mean, this is why I [00:20:00] would not want to be in growth. Right. I mean. In, in, in growth capital right now.

Vic: I agree completely. That’s why I’m not either. It’s, it’s, it’s challenging.

You have to write ridiculously large checks. And you got to get access to deals that everyone else knows too.

Marcus: Yeah. And it’s like, is CoreWeave going to go public? I can’t. I don’t see how they can go public. Does that business model sound like a sound like a solid public? No, let’s trade a company. Okay, that’s that.

Let’s start there. That does not sound like a publicly traded company to me. Renting out rack space. They don’t own the data center. So I’m saying

Vic: so like they have a piece of

Marcus: the

Vic: data center. Yes, asset light, which is okay. But I mean, it’s okay. P& L. It’s not defensible. It’s not defensible.

Marcus: Yeah, it’s not defensible.

It’s it’s it’s great for venture, especially if you’re trying to like, you know, ratchet up your your margins and You know, grow very, very quickly, focus all on sales and marketing, but that’s not defensible, man. And also if you’re asset light in that kind of business model, you can be strategically boxed out.

Vic: Yeah.

Marcus: That’s another thing. [00:21:00] Right. Okay. Uh, moving on. But on health launches platform to streamline provider credentialing cuts. And, uh, They cut verification time by, okay, by a hundred percent.

Vic: It doesn’t, there is no time anymore.

Marcus: They cut verification time by 99. 9%. Dude. Do people even think about like how things like that sound?

Well, just, just like how it sounds when you say stuff like that. Like even, even if it’s true, what you’re really saying is like, you’ve, you’ve totally eliminated. Something just say that you’ve eliminated something like cutting the verification time by 99. 9 percent just anyway there’s a redesigned health company and Yeah, look, I mean you and I talked a little bit about it.

So they raised eight point seven five million dollars in seed funding They’ve partnered with Amwell Mockingbird the clinic by Cleveland Clinic and Brevard Health Alliance FQHC in Florida. So, um, so basically a CSAGE company. I mean, that, that’s like, that’s a [00:22:00] client list of a CSAGE company. Um,

Vic: and credentialing is a hassle.

Marcus: Yeah, but dude, as you and I both know, we know probably the company that’s just crushing the space that nobody knows about. Um, and they’ve been in this space for a decade now and I’m not competing against them, so that’s all I got to say about that. I think people think that, that nobody’s actually tackling credentialing.

But that’s not true. Um, there are companies out there doing a hell of a job at credentialing. Now, I guess the one thing I would say though, is looking at this client list, there’s no hospitals here, right? So it’s not Cleveland clinic. It’s the clinic by Cleveland clinic. And I’m assuming that’s like their, you know, uh, Either virtual care or urgent care model.

Um, they’ve got an FUHC, they’ve got AMWELL, which is telehealth. So maybe what they’re doing is they’re going to these ancillary, you know, provider based organizations that are not hospitals, and maybe they’re just. You know, tackling a [00:23:00] different market segment with very similar technology, which is a model that can work.

Vic: Yeah, I mean, starting off in a beachhead part of the market and then growing into the overall market is a very common thing. A lot of startups do. And I think credentialing, as you said, we know, we know one big company and I know a couple other small ones that are already doing this. Yeah. But it’s very, uh, core to the identity of the hospital, and they have a lot of liability if they mess it up, so.

That’s right. Um. I, you know, several years ago, I tried to replace this at a big for profit hospital and they just didn’t care. They’re like, yes, we have four floors of people doing stuff, but they haven’t made any mistakes. We, you know, we haven’t gotten in trouble and why it’s not broken, why we want to fix it.

Right. So I don’t know. I think it’s a kind of, they’re attacking a small ish, you know, kind of, I don’t know, small [00:24:00] side of the space. And it’s a, it’s a hard thing to displace.

Marcus: I feel like this is one of those spaces that, um, you know, either you’ve worked in it and you know how hard it is. And so you go off and you create the company that may be with the founders are, or it’s one of those aspects of healthcare that, um, if you haven’t spent a lot of time here, you look at it and you go, Oh my God, like, it should be easy.

Yeah. Yeah. This is, this is like, and you know, just not kind of understanding all the, psychology issues that are going on. I lost

Vic: money in

Marcus: 2017. Uh, all right, good. We’re moving on to payers. So, uh, Wall Street Journal, CVS made a big bet on Medicare. It’s looking risky.

Vic: Yeah. So last, uh, open enrollment. So, you know, every, every like around November, December timeframe, there’s enrollment for Medicare Advantage and CVS made the decision to be very liberal on their approach to how they would classify.

Kind of extra things that are sort of for [00:25:00] sports and fitness and health. So golf clubs, fishing rods, pickleball paddles. They were giving to seniors or reimbursing them as a way to attract, hopefully, healthy, inexpensive, very active seniors. I think that was the idea. And they did attract a whole bunch of new enrollees.

They grew quickly. Free stuff. Yeah. free stuff. Um, that was the right before 2024, where all the rates have been really challenging. Oh, okay. Got it. And so they, they sort of piled in a bunch of new enrollees as they were getting less profitable. Got it. Got it. Got it. So, you know, maybe it is going to, if they keep them for several years and it, It might plan out, but the early kind of returns are they, they ramped up, you know, just before it became not that profitable.

Marcus: That’s just a bad timing thing, right? You know, um, I don’t know. The CBS folks [00:26:00] are pretty good operators. I, I expect they’ll, they’ll navigate that.

Vic: Yeah, they, they, um, I think they, maybe they missed earnings or, or they were commenting on this. Or lower than expected. Yeah, they lower than, lower than they planned on.

Yeah, yeah, lower than they planned on.

Marcus: Okay. Yeah. That that’s, it’s something to watch, but I don’t know. I’m

Vic: Medicare advantage, you know, it’s a lot of money flowing through it, but you’re going to have to manage it really well. Yeah. I think that’s the takeaway from Emily a couple of weeks ago from my point.

Marcus: Yeah. I mean, you’re good. Well, you’re going to have to manage it really well. You’re also going to have to change your customer acquisition costs and your, and your premium model, right? I mean, that, those, there’s two ways to handle this, right. Focus really hard on like the outcomes and your star ratings and all that kind of stuff, or just like change your premiums and your customer acquisition costs, right?

So giving away free stuff. Probably at the same time as, you know, your, your margins were being compressed. That’s probably just bad math, right? You know, and, and they probably will change that model going forward, um, as they learn how to, how to improve the margins on the seniors they’ve already attracted.

Yeah. Yeah. Okay. [00:27:00] That’s right.

Vic: All right.

Marcus: What’s

Vic: next in the payer universe? So then Cigna also came out with earnings this week. And As you’ll recall, they sold off their Medicare business, so they have mostly employers now and they beat, they beat earnings, they beat estimates, performed well. And so you’re seeing now kind of a, just a different strategy playing out where Cigna has focused on employers, at least for right now, that looks pretty smart.

Marcus: Yeah, look, it streamlines their business. It takes them, you know, much more outside of the, Um, the crosshairs of all the crazy stuff that, you know, CMS is going to throw at them. Right? And, uh, allows them to just sort of navigate with employers who, they bark a lot, right? But they don’t really do that much changing.

Yeah. You know what I mean? So, uh, I, I think, Cigna’s, I think, going to be one to watch, I got to say. Uh, because I, I, I think that, uh, That offloading Medicare [00:28:00] strategy after the whole Cigna Humana merger, you know, fell apart actually going in the other direction, you know, selling off, uh, you know, the Medicare business and streamlining, I think it’s going to prove to, to really deliver some great results, uh, stock wise for the rest of the year.

So, um, and, and I think probably for the foreseeable future, because as we can see, uh, these administrations are using. You know, Medicare, Medicaid rules rulemaking as a political football. Yeah, there’s no question about it. They are doing that. And, um, I don’t know. As a business, that’s a tough stuff to be on the receiving end of that.

Don’t you think? Yeah. Another story about Cigna. This is from ProPublica. This is, you know, a little bit of a expose kind of kind of hit piece thing. Um, but talking about how a doctor Cigna said that her bosses pressured her to review patients cases too quickly and that. She claims that Cigna threatened to fire her.[00:29:00]

Vic: I don’t think it’s surprising at all that a payer is employing docs to try to look for ways to deny claims with reasonable medical, um, kind of evidence. She worked there for 15, 20 years. Um, but she now is coming out and saying how they, how much pressure she got to deny, deny, deny. And I’m sure she got pressure to deny.

