84 – Can Your AirPods Now Replace a $5,000 Hearing Aid?

[00:00:00] Marcus: If you enjoy this content, please take a moment to rate and review it. Your feedback will greatly impact our ability to reach more people. Thank you.

[00:00:07] Vic: All right, buddy. How's it going? It's going well. Another week. I'm excited to get to the weekend. It's been a long, long week.

[00:00:13] Marcus: I know it has been a long, long week.

[00:00:15] Marcus: We were both remarking how we, uh, we're just feel tired today. Uh, well, the show must go on. That's right. The show must go on and we will not burden our Faithful listeners with, uh, hearing us whine about how tired we are or do too much intro talk because we have to do a short show today because I got to get to a date with my wife.

[00:00:34] Marcus: So, um, let's dig in

[00:00:47] Marcus: first thing we're going to talk about is inflation. I can't believe it hit 2. 5 percent Vic.

[00:00:54] Vic: I mean, it's getting close to rounding down to two to two.

[00:00:57] Marcus: Yeah.

[00:00:58] Vic: You know, this is

[00:00:58] Marcus: probably the point where [00:01:00] we should just say, we've been doing this for a year and a half and we cover these stories. We should just never say never.

[00:01:08] Marcus: Right. Yeah. Cause like, we don't know what the hell's going to happen. I mean, we cover it every week, but it's, it's, things can still blow our mind all the time. Right.

[00:01:16] Vic: Yeah, that's right. I mean, I, I was not expecting it to be a two and a half. And. I mean, we have several stories. It now seems like the risk is that, um, the economy's getting much harder and inflation is coming down a lot.

[00:01:32] Vic: So, the Fed, you know, I think needs to step in. I re looked at the odds like we did last week, and it's shifting more to 25 basis points. Kind of a

[00:01:42] Marcus: prediction. Because the job stuff was not great, but also not that bad. Yeah. So, it's kind of a frustrating jobs report. You know, it's, it's hard. It's screwy where you're like hoping for worse results.

[00:01:52] Marcus: I know that's that's the bad thing about all this, but let's dig into some of the some of the signs of cracks in the facade. So, [00:02:00] um, Ally Financial, which is a, uh, an auto lender, um, their CFO surprised the market by saying, This last quarter was kind of a disaster in terms of credit quality.

[00:02:10] Vic: Yeah, they were at a Barclays, uh, financial institutional kind of a conference and the CFO came out and said that not only is the borrower struggling with high inflation and the cost of living, but also, uh, really weakening jobs environment.

[00:02:26] Vic: And that was not expected. And so Ally stock went down, but the entire segment that brought the category down, brought the whole category down. So there's going to be, um, you know, more delinquency, people struggling to make payments because they don't have jobs anymore.

[00:02:41] Marcus: Yeah, I mean, the pressure is real. Um, you've been tracking China for a while now.

[00:02:47] Marcus: You've been talking about the deflationary issues there. Just for listeners to put this in perspective. You know, China is basically the world's manufacturer. And, um, when demand goes down, when, when people stop buying things, well, that puts pressure on the manufacturing hub [00:03:00] of the world.

[00:03:00] Vic: Yeah, and they've been trying to do stimulus over there.

[00:03:04] Vic: The government's put a bunch of stimulus out already, and they cannot get the economy really going because the rest of the world is slowing down. Right. Um, so the, the inflation in China, their, their consumer prices is really at zero, but the producer prices, which is what, you know, the raw material inputs, and then also as they sell things to us, to the rest of the world, what price they're getting, that's below zero.

[00:03:28] Vic: Yeah, those prices are down. Yeah,

[00:03:29] Marcus: they're losing value. Yes. Right. In what they're

[00:03:31] Vic: producing, which is bad. So, to me, that says that, I think, in, on a longer time, right, I don't know how long it takes to propagate through, but our inflation will go down almost inherently. Right. Sometime later if China's is going down.

[00:03:45] Vic: That's exactly right. Yeah, at least for some period of time. So, I think the Fed can, they can cut, you know, 100 basis points, 200 basis points. That would help my portfolio.

[00:03:54] Marcus: It, it, it does feel like everyone is starting to worry a little bit that. We [00:04:00] are slightly late, right? You know, you don't hear all sorts of alarms going off, but there is more and more conversation about the Fed is late.

[00:04:07] Marcus: The Fed is late. The Fed is late, and it would not be out of the question for them to be late because Jerome Powell is fully data dependent. He only deals with data results. He's not forward looking at

[00:04:19] Vic: all. I guess so, but you could look at China data and still be data dependent. Could look at Ally Financial's credit.

[00:04:28] Vic: Borrowers having, you know, harder time paying. Well, that's the data points is

[00:04:32] Marcus: new data.

[00:04:32] Vic: Yeah. Yeah. But I think like he doesn't need to only look at his own BLS data. There's other data sources out there, but I don't think he actually, I don't know what he looks at, but

[00:04:42] Marcus: this article from the wall street journal headline, it unemployment hits 6 percent amid overall us jobs growth.

[00:04:49] Marcus: So gosh, Vic, this was the one that, that jumped out at me because, uh, How long ago was it you and I were talking about this is before AI yeah happened Yeah, [00:05:00] and I've told you I thought that the the no code movement had gotten to a level of maturity Yeah, this again before I think it was

[00:05:09] Vic: maybe two years ago I was trying to learn some basic coding stuff and you said don't worry about it English is the coding language.

[00:05:16] Vic: Yeah Something like that.

[00:05:18] Marcus: Yeah, and this was definitely before ChatGPT. I could just see where everything was going. It was very clear. As a programmer, it had gotten so obfuscated from even what I had dealt with, you know, in terms of like really writing server level code and picking apart frameworks. But this, to me, is a pretty scary headline.