Um, I just don’t think it’s that surprising. I think a lot of the payers are fighting with providers a lot about. You know, kind of pre approval things or, you know, should they have done that or not?

Marcus: I, I, I think probably there’s two things about this story that were interesting to me. One being that the doctor said, uh, that her bosses were pressuring her to review cases too [00:30:00] quickly, uh, as opposed to being correct.

So, so efficiency over accuracy, right? I think that’s, that’s a little bit of a, you know, and look, Publicly traded company, quarterly earnings, right, you know, it’s like, it’s like, what are the incentives here? Right. You know, what are the incentives? Incentives drive behavior. So that one kind of makes sense and smells like it was likely something that was going on on the inside.

Right. But the second thing, which is, this is just my, uh, my, my naivete and my ignorance because I didn’t work in the healthcare industry. Um, the fact that there is a doctor on the other side of that claims evaluation that is determining it. And, you know, of course there is some of that going on, but, but that’s not how I’ve ever visualized it when I’ve had a claim denied.

Like when I’ve had a claim denied, I always just think about, There’s some algorithm there, right? I haven’t thought, Oh, there’s a doctor on the other side that is sort of in a medical evaluation based on the [00:31:00] facts jousting with my doctor’s evaluation. I just had never put those two things together. Yeah, they have to do that

Vic: because otherwise the

Marcus: payer loses.

Well, it’s an obvious thing. I’m just saying. I just don’t think the average person thinks about it that way. I think they just think insurance companies suit actuaries, blah, blah, blah. Not that there’s a doctor on the other side working for the insurance company reviewing the claim. And saying now look all my health care friends who are listening or be like Marcus.

You’re like so stupid You didn’t know that. I’m just i’m just saying for me that was like it’s like actually kind of illuminating

Vic: Yeah, and I think it’s the I mean at one level. It’s it’s the way Our american system is set up, right? Like we have our judicial system. We have our medical system We have payers and providers.

They should have experts counterbalance each other Um, that is how it’s designed. I think Um But it also relies on [00:32:00] humans, like, really trying to do what’s best for the patient. And as you said, the financial incentives at these big public companies are significant. And so I think that’s, that’s the story ProPublica is breaking.

Um, and I can’t say if that’s, that’s surprising.

Marcus: All right. This is a big one. Uh, Wall Street Journal headline, Biden administration aims to reclassify marijuana as less dangerous drug, man. Uh, This is, there’s so many implications. There’s no way we can cover them all in this show. Um, in the future, it would be great to, you know, bring some experts who can talk about the, um, the, the projected impact to the healthcare system based on what we’ve seen just in the last 10 years of decriminalization of marijuana use, um, and what that is introducing to.

[00:33:00] Um, addiction, behavioral health, um, you know, physical health, et cetera, et cetera, like I I’d love to sort of get a better understanding of how the decriminalization has, uh, increased burden on the healthcare system. Cause I, I hear rumblings of that, but I don’t have any, you know, I don’t have any real good base of knowledge of that.

So we should, we should seek to bring a guest on the show pretty soon to cover that, but I think the financial implications of this. as well as the criminal justice implications are really significant.

Vic: Yeah, there’s no, no question. So the states have legalized marijuana, several states, 20, 25, something like that.

Um, and there’s businesses, because of that, there’s businesses operating in those states. But the way, the way that marijuana is classified as a class 2 narcotic, it’s being moved to class 3, which means you can get a prescription for it.

Marcus: I mean, it’s just so we were sort of, [00:34:00] uh, not just using jargon. So class two is like LSD, like hard drugs.

Yeah, right. Heroin is anything

Vic: that is illegal. Heroin, cocaine, all those are all class. Two drugs, right? And class three is like Tylenol, right? Class, no, Tylenol is over the counter. Okay. I think there’s a prescription. Oh, so Sudafed, is Sudafed class three? Sudafed, if it’s prescribed. Prescribed, yeah, the prescribed Sudafed.

I think class three is prescribed. Okay, okay, got it. So you need a prescription for Xanax. And so it’s a class three. Okay. And so it’s moving to class three. But there’s a federal tax called 280 that has been really making it difficult to be profitable as a marijuana user. Uh, manufacturer, grower, I guess, or retailer because I don’t understand how the tax works, but, but class two drugs have really negative tax consequences because the federal, the IRS doesn’t expect you to be selling them.[00:35:00]

And so this will, I think, immediately make all those businesses much more profitable, uh, with like the stroke of the pen as soon as, as soon as it gets kind of, if it, maybe it is approved already, which it gets put in place.

Marcus: Yeah. And so I think that there are two. downstream potential impacts from from there, right?

So there there’s a banking bill that’s currently, you know, Basically has been held up by this right as long as long as marijuana was a schedule two drug Can’t go across state lines can’t go across state lines. So banks can’t touch it, right? But I think as it moves to schedule three, it’s not an immediate trigger, but it kind of makes way for A banking bill that will make marijuana businesses bankable, right?

And those are kind of the two big things, right? Well, maybe, maybe there are three. There’s a third

Vic: because we’ve got to get to criminal justice. Yeah. Yeah. I was about

Marcus: to say there are three, which is the criminal justice issue. But, but if we talk about what has held back the cannabis industry, one, [00:36:00] it is It’s the margins are bad because of the tax issue.

Vic: Plus, it’s a, it’s a competitive market. It’s very hard. It’s like selling anything in retail. It’s a tight space. And then they have this bad tax thing.

Marcus: Yeah. And, and you don’t have good infrastructure because you’re not bankable. You can’t run on, on, uh, usual, um, payment rails. There’s all these, all these things that won’t touch you.

Right. Then the second thing is the banking thing, because you, you can’t move money. People are like literally just using ATMs to like. You know, handle purchases and you can’t put your money anywhere. So you leave her walking around with garbage bags full of cash. Like that’s literally

Vic: putting bags of cash in the bags of cash in a bag

Marcus: in a car.

Are you all right? But then the third thing is the criminal justice thing, which is like, you know, you cross state lines, you do anything outside of a state that has totally made it allowable and you’re going to jail.

Vic: Yeah, right. And I think that’s the argument for this change. And to Biden’s credit, he, he, um, uh, what do [00:37:00] they call it?

He, he like shortened the sentence to time serve for like 200 or 300 people at the end of the year who had marijuana charges because they lived in the wrong state. Right, right. So, yes, there’s a lot of. Lower income people that end up in jail because they have marijuana in one of the 25 states where it’s not legal.

And I think as a society, we have collectively decided that that’s not really worth sending someone to jail. Because it changes the whole trajectory of their life. They’re doing all kinds of not good things for society and not good for them. Yep. So, I think that’s a very positive thing. The other side of it is, um, I mean, there’s a lot of rumors.

Part of this is, this will allow it to be studied by federal labs. Right. And I’m interested in that, because there’s a lot of rumors, but they’re not studied, because no one, no lab will study it. Yeah. That [00:38:00] the marijuana product is a lot more strong and it’s affecting teenagers, especially with so there’s like behavioral health issues, right?

Marcus: Right,

Vic: but it’s sort of hard to unpack that from the pandemic behavioral health issues because it all kind of came. Around the same time so I’m excited about the research side of this It’s gonna take maybe a year take a little while to get a study up and going But there’s a lot of rumors that I have no frame of reference if they’re true or not But I mean, I haven’t done this stuff But like there’s things called dabs that are like 300 times stronger than a normal joint or whatever.

Yeah I don’t know if it’s true or not, but it seems like, uh, some study would be good. This is huge. Yeah. It’s going to be great. I mean, it’s, I feel like it’s already legal in half the states. If you want to buy marijuana, it’s not hard to find it. Yeah. And then the rest

Marcus: of the states, there’s like a hybrid of it, right?

You know, you’ve got synthetic, uh, you know, you’ve got the Delta eight or Delta nine, whatever. [00:39:00] So, yes, I mean, it’s, it’s. At this point, it’s probably time for the federal government to create some clarity and a uniform pathway for us to advance on on this business, because we’re already doing it. We’re just doing it in a really like janky, clunky way.

The only people

Vic: that can’t get marijuana are the federal labs that should study it. Yeah,

Marcus: yeah. Good point. Good point. So anyway, this is definitely a story to continue to watch from a variety of different. Um, levels. And I certainly want, I want to start trying to find some guests. We’ll try to find a guest.

If anyone’s

Vic: listening that knows the guests, let us know.

Marcus: Yeah. Um, okay. Maybe let’s stop here and let’s let Doug share a little bit about Jumpstart Foundry, then we’ll come back and we’ll get back on our Ozempic thing.

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 [00:40:00] the United States. 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 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. 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 [00:41:00] stage companies in the country.

Through those most innovative solutions that Jumpstart 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. So the FTC, um, every week, every week, every week,

Vic: Lena is

Marcus: in the news.

She’s dude, not only she in news all the time. You know, she’s on tv a lot now.

Vic: Yeah.

Marcus: Have you noticed that like like if you watch cable news

Vic: She pictures out there. She she’s got a pr person. I don’t know what she’s working on man

Marcus: She is working it in this election. Uh this election year. So anyway, um, Ftc targets junk patent listings on [00:42:00] ozempic and other drugs.

So this is that whole orange book thing We talked

Vic: about it maybe a couple months ago. Yeah.

Marcus: Yeah. Um, so Say a

Vic: little bit. They are attacking ozempic for You What is a pretty common practice of extending the patent life. By making adjustments to the device and the way the device works with the pharmaceutical and how it all works for the consumer.

I venture to say every product company that does devices that mix and also deliver a pharmaceutical, they all try to, they’re all trying to make their device better and in doing so they extend the life and FTC is now Cracking down is the word that the journal used on it to really dig into this and make sure that’s not a frivolous, um, unimportant thing.

Like they changed the color or they put five threads of the screwing aspect versus four. Right. Um, [00:43:00] and so I think it’s probably healthy that they look into it. If it is frivolous, they should stop it. But at the same time, if they make a meaningful change. That should be in the orange book. So

Marcus: this to me feels like one of the first areas that the FTC is focused on that we’ve covered in months, where I’m like, actually, this feels like an anti competitive issue, you know, where, where at least you need to dig into it, right, you at least need to dig in and kind of see, hey, You know, our people who are leveraging, it’s not quite a loophole, but our people who are leveraging this orange book, you know, pathway, are they doing it the right way?

Or are they just kind of making up some shit so that they can, you know, hold on to the patent for longer? Right? I

Vic: mean, I think good for the overall society. We want to protect IP rights for, say, 20 years. Yep. And that encourages people to invent something new. Yes. And then if they make a meaningful change to that, they should get an extension.

But it shouldn’t be just an automatic, you say anything is new [00:44:00] and just automatically it’s put in the book. Yeah, yeah,

Marcus: yeah, exactly. All right, uh, oh boy, this is another big one.

Vic: Man. I’m worried about even covering this, but we have to just like, Fight through

Marcus: it. Oh, no, no, no, no, no. We know we have to cover this.

We have to cover this. So yeah, we have to cover

Vic: it.

Marcus: It’s a

Vic: health care issue, but

Marcus: yeah, so Florida, um, they have now, uh, passed their six week abortion ban. It’s now law. And, um, interestingly, they were behind the rest of the South, uh, in getting this across the line, but I think that’s why this is such a big deal, um, you know, you might look at the headline and obviously, you know, Ron DeSantis is a very polarizing figure, uh, there’s, there’s no question about that.

He, he, he wants to be, he’s designed himself to sort of be a very clearly polarized figure. Polarizing figure, but, um, it’s not so much the abortion ban, although I think many people will think this is terrible. I, you know,

Vic: six weeks is tough. It’s

Marcus: tough. And also my whole problem with with all of this is [00:45:00] it does not, um, Uh, it, it, it does not recognize the myriad of healthcare issues and the danger to the woman’s life, um, that you introduce when you put these wholesale bands with very little, um, you know, caveats or very little, uh, exemptions.

It’s just kind of very down the middle and, and it’s clearly based on ideology and theology that’s, it’s not based on, you know, medical. Information that sort of says, hey, these are scenarios in which a woman’s life is a woman’s life is on the line So that’s why to me that’s not political. That’s just like this is bullshit, you know These lawmakers should be more thoughtful about this kind of stuff And that’s my opinion, you know, that’s my opinion.

I

Vic: mean, I think There’s a lot of women that don’t know they’re pregnant at six weeks. Yeah. I mean, just by definition, four weeks would be like, kind of the fastest you could know. And so, I don’t know, it just seems very [00:46:00] Cruel? Cruel. Seems cruel and unlikely to be possible for a woman who is trying to follow the rules to actually

Marcus: I would say it’s a cruel rule, so anyway, um, that notwithstanding, um,

Vic: it’s law now, it’s law.

And

Marcus: so,

Vic: you know, the times did a pretty good job. And so, um, if people are listening in audio, first of all, you should check out our YouTube, uh, podcast. We have some new graphics and it’s, uh, really good. And this, this segment will be better.

Marcus: Yeah. Yeah.

Vic: So,

Marcus: yeah. So the headline and also the links were all in the show notes, so you can always see it there.

But, uh, the headline of the secondary story is, uh, Florida’s abortion ban will reach well beyond Florida. And it basically shows that since, um, you know, the Roe v. Wade was overturned, um, you know, in 2021. Uh, abortion was legal in every state. The average American woman lived less than 25 miles from a [00:47:00] clinic.

So, you know, it’s pretty easy to get access to an abortion.

Vic: Yes. Three years ago. It’s crazy.

Marcus: Yeah. Um, you know, then the Supreme court overturned Roe v. Wade and, um, huge swaths, almost immediately huge swaths of the South. We’re talking Texas, Oklahoma, Arkansas, Louisiana, Mississippi, Alabama, Tennessee, Georgia.

They all had bills, they all had

Vic: laws passed that were like, triggered when Roe v. Wade, yeah.

Marcus: Exactly, um, Florida, North Carolina, and Virginia were the only states in the South that were offering abortions after six weeks for, of pregnancy. So that, that, those were the outliers. Um, and now, That Florida is closed out this, this graphic as I’m scrolling through, it kind of shows you now that that Florida is closed out, basically all that is left is Virginia, North Carolina, which as anyone who knows, you know, you’re basically at the Mason Dixon line now, so, so the South is effectively closed out for business when it comes to getting an abortion.

Vic: Yeah, I mean, if you live in Tampa or Jacksonville or even North Florida, it’s a long drive. [00:48:00] It’s. 500, 700 miles to go get an abortion in North Carolina. So that’s a different, there’s an income level there that like, not everyone can do that.

Marcus: And, and look, I have to say one of the things that is so, um, mind bending about this, this particular era, era that we live in right now.

And I really, I mean like post pandemic era, right? Cause it’s, it’s, this is a different era, post pandemic era is that it seems very clear to me. After living in Nashville for almost 24 years now, but being born and raised in Brooklyn, New York that the Southeast United States is becoming the new economic engine of the United States.

Like relative to every other segment of this country, the one that is growing more than any other one in economic power and population growth and corporate relocations, you know, we just had Oracle say they’re moving the world headquarters here to Nashville. It’s clearly the Southeast. You don’t [00:49:00] hear these kinds of stories happening in coastal cities, not in the Midwest.

It’s like, it’s the Southeast. That’s where it’s all happening. Like this is where the economic growth is happening. And at the same time, you’ve got these sweeping, you know, state legislatures and government regimes that are putting these laws into effect that I think are very unfriendly to many of the headquarters that are relocating here.

And, and so it feels to me like. People are moving here for a couple of reasons. One, um, there’s more real estate development opportunities to kind of build things the way you want them. Um, these are very business friendly states. Um, they’re very low tax.

Vic: I mean, the fiscal policy part of it and the business friendliness, I mean, just take Texas, Tennessee, and Florida, right?

No, no state taxes. Very Low taxes in general and business friendly very business, right? So I I like that but then the Republicans Republican [00:50:00] mostly But then the Republicans also pull in these crazy social religious things I mean, I’m not very religious, but I don’t know why you have to mix that in with my state government, dude Like I

Marcus: just feel like the GOP could run away with it Right now if they would just Quit it with this shit.