[00:05:37] Marcus: IT unemployment hits the roof. Six percent amid overall U. S. jobs growth. So, like, we gotta just frame this up. First of all, that is higher than overall unemployment. Yeah, unemployment is four or something. Yeah, by almost two percent. Yeah. Okay. And we're talking about the industry that is most going to leverage AI and [00:06:00] streamline their businesses, right?

[00:06:02] Marcus: Um, and you know, so they're, they're cutting unnecessary business units. Plus they're leveraging AI and automation to do the work of, of, of humans. And if you've ever played with any of these LLMs, they are pretty good at coding in terms of, you know, You know, being able to replace a junior coder. I'm sorry.

[00:06:19] Marcus: They just are. They just are. Um, and so this 6 percent number, I think what's so scary about it is even if the Fed starts to bump up the basis points and, you know, we start to lower the, the, the Fed fund rate, I don't think this number goes down anytime soon. I, I actually think it's going to increase because this is the arms race that these tech companies are in right now.

[00:06:42] Marcus: Yeah. Right. It's how, it's, it's how do they maximize employee revenue per employee, right? That's the metric. I mean, I

[00:06:50] Vic: think like from my point of view as an investor, or like we invest in high growth startups and typically you'd have the founding team. Usually [00:07:00] you have a really good technical person that's architecting what it's going to be.

[00:07:04] Vic: and a sales visionary, someone on the other side. And then for 25 years after they got proof, you know, kind of their product working, they got the people, the product market fit is starting to be bought. You'd have to hire 10, 20 developers to build, you know, a scalable enterprise kind of grade system. And I don't think you need those people anymore.

[00:07:26] Vic: You still need the technical architect. You need the, the man and woman who's designing the whole thing, but that Transcribed Big group of developers to sort of make it all work. I don't think you need many of those, if any. So, and then the problem is that these are white collar, you know, fairly well off.

[00:07:46] Vic: Folks and I don't know that there's gonna be a lot of new jobs coming up I mean look

[00:07:53] Marcus: big tech has become a big employer right a massive employer Yeah, and [00:08:00] in the United States and they've been the one leading the way over the course of the last two years with layoffs You know Zuckerberg kind of really started the process But they're not stopping that, you know, everyone else kind of chilled They're continuing to do these rolling

[00:08:15] Vic: layoffs.

[00:08:16] Vic: Well, I think they've found that as they cut middle management and even automate some of the jobs that humans used to do in, you know, things like QA in a website or. I don't know, changing the way a report works in a database that now can be automated, right? And so you don't need people and it's much cheaper and more effective.

[00:08:37] Marcus: Uh, let's move it to VC Microbiome Health Science Company. Viome raises 25 million to build out its diagnostics division. So gosh, you know, just various stories in the diagnostic space. So there was a lot of fear around the FDA and some of the new regulations they were sort of putting in place, sort of, uh, impacting, uh, Uh, lab designation and the ability for venture backed startups to be [00:09:00] able to do diagnostics.

[00:09:01] Marcus: Um, but now we're seeing, you know, money going into, and Viome's a pretty big name in the space. So, you know, it's, it's, uh, it's, it's certainly good to see this happening in terms of consumer diagnostics, um, you know, cancer detection and things of that nature.

[00:09:16] Vic: Yeah. They're really a longevity and, um, People that are really interested in getting in front of their health.

[00:09:23] Vic: I'm one of those people. And so they are building out that space trying to detect cancer early or in other things early so you can, you can get in front of it. So I think it's good.

[00:09:36] Marcus: All right. Next story is, uh, SpectraWave announces 50 million series B financing to drive commercial expansion and product additions to the HyperView imaging system.

[00:09:45] Vic: Yeah.

[00:09:45] Marcus: A

[00:09:45] Vic: lot of words there. It's a cardiovascular, uh, imaging system. Intervascular, like inside the vein, as you're gonna put a stint in. Um, I've gotten interested in cardiac stuff and it's [00:10:00] a, you know, it's a big group of investors. Deerfield and J& J are big, big investors. So, you know, I think good and I think pretty.

[00:10:09] Vic: Not gonna change everything, but be really helpful and pretty extensive.

[00:10:12] Marcus: Yep. All right, and the final story Habitat Health announces the founding leadership team and more than 50 million in venture capital investments This is one that I knew about because the chief medical officer Carmen Peralta is an Aspen fellow alongside Yeah, and and she's actually in the class B before mine, but she graduated with, with our class.

[00:10:33] Marcus: So I got to celebrate with her in Alabama and she's, uh, she's brilliant and also an absolute sweetheart. So I'm so happy for her and the rest of that team. This is a Pace business. So it's backed by Kaiser Permanente, but they are starting in California and they are delivering Pace services. So, you know, one of my investment thesis is that the Pace market is going to continue to grow.

[00:10:54] Marcus: Um, that there are, Uh, you know, very, very, um, uh, fragile [00:11:00] populations in the dual eligible world where pace is the best model for them. Um, and glad to see Kaiser, you know, lean in and, and get this new business off the ground with, with a great leadership team. Yeah. Yeah, I agree. Uh, all right. So just a little bit about what's going on in VC.

[00:11:17] Marcus: Carta sends out, uh, Peter Walker, who leads a data insights at Carta. Um, they send out a great email to those of us in the, in the industry, we're gonna start to incorporate them a little bit more because I think they've got. You know, I think as far as they've got, they have at least half the market on their platform.

[00:11:33] Marcus: So they've got statistical data that's relevant to, to us and they're constantly giving us more and more insights about what's happening in the market. So I thought this was an interesting one to kind of bring up because we've been going through about 18 months of down rounds. Right. Uh, and they put out their data minute, uh, this week and they said, are we past peak down round?

[00:11:52] Marcus: And it does appear that in, in 2024, we've started to kind of go back up in terms [00:12:00] of the percentage of all rounds that were down rounds in a, in a given quarter. So it seems like. We've done all the corrections, you know, down rounds for us are corrections, basically. And it seems like we've done all the corrections we really needed to do.