It’s like on the economic side of things. Uh, and, and look, I, I’m, I’m not going to tell anybody what I’m registered as, but like, I basically feel like I have no home, like at this moment, I don’t feel like I have a great home. Okay. But you know, if you’re listening to this show and you’ve been listening, I think, you know, Vic and I are free market capitalists, right?

Like we, we invest capital. We like capital. We’re both entrepreneurs. We like business. I make

Vic: money. I

Marcus: don’t want to pay a lot of taxes. Exactly. All that, all that kind of stuff. Right. Um, but like. We don’t like telling them what to do with their bodies. Like, you know, this is, this is not

Vic: like, I mean, I, I think.

The challenge with our two party system [00:51:00] is that I am fiscally conservative around, like, spending money, taxes. And when you say fiscally

Marcus: conservative, you mean from a state perspective. You mean taxes and Even for yourself, like

Vic: Yeah, for my personal family or for the city of Nashville or the state of Tennessee or the U.

S., I want to keep taxes low and I don’t want my government spending much money. Mm hmm. And I want them to get themselves organized and, you know, fix the streets. Police. Yeah. But, but, but you want police, but you want

Marcus: them to charge enough money in taxes to fix the streets and to protect you. Right? Yes.

Vic: But I want them to do that effectively.

Yeah. And so I think Tennessee, just to, to say what I know best, does that pretty well, pretty, pretty well,

Marcus: yeah. I mean, there, there’s, there, there’s issues here and there, but I, but I, I think, I think generally , so like

Vic: when I say fiscally conservative, I. Don’t want the state creating wealth for me. I want them to sort of set the playing field follow the rules kind of [00:52:00] be the referee And then allow business people to grow and prosper and communities

Marcus: to support their own and neighborhoods to be healthy And non profits to be in place and then when

Vic: you go to the social issues Okay, i’m out of my bedroom.

I’m liberal. But yeah, I don’t I don’t want you in my bedroom I don’t want to go in your bedroom. I don’t care who you love, right? Doesn’t matter to me. Yes And I think

Marcus: that’s a lot of the country and stay out of my doctor’s office. Yes. Like if it’s me and my doctor and we’re having conversations about me, you stay out of there,

Vic: right?

And we have the Republicans that are fiscally conservative, but socially they are also conservative in a way that’s hard. And then the Democrats, I mean, I grew up in Boston. Similar to New York, but not the same, but the taxes up there are crazy and they spend so much money and it’s not, the roads aren’t better.

And they can’t

Marcus: justify it. They can’t justify it. Yeah. I mean, I mean, I mean, a lot of it is to upkeep existing systems. It’s [00:53:00] not to create new things. I mean, I think that’s one of the best things about the South is it’s, it’s being developed now in 20, in 2024. Right. I mean, the, these big, you know, you go to like New York, you’re in the middle of the city and you look up and Manhattan.

It’s unbelievable. It’s so crazy how many buildings are in New York City, right? It’s, it’s, it’s a, it’s a marvel that humans were able to create enough cooperation and economic security to build New York City. It’s unbelievable. But now you got to maintain it. Yeah, it’s old. I mean, it’s old, right? It’s not, you know, New York’s not that new.

And that’s, that’s the difference of like a Nashville or like an Austin. You know, these are, these are new cities effectively. Um, Um, from a building perspective and that, that creates a lot of excitement. It creates a lot of economic excitement, you know, but, but man, it’s just, it is so much in conflict with the circus that is, you know, the state legislatures across these, these different states, um, you know, with these silly laws and bills.

Anyway, [00:54:00] I feel like we went on a diatribe doing the thing we said we weren’t going to do, but I think this is the truth.

Vic: Like it’s just, I mean, it’s the problem with our two party system. But like, I don’t like. Either party, because they both have half of what I want, so I’m never happy. I don’t know, but anyway, it’s going to be hard for people in Florida that need to get an abortion.

Marcus: Well, now across the entire South, because this is the point of this New York Times article is that at least people in Georgia and Alabama,

Vic: you know, they could have driven to Florida.

Marcus: Now they can’t go to Florida. So. Yeah, I think that was kind of the point there. All right, onward. Okay, so you found this story in the Wall Street Journal.

Yeah, but you’re living this. Well, no, I’m not living this, but I’m living a version of this that’s far better than what the story talks about. So, the headline is, uh, millions of American kids are caregivers now. The heart, and then in quotes, the hardest part is that I’m only 17. So, and then there is this, I mean, this, this picture.

You know, the Wall Street Journal knows how to get it out of you with these pictures, man, on these special interest [00:55:00] stories. Um, and it’s this, it’s this kid, it’s a kid, um, you know, taking care of a loved one, and I don’t know if that’s, that’s, that’s his, you know, mom or grandmother. Um, But it doesn’t even matter.

You know, it’s a, it’s a teenager taking care of a relative, right? And, and, um, this whole caregiving thing, which I’m not going to let go because I’m living it every single day. Uh, and the reason why I said, no, this story is not about me is because I’m 48 years old with, with resources and connections living in Nashville, a healthcare city, like, you know.

Don’t spend any time writing a story about me. There’s no boohoo here. All that’s happening with me is I’m getting to live this experience. So I’m being awakened to what so many people who have not yet lived it are going to experience when it comes to caregiving for, for aging loved ones.

Vic: One of your sons or one of my sons having to come home from [00:56:00] school and then take care of.

Their mom and that’s their job and they’re not they’re not ready. It’s going to mean that they don’t do things they should do when they’re 17. That’s right. And this is just the beginning of it, right? The boomers haven’t fully come in yet. So we don’t have the caregiving resources. And especially in lower income, they can’t afford home health.

They don’t have the contacts to call someone and get it fixed. And so they just make do because, you know, he loves his mom. But but that’s I don’t know that that’s right in America. Like, we should do better than that.

Marcus: Yeah, I’m just looking into the story. So so the young man’s name is Leo Remus, and he’s taking care of his disabled mom.

She is she’s she’s in a wheelchair here. You know, I think, you know, What what what I would say first of all we’re gonna put the link to the story in the show notes Please please go check out this story. Um, [00:57:00] I have tons of resources Tons of connections. I’m in a great city for this and you know, thankfully my parents have their own house and they have resources Okay, so all those things are true Our family is about a hundred days into this journey now.

We’re at about a hundred days now. Maybe, maybe a little more than a hundred days. Um, we’ve actually put some great things in place for my, my parents in their home. So they can stay. In the

Vic: last two weeks. In the last two weeks. Yeah.

Marcus: Last two weeks have been unbelievable. Okay. I still, every day. We’ll have 10 new tasks virtually, like we’re talking phone, text, email, blah, blah, blah.

Yeah, we were in a

Vic: meeting earlier and you got a, you got a text or a call and had to go. it was a call, yeah,

Marcus: yeah. Every day, when I wake up, there’s 10 or more tasks that will fall in my lap before I go to sleep. That I don’t know about when I wake up.

Vic: Yeah.

Marcus: [00:58:00] That’s every single day. And that’s me with resources and a team.

Yeah. And all this stuff, dude. You know, I cannot imagine being a teenager. And doing this, okay?

Vic: Like, it’s just It’s not fair. No! I mean, it’s not fair to him. It’s not fair that his mom’s in this situation. It’s just not Like, this is in, in the United States. And This isn’t like some other country. And,

Marcus: and, and look, I, I, I think, I think we need to be, uh, intellectually honest.

We just got done talking about Being fiscal conservatives, being free market capitalists, some of this has to do with America being so hypercapitalist that we don’t have communities that pitch in and support. You know, another thing that I, that I’ve had over the last, uh, 30 days is, you know, my sisters came down and spent, you know, more than two weeks.

My, my sister left on Wednesday. Guess what? My cousin showed up today with, with my aunt and they’re going to [00:59:00] be here over the weekend. Right? So I’ve also got this community of family. That’s like all dropping what they’re doing and coming here to help.

Vic: Yeah. And that used to be the normal. Like, the extended family was within a 30 minute drive.

Yeah. And now, we’ve all moved all over the place. Right. And so they’re flying in, or they’re moving around, which you can do, but not every family can do. And what kind of

Marcus: network, from a social capital perspective, does a teenager have?

Vic: I mean, even if, even if he has, say, 20 friends, they don’t have any ability to help.