[00:12:11] Marcus: And now we're sort of moving back down into regular flat to up rounds again.

[00:12:15] Vic: Yeah, I think that's right. So just people that are listening and not watching, there are always some down rounds. So the chart shows it. It's kind of like. It's, uh, 8, 5, 10 percent in general. And then when you have, um, you know, really high valuation times and this typically, uh, correction, which we've been going through since, uh, You know, early 2022, and now it's starting to turn back.

[00:12:41] Vic: It peaked at maybe 30 40 percent of the rounds were down. I mean, now it's coming down. I mean, 30 40

[00:12:48] Marcus: percent of the rounds being down is Yeah, it's rough. That's, that's a, that's a big correction. Uh, alright. Big news on the policy side, the White House and, you know, look, we got two more [00:13:00] months of the Biden administration.

[00:13:01] Marcus: So it's unclear what the long term implications of this, but the Biden administration puts a rule in place that requires insurers to pay for mental health, the same as physical health. So, uh, as you put it, it's kind of like a title nine situation where it brings parity to the two different forms of health care.

[00:13:16] Vic: Yeah. Yeah. And I think, I mean, payers, especially employers are worried about it, but I think it seems fair. If you are struggling with mental health or you're struggling with a hurt hip, yeah, I mean, you still need to get it fixed. So, just because we can't quantify it and measure it or see inside, Um, you know, the cognitive part of the brain doesn't mean we shouldn't cover it.

[00:13:41] Vic: Yep. This was meant to be in the Affordable Care Act, but there were various loopholes that allowed people to sort of escape it. So over time, they've been closing and trying to correct that. I think it's healthy. I mean, you know, I was a male athlete in college when [00:14:00] Title IX came out. But it, it's healthy.

[00:14:02] Vic: It helped everyone, really. I mean, it didn't hurt the, I don't think it would hurt the medical side to increase behavioral health, mental health treatments and access. Yeah,

[00:14:13] Marcus: yeah. I mean, look, it's going to be a shift. It is going to, uh, upset some costs. It's probably going to make things tighter for health plans and for employers.

[00:14:22] Marcus: Um, but all actions have an equal and opposite reaction. So we'll see. What lobbying groups say, we'll see what the employers do. We'll see what things get cut back. Um, it'll just be interesting and I'm hoping we'll see what innovations can actually, you know, enable this to be done. Well,

[00:14:38] Vic: yeah. I mean, one of the issues is that a lot of providers in mental health.

[00:14:41] Vic: Don't want to be a network. Right. But I think there's a way to solve that. You need to increase their contract rates. Yeah,

[00:14:47] Marcus: exactly. That will fix it. That's right. Um, alright, so Harris and Trump square off on abortion and Obamacare in the first debate. Um, this was debate week. Yeah. And um, look, it [00:15:00] was probably about The level of debate people could have expected, um, you know,

[00:15:08] Vic: I

[00:15:08] Marcus: thought

[00:15:09] Vic: it was a good forum.

[00:15:09] Vic: I mean, turning the mics off and having no notes are both good innovations, I think.

[00:15:14] Marcus: Yeah. And also no, no audience. Um, I think was, I think was good. Um, you know, Kamala Harris, I think was more of an unknown, right? People have seen her do speeches, but they You know, the only debates they saw her do were back from the last, you know,

[00:15:30] Vic: the world's changed a lot since then, and presumably she's changed a lot since then.

[00:15:34] Marcus: Yeah, exactly. And also, those were not one on one debates. Those were like multi party debates, and you're not really debating. In a primary,

[00:15:41] Vic: you're trying to get the base. Which is very different than very different, very

[00:15:46] Marcus: different. You're like agreeing with people, but you're trying to make your own little subtle points.

[00:15:50] Marcus: This was the first time we got to see her sort of one on one in a pure debate. And we know that she, you know, her background is a prosecutor, right? So she was trained in the courtroom. [00:16:00] And I think she showed her ability to sort of stand up in that one on one setting and keep her discipline around her points and her talking points.

[00:16:11] Marcus: Respond well to Sort of the the playbook of Trump that I'm using her words playbook But but you know, we've seen Trump in debate forums enough that you pretty much know what you're gonna get, right? Yeah, and she was well prepared. This is sort of the bottom line I think it was harder for him to prepare for her and I feel like that that showed You know

[00:16:32] Vic: I mean, yeah, I guess so.

[00:16:34] Vic: All he needed to do was not get so emotional and stick to policy, but he, but he can't, or he didn't at least.

[00:16:42] Marcus: But I guess what I would say is, um, she did things Joe Biden would never do, right? Yeah. Joe Biden would not have talked about how people were leaving his rallies, right? I mean, she, she hit him in the points of pride that really matter to him.

[00:16:58] Marcus: Yeah. And Joe [00:17:00] Biden wouldn't have done that. Joe Biden would have said, come on, man, everyone knows he would have done the Joe Biden thing. Right. You know, he would have talked about the American people, hardworking people, the right policies, what his administration did, what their administration did. You know, she took shots.

[00:17:16] Vic: I mean, it's a one on one debate. I think she had. a strategy. I was watching it with my 18 year old. She had a strategy to get her points across, but not go into a lot of detail. I think she doesn't, I mean, she just got nominated recently. I don't know if she knows enough policy detail. There's also

[00:17:33] Marcus: not that much upside to her going into too much detail.

[00:17:37] Marcus: Right. And

[00:17:37] Vic: then she very intentionally, I think, hit him with lines that were designed to foster an emotional response. So he would look bad to the TV audience and it completely worked.

[00:17:51] Marcus: Yeah. So, so anyway, I mean, look, I thought that the abortion part of the debate was probably one of the [00:18:00] most intense parts of the debate.

[00:18:01] Marcus: She, she brought up visuals of, you know, women bleeding out in parking lots. That was kind of a hard part to sit there and stomach actually. I think that visual sides. Pull out

[00:18:14] Vic: the extreme examples. Yeah. I mean, that's the other side. I mean, Trump's talking about the very few cases where it's a very late stage abortion.