No,

Marcus: dude. No, you don’t have a network of people with social capital at 17. You don’t. So if you don’t have a community, or if you don’t have neighbors, or you don’t have family that can actually help you, you are doing this by yourself. Okay. You’re doing this by yourself. I just I can’t imagine and I’m thankful that you found this story and I’m going to spend some more time, you know, digging into it and reading it and getting a better understanding of it because, [01:00:00] uh, this is something that’s happening in our community and I don’t think I’ve ever seen a nonprofit in our community dedicated to this.

So I think that’s one of the things I want to go see is, is there a nonprofit dedicated to helping teenagers take care of their aging loved ones?

Vic: Mean teenagers, but, but adults too. Like, uh, I mean, I think it’s, it’s

Marcus: it’s a different level of burden. I’m not saying it’s not bad for adults. Yeah, but man a 17 year old you’re you’re thinking about think about think about charlie Yeah, he couldn’t there’s no way he can do that.

That would be

Vic: he has enough trouble like getting up and feeding himself Like that would not be able to do it. No, it’s just it’s just

Marcus: not

Vic: it

Marcus: wouldn’t be fair. Yeah, it wouldn’t be fair, right? Um,

Vic: you know like yeah, I think it’s uh, I mean it’s terrible for teenagers I think there’s a socioeconomic thing like the the less money you have The harder it is to care for your family You Loved ones.

Yeah, it’s like the nonprofit. Maybe it’s teenagers, but it may just be lower income to this Roy [01:01:00] needs help

Marcus: All right, moving on Walmart is closing health centers tell health unit as costs rise So, you know Walmart is gonna do what they need to do in order to you know, maintain business performance for sure But gosh, you know, was it health further?

2000 17 or 18, I think it was 17. No, no, no, no. It was 18. It was 18 because it was the one that HCA sponsored where I had Milton Johnson and Marcus, Marcus Osborne. So, so for listeners who don’t, don’t know, obviously this podcast is called health further, but you may not know. We used to throw a conference called health further back in, you know, before the 2020s.

And, um, in 2018, when we threw it, we had, uh, a guy who was a superstar. Yeah. For I saw

Vic: him at a vibe this year for

Marcus: running all things health and wellness innovation at Walmart. His name is Marcus Osborne. If you’re, if you’re in a space, you probably know who Marcus is. And so anyway, I [01:02:00] got to interview him on stage and he was, you know, it was, it was amazing because he was just like, you know, slaughtering all the sacred cows from the stage, you know?

And

Vic: I mean, that was probably the beginning of this Walmart health adventure. That might’ve been like, right. The first year they started. Yeah. 2018. Yeah.

Marcus: And they started kind of building out all these things. And now they’re now. You know, this decision affects all 51 centers that had opened in five states.

So the experiment is over.

Vic: Yes.

Marcus: Um, and you know, they’re going to keep their pharmacies in their vision centers. Why? Because that’s what grocery stores do. That’s fine. You know, um, but they’re, they’re, they’re done with the full, basically they’re getting out of the healthcare business. Yeah, they’re getting out of the healthcare business.

And, um, I was, I learned about this story actually on LinkedIn because, you know, my friend Edmondo Robinson, former official officer at Moffitt, uh, and now off, uh, founding some, some really cool stuff. Um, he posted about it and he, uh, he was just basically talking about how, you know, these [01:03:00] outsiders really need to look at how they can partner with incumbents like straight up.

So I asked him the question, I asked him three questions. I said, so, so. I have three questions about your statement. The first one is, um, you know, when you, when you, when you say they should, you know, partner with incumbents, are you saying that, um, hiring doctors, you know, clinicians and, uh, admins are and or admins is insufficient?

Um, you know, two, are you saying that they can’t actually compete when they get into the space or three? Is it that when they get into the space, they realize, oh, this business is just not as good as the business that I’m already in. And I’m just out, you know, like, like they don’t know that until they, until they get in it and on the way in, they think, Oh, this is going to be easy.

These healthcare people don’t know what the hell they’re doing. And then they get in there like, Oh, actually, this is a really [01:04:00] hard business compared to my business in

Vic: the quagmire. Yeah. And

Marcus: like, I’m, I’m, I’m getting all the way out because, because fair point to him, he kind of pointed out, you know, we’ve seen it with Haven.

We’ve seen it with Apple. Now we’re seeing it with Walmart. I mean, Google, Amazon,

Vic: everyone has tried to do too many of these 4 trillion a year. I mean, it’s always, you got to go after it. It’s always

Marcus: tempting. Yeah. But you can’t do too many of these before you actually got to say. Uh, you know, probably need to consider getting out of it, right?

Um, entirely, like, and not going back to it, like, like, learn my lesson. Uh, and he basically said, yes, you know, it’s, it’s insufficient to just hire, uh, you know, docs and, and admins, which I thought was really, Pretty interesting, right? Because you would think, okay, well, why, why is that? Why can’t, can’t you just go hire the same people that are running these other businesses?

And I think the fundamental point he’s making is Walmart does not exist to operate a healthcare business. The reason they’re getting [01:05:00] into it is largely economic. And if, and if the reason is economic, then as costs rise, you’ll get out, right? Healthcare businesses, they’re in it for healthcare. Like, that’s what they’re in it for.

And then they’re going to optimize and do the best they can from a performance perspective. But they’re not comparing it with some other non healthcare business line. They’re, they’re just trying to do the best they can inside of the confines of healthcare. You know what I mean? Yeah.

Vic: Well, I mean, I guess if you’re coming into healthcare, cause you think it’s going to be easy money and, um, you know, kind of simple, then you should, Walmart should never have gotten in.

And I’m not surprised they got out. I think that there’s a, do you remember what Marcus said from, from, from the stage? Cause I do, I don’t know it word for word. So what, but he was, he was very ambitious vision.

Marcus: Well, the main thing that he pointed out, which is what I think a lot of these organizations.

Look at and what [01:06:00] drives them to do it is they look at how much Healthcare costs make up their own optics and then they and then they layer on top of that How many people walk through their doors right and they take those two things and they just sort of think We can we can make this better We can we can we can do better on the op ex side and on the top line revenue side.

That was what he said yeah,

Vic: and I Disagree with your friend. I think that they are trying to You Disrupt and redesign the health care system and to date they have all failed 100 percent have not been

Marcus: successful. Oh, I don’t think you’re disagreeing with him unless you have something else you’re going to say.

Vic: Well, well, I think eventually I think someone will break through. Well, they have to have the will to have the will to

Marcus: stick through this. Yeah, like like WalMart could have hung in there and just eaten it, you know, taking it on the chain for the quarter. [01:07:00] There weren’t willing to do that. Right. I think I think that’s the point.

He and others who continue to point this out keep making right and and so far, these industries and these companies are proving the doubters. Right. Yeah, because they’re not willing to stick in there.

Vic: Yeah, I think that’s right. So, I mean, we, I think Walmart is probably a good example. They took five years.

And whatever it was, several billion dollars invested to try to do basically an advanced primary care practice on top of their next to their stores. And after five years, they were not successful and they don’t have the stomach or the willingness to take another five years and more billions of dollars.

But I think that they’re, and so, I mean, Amazon has tried maybe four times, they’re trying it again in the prescription delivery, where in L. A. and New York, they’re doing, um, two hour, same day [01:08:00] delivery, and they’re going to roll out a bunch of states. So, like, now they’re taking a prescription, pharmacy prescription, tacked.

And I think they will take two, they cycle faster than Walmart, I think they’ll take two years and run hard at it and learn, and if they find an opening, they’ll keep going, if not, they’ll just like, gear back, figure out what they learned, and then try another angle. Right. Um, eventually, someone’s gonna figure out a combination that works.

But so far, no one has.

Marcus: It’s hard. Again, again, to me, I’m not sure it’s so much about they’re going to find something that works as it is about they’re comparing businesses. You know, they’ve got this one business, decades old, they know how it works, it’s made them a fortune 10 company, [01:09:00] you know, and then they get into this health care thing, and their evaluation of how it should perform, you know, they start realizing there’s all these factors that actually influence it.

Like we were talking about the policy thing earlier, right? What the hell do you mean like policy, you know, you know, there’s a political fight and somebody decides they want to pass some rule and now my margin is this and now I got, hold on, I have to pay this person this because this person said so, you know, like, I think it’s more that I think they start realizing, holy shit, like, Being in healthcare means you’re, you’re way more under the thumb of the government, you know, you’re way more, uh, dealing with labor issues in a way that you, you know, where, you know, you might be able to swap out, you know, associates at Walmart, you can’t swap out docs, that ain’t that easy, you know, it’s just a harder thing.

It’s a,

Vic: it’s a, it might be the most regulated industry where you can also start a for profit business. Where you can do it, where you can actually [01:10:00] do it. a for profit business. You can’t just start

Marcus: an airline like that. You

Vic: can’t start an airline, you can’t start a political party and be a for profit.

Education, you maybe can do, but there’s not a lot of for profit education. And so, I think a lot of people look at it and say, well, it’s so inefficient. And we’ve all seen that price curve where like, everything is going down in price except for healthcare and education. Right. So we can go in, but The regulation and the complexity and the humans.

That have, you know, human health care needs is a lot of work and hard.

Marcus: Yep. Absolutely. All right. Uh, okay. This is back to CVS. Uh, I thought this story was, was, was pretty cool. Um, so CVS is, is basically getting in the business of making copycat biologics. And, uh, to me, this just looks like Kroger doing the simple truth brand.

I mean, it’s basically, they’re getting fully vertical and they’re, CVS

Vic: does their brand of, they have a house brand of [01:11:00] water and chips and whatever. It’s just

Marcus: vertical. Yeah. Yeah, it’s just vertical. So it makes sense. Um, you know, having, I think there’s a couple of things to this. One, um, you know, the drug supply chain is a little wonky.

And so I, I think there is an opportunity for. Um, I think there’s an opportunity for, uh, you know, these different corner store drug drug stores to provide better customer service and more predictability by controlling the full supply chain and controlling their own biologics, especially in the third

Vic: parties.

Private label space. Yeah, it’s pretty well established science of how you make it.

Marcus: Yeah, exactly. And then they can position it better They can push it they can, you know, make sure their pharmacist say hey Did you know that you know, you can tell your doctor about blah blah blah and we have this and maybe you save X amount Of dollars or whatever, you know, so There’s certainly gonna be some yield opportunities there Um, and I think it’s [01:12:00] likely we see more, um, of, of this more, more white labeling and more, you know, branding of these kind of, uh, copycats across the, across the board.

Vic: I think so too. And I’m going to give Cuban credit. I think. They don’t do this without Cuban starting his, um, drug platform.

Marcus: Yeah, yeah. I think that’s right. I think that’s right. I think, and, and, and look, Cuban is, is not done. I mean, you know, Cost Plus Drugs was the beginning, but, uh, you know, I, I heard that podcast, you know, with Lex Freeman that he did.

Yeah. And I think he’s, he’s got a full, full agenda on the healthcare industry of stuff he’s going to go, go tackle. Which would be great. It’s good. It’s good. It’s good. He’s, uh, he’s good for the space and he’s viable and he’s got the capital on the platform and the brand to actually like get it done and, and instigate and do things.

Unlike

Vic: a publicly traded company like Walmart, he can sustain losses. And I mean, if he decides he wants to do it personally, he’s going to do it. That’s right.

Marcus: That’s

Vic: right. Um, all right. And then Walgreens. Walgreens also [01:13:00] has a, uh, thing this week, they bought 300 ish specialty pharmacy, uh, groups with cell and gene therapy across the country.

I

Marcus: think it’s really smart.

Vic: This is, this is a better move. They’re both, both are good, but This is much better higher margins.

Marcus: Walgreens needed a better

Vic: move.

Marcus: So I think this is really smart. You know, high margins, uh, limited access from a, from a supply chain perspective. Um, and it just kind of stabilizes what felt like a free fall for this brand.

I mean, you know, I look, Walgreens is my personal pharmacy for our family. And it’s, it’s, you know, they’ve got great locations in Nashville. So that’s, that’s part of why they are our pharmacy. Everywhere.

Vic: I mean, that’s their thing.

Marcus: Yeah. But I, but I hate to hear like, The constant stories about what’s happening at corporate, the challenges, you know, all that kind of stuff.

So I enjoyed seeing this, this headline, um, and I, I hope they figure out a way to turn it around and, and, uh, you know, offer more things, get, get back on the offensive. Cause they’ve been, they’ve been reeling for a little bit. Um, [01:14:00] you know, their, their clinic stuff kind of backfired. Not sure how the village MD thing is actually going, but specialty pharmacy pharmacy should

Vic: be able to do that and make a decent amount of money.

Doing it.

Marcus: Agree. Agree. Uh, okay. A couple of health health system earnings, uh, results. We’ll, we’ll move through these pretty quickly. HCA just sort of nailed all there.

Vic: Yeah. HCA they’re doing really well. The, the volumes are. Really high. And the patients are, you know, high acuity. Yep. So, and,

Marcus: and tenant also following suit.

Yep. Yep. Same situation.

Vic: Well, they both be, both stocks did well.

Marcus: Yeah. I mean, they really have turned into the two big juggernauts and the for profit space, haven’t they? I mean, just HCA and tenant kind of. neck and neck, you know, with the quality of the results, you know, the size of the platforms that they have.

Um,

Vic: I think they’re by far the best properties, the best management teams, the best platforms, really, really. What’s interesting is the, it used to be that the payers were kind of inversely correlated from the health [01:15:00] systems. Right. We’re like, if one was doing well, the other one wouldn’t do well. And they’re kind of both doing well now.

Marcus: Well, in the case of these, they just have such really strong relationships with their pairs, which is part of why they do so well. Right. I think

Vic: it is probably impacting Lesser positioned health systems. Yes. They’re not a profit. So we don’t see it.

Marcus: Exactly. But when you’re in a really good market and you’ve got really good coverage and you’ve got really good specialty groups and just really strong networks and great markets, I think that’s basically it.

Um, and Emily brought this up, uh, last time we talked, if you are a health system with a really strong network. In a really great market, you have a lot of leverage in your negotiations, period, and a story. And so you’re not so much divergent from, you know, how the payer performs versus how you perform, right?

There can actually be some, uh, you know, rising tide lifts all boats in those situations. Uh, okay. So a couple longevity stories. No, no, no, you go ahead. I mean, I mean, [01:16:00] he’s jumping around. Yeah, I gotta like scroll down. I can’t like look at that. Yeah. So yeah, so Wall Street Journal has this guy is a Harvard geneticist.

His name is David Sinclair. I’ve like seen him, you know, around a couple times, probably on Twitter. They’ve got this really kind of freaky bouncing around, you know, that kind of feels like a hit piece when they do that, you know, they have a weird photo of somebody like moving around looking kind of synthetic.

But anyway, this guy basically says he’s he’s cooking up a cocktail that That treats aging as a, as a disease, right?

Vic: Yeah. And he, and he is, he is using that cocktail himself, himself, but he also is selling it for your dog. Oh, and as part of that deal is you have to, I think, collect data. For him as part of the thing with your dog.

Got it. And so, um, I don’t know. I think it’s interesting. Um, And we had three stories about longevity. So, um, anyway, this is david sinclair from harvard Okay,

Marcus: second one is around scientists [01:17:00] uncovering a powerful link between dietary choices and brain health So the reason why you asked if we should cover it the reason why I wanted to is because um, I recently signed up with this group called wild health and they ran a whole bunch of um, Genetic stuff on me and they came up with Uh, you know, links to, in Kentucky, um, maybe, I think I know Wild Health.

Wild Health, okay. Well, the, it’s, it’s like telehealth, but it came out of CrossFit actually. Okay. Well, they, they, they run your jeans and then they give you like this, um, it, it’s actually really great. Uh, they give you this, this whole sort of health story, um, with every single like snip. And they kind of go through each one and they’re like, Hey, this one maps to, you know, this particular disease and it tells you sort of how, how it’s certainly currently rated.

Um, and so they, they have this connection between

Vic: nutrition advice.

Marcus: Yeah. I mean, they basically tell you like, you know, do you have any allergies to celiac? Are you lactose intolerant? Blah, blah, blah. Like all that’s actually encoded in your genes and you can, we now have enough information to see that. So one of the things that, uh, I learned in that [01:18:00] conversation.