[00:18:24] Vic: And she's talking about the few cases where a woman dies in a parking lot. But that's for a fact. They both use it. I don't like it because it's, it's You know sort of trotting out really terrible stories that are not the not really the main Line of really rough imagery

[00:18:43] Marcus: but

[00:18:43] Vic: terrible really rough both sides really rough imagery,

[00:18:46] Marcus: right?

[00:18:46] Marcus: Yeah, so Um, so yeah, and yeah, I mean,

[00:18:50] Vic: I think she did. I think she won it Uh, but then when you pull up the, uh, like the betting pools, the, the polymarket, so I use polymarket because people put real [00:19:00] money, uh, at stake versus, I don't know who answers a survey call. No, no, no. Polymarket

[00:19:05] Marcus: is, is, is where

[00:19:06] Vic: we should be going.

[00:19:07] Vic: And so it has changed maybe 1%. You can go down a little bit and you'll see the, um. The rate over time, the rate of change. Yeah. I mean it's not really that different. It's, it's, it's basically a dead heat.

[00:19:20] Marcus: Yeah, that's right. You know, um, it's, it's very, very hard to see who is gonna win at the moment. Uh, she is up 50% to 49%.

[00:19:29] Marcus: Right, right. Um, so that's pretty, I mean, that 50 to 49, that's tight. The

[00:19:33] Vic: error rate is probably the error Margin for error is probably more than 1%. That's, that's, that's pretty tight.

[00:19:40] Marcus: Um, all right, Steward Health. Gosh, I wish we could stop talking about this, but it

[00:19:44] Vic: keeps coming back.

[00:19:45] Marcus: Well, you're not going to be able to because this is, it's going to become a cornerstone case, right?

[00:19:52] Marcus: It's going to become a cornerstone case. Uh, Ralph De La Torre, who is the CEO of Steward Health, um, [00:20:00] he's becoming an infamous character. He's becoming an infamous character. More and more information is coming out about his, uh, management of funds, his personal use of funds, um, his allocation of funds to things that he deemed important, different philanthropic things that he wanted to allocate capital to, uh, some of the models that he used for acquisitions and or selling off parts of the business.

[00:20:28] Marcus: Um, and he was subpoenaed. By Congress.

[00:20:33] Vic: Yes. The Senate. This. This. Committee had not subpoenaed someone since 1981 because most people show up because they don't want to get in more trouble I mean, so yeah, I think about Zuckerberg has been I mean, there's been all the big tech I mean, this committee

[00:20:54] Marcus: is the is the committee on health education labor and pensions.

[00:20:57] Marcus: Yeah, this is like a very serious serious committee. [00:21:00] Oh,

[00:21:00] Vic: yeah.

[00:21:00] Marcus: Yeah.

[00:21:01] Vic: They this is a real deal committee. So he he refused to show he refused the subpoena, which I didn't know you could do. He's I don't I don't think you really can do it. I don't think you can. He's he was claiming that because he's his company's in a bankruptcy proceeding, he can't speak.

[00:21:19] Vic: I don't think that's actually correct, but but in show, um, and Bernie Sanders led off the committee. Um, showing his planes and boats and all the, all the money he wasted, he got personally. Um, and then today the Wall Street Journal came out with a very detailed Kind of following the money from Cerberus who invested and then, you know, took a dividend out, 790 million dollar dividend.

[00:21:50] Vic: See,

[00:21:50] Marcus: this is why we're not gonna be able to stop talking about the story. Yeah. Because, because, because the policy impact. Yeah, the private equity is under. That's right. The policy [00:22:00] impact that's going to be a response to this is going to be brutal. Yes.

[00:22:04] Vic: And then, um, C SPAN recorded the whole thing. Uh, it's like two hours long.

[00:22:11] Vic: I, I clipped five minutes that will include the show notes. It's a woman who's maybe like, uh, chief nurse. She might be head of nursing in, in the OR. I mean, an ED maybe. Uh, but she described, Uh, I think it was 15 deaths that occurred because they lacked supplies. And, you know, they were, they didn't have the money to pay creditors, so they couldn't get the supplies.

[00:22:36] Vic: It's a sad, the sad story. The media is not gonna let the story

[00:22:40] Marcus: go. Yes. The media is not gonna let the story go. The, the, um, you know, the, the different nonprofits that have been stood up to, to, uh, shine a light on private equity and healthcare, th this is going to really result in some. Some very tough policy stuff and then that tough policy stuff is going to have [00:23:00] Yeah, it's going to go too far and

[00:23:01] Vic: yeah, right.

[00:23:02] Vic: Things like in California where you can't do a private equity deal, right?

[00:23:05] Marcus: Yeah, right. Well, more of that's coming. More of that's coming, unfortunately. Um, all right. Moving into a good story. Yeah, yeah, yeah, yeah, yeah. Moving into industry, uh, innovation stuff. Applied VR's for Flagship VR device for chronic lower back pain now in network for Highmark members So this is a digital therapeutic and it's kind of in the universe of what Aaron Garnett's business does behave VR.

[00:23:30] Marcus: Yeah And it's being reimbursed.

[00:23:33] Vic: Yes, and it's I think great that Highmark is stepping out and agreeing with me and thousands of other people that think this is a real, it's an effective way. It doesn't mean you don't need rehab or Medicaid or, you know, pharmaceuticals, but using VR to help someone meditate and [00:24:00] understand how to sort of get their back pain more manageable through non pharmaceutical things is, is great.

[00:24:07] Vic: And we, of course, we should use an all of the above. So, I think we should just give credit to Highmark for coming out. Now, they, the VA has been using it, so they're not the first payer at all, but they're the first commercial payer. CMS doesn't, doesn't reimburse it. Um, so hopefully this will be the first of several, um, but great to see.