Was, you know, some of the advanced findings from a nutrition perspective as they relate to, um, brain health and neuro, um, neurodiseases and especially things like Alzheimer’s and dementia. And one of the things that the, you know, the doc was sharing with me was, um, you know, early indications that creatine, for example, is like really, really good for long time, long term brain health, which I hadn’t heard before, you know, it used to be, they said, you know, Hey, take your creatine like an hour before an hour after a workout for muscle development, but they’re now starting to find all these other things that creatine is like really, really good for, and they’re learning that it has nothing to do with like, not nothing to do, but it’s not as much about taking it right before, right after a workout.

It’s about a saturation level. So he was like, no, you can take it every day. Just like take it every day and like get your body. Make sure

Vic: you have enough of it. Yeah. Yeah. Just

Marcus: up your baseline of it. It’s it’s like creatine, a lot of vitamins like

Vic: that. Yeah. Magnesium,

Marcus: zinc, zinc. These are all things like you just want saturation and [01:19:00] absorption.

If you

Vic: have too much, it’s not you process it. It’s fine, but you need to have enough.

Marcus: Right. And it’s like, it’s just the connection between gut health, brain health and, and. Newt, and what you put into your body, how it actually is affecting your brain. Um, so, and not much more I want to say than that, other than this is an area people need to, you know, look, if you’re like me and you’re just constantly trying to be sovereign over your own health and you’re hacking your own stuff, hacking is a, has a bad connotation, but you’re constantly trying to learn in this space.

Look into brain health and nutrition for sure. There’s a lot of information that is emerging around this. Brain health,

Vic: nutrition, and gut health. There’s a good Netflix documentary right now about gut health. I can’t think of the name. And then we’re going to have Lauren Driscoll next week. Oh, good. I recorded a couple weeks ago, but she’ll be on talking about NourishRx and her.

Marcus: Yeah, and then sleep, right? Which is another huge one, actually, for brain health. Like, you need, you need good sleep. Um, but, but, I learned this from my aura ring a long time ago. Um, what you eat [01:20:00] and when you eat impacts your sleep. Basically, like You need

Vic: to give yourself a little time after dinner before you’re going to go to sleep.

Marcus: Oh, and I need to ask my friend Stan Frencher this, uh, what he thinks about this. But the doc actually told me, um, that, uh, for, for guys with a potential risk of prostate cancer, How close you eat to bedtime actually has an impact on that. So I, I need to fact check that with a couple of other people, but I thought that was an interesting thing.

I was like, yeah, that’s, that’s, that’s interesting. So anyway, we’re all, we’re really saying here is a, we’re going to talk more about longevity and B. These are just areas to look into, right? It’s longevity is an emerging space. It doesn’t fit into the. Uh, I don’t know, sort of standard canon of health care and a lot of physicians, and I’m friends with a lot of physicians, feel like a lot of this stuff is kind of, you know, kooky and or out there and at the same time, they are admitting there’s something to it, right?

They’ll say both, you know, yes, and right. So, um, yeah, it’s just a space I’m certainly interested in. And

Vic: yeah, I’m looking at a sleep investment right [01:21:00] now. So that’s how I came across this. Oh, cool.

Marcus: Uh, all right. Into our AI, uh, review. So. GitHub Copilot Workspace. This is on the Microsoft side of things.

Vic: Yeah, so GitHub, for people that don’t know coding that well, it is a sharing repository.

Millions of people, a lot of people are on there. Lots, big community. Microsoft bought it maybe five years ago. Um, and they have CoPilot, which is AI coding assistant, sort of like a pair programmer, like one, the human is working and then the AI is working as well. And then they just launched Workspace, which takes that, uh, technology, but puts it in a, in a UI where you can easily, um, complete projects just with the human providing English.

So I want to write a front end user interface in Redact. And I wanted to have these buttons and you just taught you just type in kind [01:22:00] of like a normal prompt and then it does the functional spec like what it makes sure that you’re saying what it’s going to actually build clearly that it does the um libraries review and like we could use this library in this library in this library and then it actually will say here are the components we should write and then it will write it all you can test it You In like a, in the interface, so you can see it run and it’s designed for GitHub.

Our listeners might not all know, but GitHub is a sort of an open source community. So if there’s a bug in a, in a program, it will get highlighted and the community then tries to fix those things. And you may be able to explain it better. But well, yeah,

Marcus: I mean, that’s, that’s one feature of it. It’s, it’s basically an online place where people.

Um, write software collaboratively. And so it’s for everyone contributing to code together as well as fixing code together, um, as well as discussing code together. So it’s all those things. It’s like a place where you, you code collaboratively, you fix [01:23:00] code and you also discuss code.

Vic: Yeah. So they launched this in the issue resolution aspect of the open source community.

So you can grab an issue. And Workspace AI like takes all of the other code repositories and all of the notes from the whole thing and then fixes it.

Marcus: So, so Vic, uh, why do you think this is noteworthy?

Vic: I think it’s noteworthy because it is the second time where it’s been like AI has been embedded into an IDE, which is a development environment where you can actually build stuff.

Mm hmm. Mm hmm. In a way that, you know, a tech savvy ish person like me that can’t code understands it. And I signed up for the wait list. I’m not in right now. It’s a very slow roll, but it looks like you [01:24:00] could actually. I mean, so the, the, um, the Nvidia CEO made headlines by saying that English is the next coding language, uh, which is a cool meme, but it’s not real.

Like I I’m on a bunch of AI tools and it’s not real yet. It will, any of the tools I use will spit out the code I need for, for a redact front end, but I can’t run that because I don’t have, I don’t have an IDE to do it. I don’t know how to compile it. I don’t have the, all the libraries set up. I don’t have my environment.

I don’t have an environment. And so what I think is interesting about this is they’re starting to build out that infrastructure. Like the core AI was exciting last year, but now Microsoft’s building out like the rest of the tool set that I think could be really important. Okay, I mean, you’re a developer, or you used to be a developer, so you may have a different view.

Marcus: No, [01:25:00] no, I want to build on what you just said. So I, first of all, your reason for thinking this is important is 100 percent valid. There’s nothing I can say to say that that’s not valid. I agree, and I happen to agree with it. I think. That’s exactly that’s a very good reason to think this is important. Let me build on that a little bit.

Um, I, I think the fact that it has you excited about that says one thing. And then there’s a second thing that I want to point to. So the fact that it gets you excited. Is important because you’re a non coder, right? And it’s getting closer to enabling people who don’t have a specific skill set to perform a skill and fill all those gaps just by by way of their ability to articulate what it is they’re trying to get done.

And that’s what Jansen Wang from Yeah, that’s what his vision is. That’s what he’s saying, right? And it’s, you know, whether or not it’s there or not. Once you actually get off the wait list and you test it. [01:26:00] The notion of it, the notion of it has you excited, right? Okay, so that’s, that’s one thing. I think the second thing is, we’re going to cover AI on this show every week.

I think people will say, well, you know, you talk about AI too much. I think the reason why we’re doing it and why we’re going to keep doing it is because I want a record of us tracking the progress. Right. To the point where we actually get to AI that’s valuable, AGI, Artificial General Intelligence, and then ASI, Artificial Superintelligence, right?

Um, I want to have a record of us talking about it and tracking this process. And the reason for that is, when we look at GitHub, what we are seeing is the coding space. And of course, this is going to be the environment where they will most, they will best figure out how to integrate large language models [01:27:00] Into a workflow that’s actually viable, like the problem today is we have these general purpose LLMs and no one can figure out what the hell to do with them, right?

They’re not put into a context with very specific guardrails designed around user experiences that are for specific people, specific groups of people. But we do in the coding space, right? In the coding space, they’re actually leveraging AI every single day. Coders are using AI today every single day.

Vic: The studies I see, Copilot makes an average developer something like three times more productive.

Marcus: Developers are using AI every day, right? Even if you in the general public, we in the general public. Yeah, are not. We feel like, ah, this stupid chat GPT kicked out this thing. It’s like, I’m not going to use it. The developers using it every day, y’all right? Okay, they’re using it every day, and

Vic: they’re three to four times more productive.

Each of them.

Marcus: Correct. And so tracking what’s happening in the developer space gives us a view [01:28:00] into what might happen in the doctor space. What might happen in the medical billing space? What might happen in the V. C. Space? Right? Like just Yeah. We should take some time and, like, reverse engineer what’s happening inside of GitHub Copilot Workspace.

What did they actually do here? You know, what human process did they replace? How did they replace it? What is the UI? Where did they inject the AI specifically? You know, because you might be able to think about a medical workflow and think about, Oh, right here. This would be the place where you would put a specific medical LLM in.

You know what I mean? Yeah. Right. So what does IDE stand for? Integrated development environment.

Vic: Okay, so that is an acronym. I think almost every developer uses some kind of environment where they’re coding all day. And I think Microsoft took the existing I show up in the morning, get my Starbucks and start working, the existing UI, and they [01:29:00] integrated AI tools to make the kind of the monotonous hassle aspects of coding and um, automate it.

And we could do that in health care. We could find parts where the can I can I can I tell you what the

Marcus: difference is? Yeah, well, the place where that’s likely to happen is epic. The place where that is most likely to happen is, well, not just EHR, Epic as an organization, and I’ll explain why. The reason why GitHub is the logical place for this is because GitHub is the place, the company, the organization, the team, that has obsessed about how developers work.

They have obsessed about it. Everyone else made IDEs. GitHub went so much deeper into the psychology of how teams, whether they be official teams like a company, or open source consortiums that sort of come to passion projects, yeah, how do [01:30:00] developers and the other associated people that work with developers, quality assurance, you know, user interface design, blah, blah, blah, how do these people actually work and collaborate, and they’ve been building tools for that for, you know, You know, well over 10 years now, so that that’s, of course, the right place to because these are people who have obsessed about that.

And I would say the problem in the medical space is you don’t have a lot of people that have obsessed about how doctors work like it’s been the opposite. It’s more like, Hey, you stupid doctor. Use this tool like, Yeah,

Vic: well, and unfortunately, with the with the HR rollout, we Financially incentivize health systems to put it in right, which was good and bad.

It drove adoption, but it also didn’t really drive utilization in a way that was natural and organic. It was sort of, well, we have to hit meaningful use threshold. So let’s, let’s force people to do it. And so [01:31:00] you have this weird, it’s, you know, we have digitized everything, but it isn’t been fully integrated into the workflow.

Okay. And I think you’re right, not many people have thought that through, and Epic has thought it through the most.

Marcus: More than anyone else, I mean, whatever you want to say about them, there’s a reason why they have the most adoption today. I’m

Vic: hopeful that Oracle can get their act together. That’d be cool, to have this discussion happening.

I mean, they have, they have, uh, they have I mean, they don’t have as much market share, but they have 25 percent or they have a decent

Marcus: 30%. I don’t know that it’s for sure across all Ascension, but Stern is what they use at St. Thomas.

Vic: Yeah.

Marcus: So maybe they have Ascension and that’s pretty big. Yeah. That’s pretty big.

All right. Continuing on the AI stuff. So, uh, quick, quick hits here, both Amazon and Meta. Um, have both publicly come out after, you know, cutting all sorts of jobs last year, both of these companies, and they basically said, Hey, we’re going to invest in AI. So they’re back on the investments in the R and D stuff.

Meta’s stock temporarily dropped. I think [01:32:00] it’s back up now. I think most people were really worried that that meta was, um, uh, you know, going back down their whole metaverse oculus quest, you know, path in terms of we’re going to build out this R and D was a horizon labs. We’re going to build this whole like metaverse thing has been billions of dollars on it.

And, and, uh, you know, the truth is AI and, and the metaverse are not equivalents, right? These are not equivalents. Um, you know, meta needs to invest in AI. AI can have a material impact on their core business. You know, unlike some goggles, AI can actually make their ad engine significantly more efficient and effective, right?

They need to invest in AI.

Vic: Have you played with it on WhatsApp? I mean, there’s, they have like 40 AIs in there that will chat with you. It’s crazy. I, I, I

Marcus: haven’t cause I just. I don’t trust the meta company, so I just I just don’t I mean, I use WhatsApp, but I’m not gonna I’m not gonna engage with their I just did it for fun

Vic: to test it out, and it’s, um, I mean, I just have

Marcus: an

Vic: issue with they are, [01:33:00] I think they’re sort of really kind of, uh, they’re open sourcing it, and it’s really good.

So it’s gonna drive the. Business model progression pretty quickly, I think, but but their goal is not to make money on the AI. It’s just to keep you in their walled garden looking at pictures and their ads and all this stuff. That’s their

Marcus: game. It’ll be good at that. That’s one of my problems with them. I have a history with them and, you know, Whatever.

All right, let’s keep moving. Uh, so Google has, uh, continued to step up. I feel like every week we’re going to talk about which company released a new LLM that is now beating other companies on the, on the benchmark. So this week it’s Google, um, and they have released a new. Medical specific AI, uh, model called MedGemini.

So they’re, they’re moving in the direction of branding all their stuff, Gemini, um, and, uh, it surpasses GPT 4. So again, two shows ago, you and I went through the hugging face leaderboard and we were talking about how GPT 4 was the top LLM in the, in the medical space. So we go back to [01:34:00] the frigging hugging space thing.

Uh, you know. Two weeks

Vic: ago, GT four was the best, I think.

Marcus: Yes. And, and now. And now Google’s, LLM, uh, which is Med Gini is ahead of GPT four. Yeah. And that’s, that’s just the pace

Vic: that we’re at. And LA they were third, we can’t show it, but they were third one of the Lama derivatives was,

Marcus: was also

Vic: up there.

Marcus: Yeah.

So that’s the point, you know. And last week, Meta was the one to release their stuff. Every week, another one of them is going to release another one. That’s the, that is the pace of this race, y’all. That is the pace of this race. It is moving

Vic: so quickly. And it’s diminishing returns, right? Like, the models are very good now.

Yeah. And now I’m 2 percent better. Yeah. What we need next is integration into the, our, our workflow, how we work. That’s why I was excited about the GitHub, the GitHub one. Right. They’ll keep getting better, but they’re already good enough.

Marcus: Okay. Last story in this marathon comeback show for us. Uh, Kaiser in the AI space.

Talk about it.

Vic: Yeah. So they are partnering with a company called. [01:35:00] Innovair, I say that right. Innovair? Uh, I

Marcus: think it’s Innovaccer.

Vic: Innovaccer,

Marcus: yeah.

Vic: To roll out AI across their, their systems in the state of Washington. Um, and so this is, um, a huge, uh, AI company in India and San Francisco. Mm-Hmm. and, uh.

Kaiser has already invested in them. It’s a good, it’s interesting because it’s, you know, it’s a big health system picking a new partner that is not in the top five. Um, and so that’s, that’s pretty interesting. They are looking at replacing their, uh, electronic health systems. Record with this so that they are able to interact with any health record, wherever it is through this tool That’s what they’re talking about.

I mean how easy that is to do or possible I don’t know, but that would be great if we could do that,

Marcus: dude I think we got to spend more time looking at kaiser man. I mean kaiser’s great They’re they’re they’re operating like on a different [01:36:00] level, you know, like they’re they’re in sort of west coast California a little bit in colorado, so we don’t get to talk about them very much Now obviously they form form ryzen with with geisinger Um, they’re going to keep the Kaiser brand, obviously, but, um, you know, just the way they operate, it’s so different, you know, so different than the Nashville, so different crowd.

Yeah. Yeah. And, and, and I, I mean, they come across to me is very capable, right? I mean, have you been to Kaiser headquarters?

Vic: I have not been to

Marcus: headquarters, no. We need to put that on our list of things to do. We need to, like, make some connections at Kaiser. I know

Vic: the VC crowd. I can talk to the VCs there.

Okay, well. We can start there. Yeah,

Marcus: let’s start there, man. They have

Vic: a good corporate VC. But they are, it’s a different model than the for profits. Because they’re a non profit, but they’re a pay vider. They’re a pay vider. So they have the whole thing. Yeah. You’re in the, you know, you’re kind of in the Kaiser Permanente world.[01:37:00]

Marcus: All right, man. Hour and 30 minutes later. Yeah, yeah, yeah, yeah. Uh, we, we finished the show. But anyway, look, lots of good stuff to cover. Uh, great job putting the show together. Looking forward to you releasing the show next week with, uh, Lauren Driscoll from, uh, from NourishRx. And we had

Vic: our first in the series of Heart Health.

Great Oh, yeah. Yeah. Yeah. That was

Marcus: fantastic. Good job on that. Um, and then as always, we will be back next week with another, uh, roundup of the news. Yeah. All right. Until next time. Bye.