[00:24:27] Marcus: Big, big milestone. Yeah. For sure. For sure. Um, okay. Elevance is, uh, growing their Medicare Advantage business with an IU health deal.

[00:24:35] Vic: Yeah. So Elevance is already in, uh, Indiana, but they bought, um, like, um, Indiana University has a medical center and then they have a payer attached to it and they sold it to Elevance.

[00:24:51] Vic: So they're getting a much, they bought it bigger. market share. I mean, Elevance is growing quickly.

[00:24:58] Marcus: Well, but, but also aren't we [00:25:00] seeing now the importance of market share in Medicare Advantage? It's like you either got to be all in and have significant market share or you got to get out of the market, right?

[00:25:09] Marcus: So we, we, we've seen, um, back out of what was it 14 markets and they dropped the rules by 500 K in doing that. They said there's going to be more options for, you know, other options that some percentage of those folks will flow flow into. But the bottom line is there was not enough scale there to justify them continuing to do what they're doing.

[00:25:29] Marcus: Uh, in those markets here, we have Elevand saying we're going to go on the offense and we're going to grow, you know, our market percentage. Uh, percentage, they already had 22 percent market, uh, market share in Indiana. So now this is going to, you know, get them over 50%.

[00:25:45] Vic: Yeah. And, and the, the, on the other side, the, the IU medical center had the payvider whole combined system.

[00:25:55] Vic: I think they probably need money. And it's I think it's a little bit like [00:26:00] selling the You know, selling the furniture, but, uh, but okay, they have a way to get money.

[00:26:09] Marcus: All right. Uh, local innovation story, cadence and life points. Cadence is a, um, a pretty scaled up, uh, remote patient monitoring platform. Um, life point has been a cornerstone.

[00:26:19] Marcus: Uh, partner for them and continue to see more and more case studies about the effectiveness of life point leveraging caduce for remote patient monitoring. So this is another one showing how remote patient monitoring is going to drive better outcomes for rural patients.

[00:26:34] Vic: Yeah. And, and I've been watching for this.

[00:26:38] Vic: I don't know why health systems don't do more remote patient monitoring. You can get 100 to 150 a month per patient in order to keep up with them. And it's great. And so they have really good results in the diabetic population. Um, and somewhere in here, there's a quote about instead of like the, the [00:27:00] episodic care where they come in.

[00:27:01] Vic: Um, Maybe twice a year right now. They have just continuous care. They're talking to him once a week all the time

[00:27:08] Marcus: It just seems like such a no brainer. And I think I told you that when When when my dad kind of had his whole episode we were talking about bringing him home I was shocked in a bad way about how little care continuum There was from the health system when it came to technology It was like and we're not talking about like low tech, high tech Health systems.

[00:27:31] Marcus: We're talking about high tech health systems, but like when it comes to extending that care relationship to the home You're basically on your own. It's it's really really bad, and I can't really understand Why as you said a it's reimbursable be it's going to lead to better outcomes See you're collecting more data.

[00:27:49] Marcus: Like you should have a better. It should be some stickier. There should be a stickier relationship there I yeah, I

[00:27:54] Vic: can't around and then D You You get the patient referral when they need something else,

[00:27:58] Marcus: right? [00:28:00] And you want to be able to start to predict when they're going to need things because you've got so much data streaming in,

[00:28:06] Vic: right?

[00:28:06] Vic: It does not make sense. They could have a profitable business. Building their brand and getting tighter ties to the community. Well, it

[00:28:14] Marcus: props the life point. Uh, I think under, under David Dill's leadership, they've done quite a few things that have been really, uh, innovative and, um, this is a good one. Yeah.

[00:28:22] Marcus: Yeah. It's good. All right. Uh, common spirit opens up Colorado hospital doors to Kaiser Permanente members and docs. So common spirit and Kaiser in partnership. Yeah. So I was really excited

[00:28:33] Vic: to see this. I have, I can't recall. Two very large non profits like this partnering together. So really, um, Common Spirit is now in network with the Kaiser Health Plan in Colorado.

[00:28:49] Vic: And so, you know, they're, they are, it's great. And it's been so competitive in the past that they haven't, I haven't seen many of these deals. I'm [00:29:00] sure one of our listeners will write in and tell me I'm wrong, but this is a big step in collaboration, which I think is good. You

[00:29:06] Marcus: know, Colorado is a pretty interesting market when it comes to Kaiser and their different physician groups.

[00:29:11] Marcus: But if, if we zoom up to 50, 000 feet, you know, there was something very interesting about the most forward thinking nonprofit Kaiser that is, you know, Working on building out Ryzant Health. Yeah, right. Collaborating with the largest non profit health system in the country, right? Yeah. I mean, you know, what, what could happen there at scale is really Yes.

[00:29:36] Marcus: Like, mind blowing. Really, really mind blowing. And, um, could this just be sort of something that makes sense in this particular locality? Perhaps, but there could also be that this is the right pilot environment to sort of see how this whole partnership works, work out some things, and then. Risen, common spirit, like who knows?

[00:29:59] Marcus: I mean, [00:30:00] but to me it's kind of exciting actually.

[00:30:02] Vic: Oh, it's very exciting. We, we need, we need new collaborations at scale. Um, and I hope it goes well. Yeah. It'd be really good. Same.

[00:30:14] Marcus: All right. Uh, Let's talk about Apple's big release. So they had their glow time, uh, special that was, uh, I don't

[00:30:22] Vic: understand the brand.

[00:30:22] Marcus: I mean, all it really matters is, is they released all new versions of new versions of iPhone. I watch, I'm sorry, Apple watch. Um, I don't think a new iPad, there was like one other device, maybe it was iPad. I don't know. I mean, I'm

[00:30:40] Vic: not

[00:30:40] Marcus: an Apple guy, so I don't watch it that carefully. Definitely iPhone and Apple Watch.

[00:30:43] Marcus: I feel like I'm missing something else that they released. Well, I thought AirPods were updated or changed. AirPods. AirPods. Which we're going to talk about in a minute. AirPods was the third one. Yes. You got it. You got it. Those are the three things. iPhone, Apple Watch, AirPods. Yes.

[00:30:55] Vic: And so the big thing everyone's looking for is the Apple intelligence [00:31:00] stuff.

[00:31:00] Vic: Yeah. It wasn't a lot of newness. I don't care about that. I think that's oversold.

[00:31:05] Marcus: I am an Apple guy. Yeah. And I don't, I don't buy that. Right. So,

[00:31:09] Vic: well, they'll release whatever they release. They didn't have a lot of unveils. Yeah. But they had two, uh, FDA soon to be approved health initiatives. And I mean, you and I have both had portfolio companies that told us for A month, and then a quarter, and then six months, and then a year, the FDA was just about to approve something.

[00:31:31] Vic: So, until it's approved, it's not approved. Um, but they're, they're healthcare applications, so I thought we should talk about them. Yeah. So, the first one is, the watch, if you wear it to bed, will tell you that it suspects you have sleep apnea. and it's, they claim it's very reliable, but then I think you have to go, you can't get a sleep apnea machine without going to get a full sleep study.

[00:31:56] Vic: Right. But there's a lot of sleep apnea patients that [00:32:00] because they're asleep and they maybe live alone or, or they haven't ever been told they have it, they don't know. And it's, it's very, Damaging, you don't get good sleep. Uh, so the watch somehow uses the accelerometer, I don't know how, to tell if you have sleep apnea.

[00:32:20] Vic: But they claim that they are, they submitted to the FDA and it's a big deal. imminent approval, whatever that means.

[00:32:26] Marcus: Yeah. Uh, I, I just think the trajectory of where Apple is going with the Apple watch in particular, um, as a, as a full on med device is really powerful because at some point it's, it's going to, like, I, I feel like the, the EKG stuff.

[00:32:49] Marcus: Was more interesting information. Um, I mean, I've got it. I, you run it a couple of times and look, I don't really have any chronic diseases. I don't have any, um, metabolic diseases or anything like that. So for me, [00:33:00] it's more like, oh, that's good information. Um, but I think sleep apnea is, this is an interesting one.

[00:33:05] Marcus: Cause a lot of people, you know, suffer with this or might suspect they suffer, you know, from this. This is one of the things I would probably be like, you know, let me run this test and see. And then if I don't think you have to do anything. You just have to wear it and it'll just tell you. Okay. So, so then here's the thing.

[00:33:25] Marcus: And I think you'd have to buy the new watch. I mean, I already have one. I'm not buying a new watch for it, but let's just, let's just say I did. I bought the new watch. I get it now I've got concierge doc. So my doc would probably love me for me to tell him, Hey, I wore my watch and it told me I have sleep.

[00:33:39] Marcus: But like people have general like PCPs. What's going to be the response from the general PCP. You know, uh, market when people start calling them and saying, Hey, my Apple watch told me that I might have sleep apnea. Like, are they going to want to hear that?

[00:33:58] Vic: Well, I mean, I can tell you [00:34:00] what my primary care doc said to me.

[00:34:02] Vic: Okay. So, my wife was convinced I had sleep apnea. Okay. Because I snore. Okay. And she, you know, slept at a hardy and last night. Yeah, so, so she wanted me to get a sleep study. Okay, so I called my, my primary care doc. He gave me to a pulmonologist and they have, you have a in clinic visit and then that's scheduled for a sleep study.

[00:34:27] Vic: It was maybe four weeks out. Okay, so there's not a lot of availability. So if, if, if, if Apple diagnosis, what was it

[00:34:37] Marcus: at the

[00:34:37] Vic: Vanderbilt

[00:34:37] Marcus: Marriott? Okay.

[00:34:38] Vic: The

[00:34:39] Marcus: sleep study because it was not at the VA Marriott. No.

[00:34:41] Vic: Okay. Um, but it's a, it's not a fun night of sleep. No, it's terrible. My dad did it. It's terrible. And, uh, you have all these wires up.

[00:34:51] Vic: I did not. I mean, they told me I slept, I didn't feel like I slept that well. . Um, but I didn't have sleep apnea. So, so [00:35:00] I was frustrated because I had to go through it and my wife still has me snoring. Yeah. So at the

[00:35:04] Marcus: end of the day, this is likely to just like overclog the sleep study.

[00:35:08] Vic: Yes. And I had to pay, you had to pay for it out of pocket because, uh, it wasn't.

[00:35:13] Vic: Now, maybe if you have, maybe this would get you into insurance coverage. Yeah, but

[00:35:17] Marcus: whatever would have qualified for coverage, you didn't have. I didn't have. Yeah. Right. Yeah. Your insurance policy doesn't say if your wife, uh, says you have a sleep apnea. If your wife is

[00:35:24] Vic: mad, was not one of the criteria. No.

[00:35:27] Vic: So I think it's going to generate a lot of people interested. That's what I think. In the sleep study capacity. Right. Maybe it will grow, but we don't have enough capacity right now. This one's more interesting. So the second one that's, I think much more interesting to me is the AirPods. Now we're going to have a clinical grade hearing aid built into them, which one is just incredible technology.

[00:35:53] Vic: The phone and the AirPods will test your hearing themselves. And then if you [00:36:00] have hearing loss, it accounts for that and, and becomes a hearing aid and the reduction of the stigma. I mean, people wearing AirPods all the time, all the time, all the time. And so I wouldn't think twice about it if someone was ordering food or at a restaurant with It takes the stigma of a hearing aid.

[00:36:23] Vic: There's a lot of people that have hearing loss and are not willing to admit it to themselves or they don't want to wear a hearing aid because they're vain. And it leads to, I think, a lot of loneliness and depression because you're isolated, you can't hear what's going on around you. So it will be great if it works.

[00:36:42] Vic: It's not yet. FDA approved my I don't think they would hopefully they don't announce it if it's not pretty. I don't

[00:36:48] Marcus: think that the tech that's in hearing aids is going to be superior to the tech that's in AirPods. That's like just the fundamental tech. So my belief is this is actually going to be a pretty low lift for [00:37:00] Apple.

[00:37:00] Marcus: Yeah. Um, I don't know. You don't have AirPods. You wouldn't know this, but it already does decibel monitoring. So like, if you're in a loud environment, you'll get a notification that says, Hey, you have had, Overexposure to loud decibels. You need

[00:37:12] Vic: to like, yeah. So this version corrects for that. And so if you're at a loud environment, it, it, it stops.

[00:37:20] Vic: That's what I mean. It was already there

[00:37:21] Marcus: and the air pod pros already had noise canceling, so it can offset with white noise and things like that. So they, they were, they were about 70 percent of the way to this anyway. Um, and that's, you know, it's crazy because that's kind of what hearing aids do.

[00:37:33] Vic: Yeah, well, so I, I looked at, I'm glad I didn't do it now, I looked at a really exciting hearing aid company about a year ago.

[00:37:41] Vic: Ah. The way it's done now is you go in person to an audiologist. Audiologist, yep. Yep, you go in a booth. Yep, and they do a very involved study. Yep. And then they, customize the hearing aid to you while

[00:37:56] Marcus: you're there. It's very, you put the hearing aids in and they have the thing and [00:38:00] they say, okay, how does this sound?

[00:38:01] Marcus: And they're controlling it from the computer to get it just right.

[00:38:04] Vic: Yeah. And so that was cutting edge technology in 1965. Um, I almost invested in a full software over the air hearing aid. They ship it to you in the mail and then they, they fit you over the cloud. Right. And so I know the technology is possible.

[00:38:24] Vic: I think it's going to be difficult for that startup to compete with Apple. Uh, so I'm glad I didn't do the investment, but, but it's definitely possible. And I think Apple. Hopefully it's close to being approved because it'd be great.

[00:38:36] Marcus: Uh, hospitals and health systems say the labor crunch continues to fade.

[00:38:40] Marcus: So just at a high level, hospitals are doing just fine. Yeah. You know, um, they, they, they're able to staff and they're getting the volume. They're performing well. Their panels look good.

[00:38:51] Vic: It mean, I agree. It, there are, there are unemployment is up slightly [00:39:00] and it might go up a little more. Now, all of a sudden, like, it's attractive to go work in a hospital and get paid.

[00:39:06] Vic: Oh,

[00:39:06] Marcus: let me go back to work. Right, right.

[00:39:08] Vic: Yeah,

[00:39:09] Marcus: exactly. Let me go back to work. Uh, alright. Now moving into the big decision of the week in the social network world, which is YouTube really in the wake of the tick tock decision, realizing they need to cut their exposure. They're going to limit teens exposure to videos about fitness and weight across global markets, starting rolling that out in the United States.

[00:39:35] Marcus: Um, this, This just demonstrates that as the regulatory environment and the legal environment get more and more dicey for these platforms, um, there are no good decisions, right? There are no good decisions. So obviously we, we, we have an epidemic of metabolic disease, which is why GLP ones are so popular, right?

[00:39:57] Marcus: In America. So you would want [00:40:00] proliferation of, you know, Sort of fitness and health, you know, content, generally speaking, right, generally speaking. However, this content is not necessarily all educational. In fact, much of it is not educational. Um, much of it is debatable. And much of it is also about.

[00:40:23] Marcus: Presenting people's bodies, um, in a certain way that drives comparison. Right. And a lot of the images of these people's bodies have been altered and the producers of the content are not being honest about that. Yeah. There's, there's actually an Instagram account, uh, called Go. I don't know if you've ever heard of this guy.

[00:40:41] Marcus: No. I need to check it out. Yeah. It's called, uh, go U2. Is is is his, is his Instagram handle. And literally. , all he does is post videos of other Instagram fitness influencers and show you where they photoshopped. Oh, their images. Yeah. Like

[00:40:59] Vic: they [00:41:00] took out their

[00:41:01] Marcus: gut or whatever. Yes. It's always the waist and the butt.

[00:41:03] Marcus: Like the, the butt is out, the waist is in. And you look, you, you look at these people, you're like, how is that possible? How is that possible? And then he shows you it's not, yeah. Look at how the, the wall is bending. Look . Look at how the swimming pool is bending. Look at, you know? Yeah. And so. This to me gets into the whole mental health issue that the, that the surgeon general is trying to point out, right, which is we're putting all this.

[00:41:27] Marcus: altered AI, you know, all these things out there, these algorithmically driven pieces of content out there for young people who cannot discern what's real and what's not right. And yes, in a perfectly curated, you know, accredited world, you'd want health and fitness information getting to them. But as YouTube really the right platform for that, I think is, is, Where this whole discussion leads us to and youtube has decided we can't manage it.

[00:41:55] Marcus: We can't protect Uh, you know the company from litigation in [00:42:00] this context So we're just gonna we're just gonna stop stop serving it up.

[00:42:04] Vic: Yeah, that's what they decided. I Think it is a slippery slope. I mean, there's a lot of content that is Has some benefit in some negative aspects to it. And certainly the court found that tick tock was liable for the death of that 11 or 12 year old.

[00:42:28] Vic: I think this is a direct response to that, but I don't know how likely it is that YouTube can cover all their surface area of. someone watching something that caused a problem. And so I guess it is positive. They're trying, but as soon as you start to say, okay, we are going to try in this domain, that kind of means that they're admitting they need to manage the content everywhere.

[00:42:56] Vic: And I think that's going to be impossible. So it's, [00:43:00] I think it's a no win situation for Google.

[00:43:03] Marcus: It is. It's a no win situation for all these networks because they're finally being treated as publishers. Not independent platforms. They are, they are now being called publishers for, because they have an algorithm.

[00:43:15] Marcus: And the algorithm is making decisions. It doesn't matter. That's not a human making decision. A decision is being made. And that's going to lead to less content. I mean, look, I don't feel bad for these platforms. I was just talking to somebody this morning at breakfast about how in 2007, when we did South by Southwest, all this stuff was nascent.

[00:43:34] Marcus: We were so naive and stupid. We thought these platforms were going to be great. And like today. It just as a marketer, he was asking me, what are the main things you should do as a marketer? I was like, the same things I was doing in 2007, have a website, have email and have a podcast. By the way, yes, podcasting was happening in 2007.

[00:43:52] Marcus: Um, because you can still control those things. You can't control these platforms. You don't even control your username on these platforms. [00:44:00] Like, you know, I'm sure the person who thought they had. At X on Twitter, didn't think it was just going to be taken from them. We don't control these platforms, so I don't feel bad for them.

[00:44:09] Marcus: They've aggregated way too much power, way too much watch time. They've made it hell for marketers. They've made it hell for parents. I don't feel bad for them at all. You know, if they have to squirm and kind of figure this out for a little bit, whatever. Who cares? I don't care.

[00:44:22] Vic: Well, I don't care about the big social media platforms.

[00:44:26] Vic: I think it's going to mean that web three. Gets a faster adoption. That would

[00:44:31] Marcus: be wonderful.

[00:44:32] Vic: I'd love for web three to get more adoption. Okay, that is not going to be curated. Yeah, but as it can't be curated. Well, it's going to be very difficult to curate.

[00:44:42] Marcus: No, I know that. But at least. That's the deal. It's like the internet, right?

[00:44:48] Marcus: It's like the rest of the internet. It's not served up via an algorithm. So, so that's, it seems like it's subscription based. We're getting pretty wonky into crypto for all you people listening. Like, but [00:45:00] basically web three, there is no head to it. Yeah. Right. And so it's the community and if you, you, you'd have to opt into an algorithm in that case, you

[00:45:09] Vic: know?

[00:45:09] Vic: Right. Cause I'm, I am going to need an algorithm, but, but I'll opt in and I can, I can change the algorithm if I want to. That's right. That's right.

[00:45:16] Marcus: All right. Well, let's, let's keep moving. Salesforce had a big rollout of AI stuff and a bunch of things for the healthcare

[00:45:22] Vic: space. Um, in health cloud, they have an Einstein.

[00:45:25] Vic: Einstein is their AI platform. They've got a healthcare Einstein kind of co pilot. Now I watched the demo. We'll, we'll include the demo. I think our listeners should watch the demo. It's the thing about Salesforce is it's not cutting edge. It's not as good as chat BGP or Gemini, but they've got it all wrapped into integrated system and it's really easy.

[00:45:46] Vic: And I mean, they're taking a fax in the AI puts all the facts. Data into the form and then they have the workflows and Einstein's filling in stuff. It's pretty good.

[00:45:58] Marcus: Yeah, look, I mean [00:46:00]

[00:46:01] Vic: a AI is Absolutely here. And yeah, and now it's flowing into like these other tools like Salesforce incumbent tools. Yeah, that's what I mean Come in tools, right?

[00:46:12] Vic: So we were talking about epic two founders

[00:46:14] Marcus: Please stop thinking you're going to do an AI point solution. Seriously, it's a waste of time. Yes. It's a waste of time. If you're going to, now, if you are going to build a AI platform for a very soft target in healthcare that most people don't want to touch.

[00:46:30] Marcus: Yeah. Great. That's more about the market you're going after and not about the technology you're bringing. You're not going to have differentiated AI. You're not. You're not going to beat Google. You're not going to beat Salesforce. Salesforce. I mean,

[00:46:43] Vic: every startup in the world learns their market. It's empathy with their market pain and then builds a solution that has some aspects that are proprietary technology But a lot that someone else could have built.

[00:46:57] Vic: That's right. It's just customized for that use case. [00:47:00] That's right

[00:47:00] Marcus: All right, two more stories and I can go to dinner. Uh, UChicago Medicine is growing into the role of an AI innovator This is a story I picked up on HFMA's blog And just a nice story about you know, sort of a Southside Chicago academic medical center leveraging in their revenue cycle and operational performance.

[00:47:16] Marcus: So just a point we've been trying to make that rev cycle back office, all things back office, health systems are deeply leaning into that. Okay. Deeply leaning into that. Anyone who thinks health systems are behind the curve on that? You don't know what you're talking about. These CFOs all know about AI.

[00:47:34] Marcus: They're all working it out. They're figuring it out. And Epic is rolling it out for them as well. So yeah, this is happening.

[00:47:40] Vic: The reason this story I think was really good is they're not in the pilot phase anymore. No. They're, they're talking about how they integrate into their three, five, 10 year plan. And it's, it's across the entire operations.

[00:47:54] Vic: And there's a lot of planning, a lot of thought and well done. It's, it's integrated like, [00:48:00] like every other systems integrated.

[00:48:01] Marcus: Yeah. And listen, uh, it, it is going to take, uh, a chunk out of the labor force.

[00:48:10] Vic: Yeah. Which in healthcare, unlike it. We don't have enough humans to deliver the care we need. Well, I'm not talking

[00:48:16] Marcus: about care, I'm talking about back

[00:48:18] Vic: office.

[00:48:18] Marcus: Yeah,

[00:48:22] Vic: back office is gonna be changed everywhere. PwC laid off a bunch of people, did you see that? I didn't, didn't include that story. No. They laid off, I forget what the number was, 2, 000 people?

[00:48:32] Marcus: And it's, it's those kinds, it's all there, um. We, we might need to start tracking universal basic income again. Just, just where people are.

[00:48:39] Marcus: I

[00:48:40] Vic: mean, it didn't work. Sam Altman ran that, uh, 10 year study. Hold on, hold on. We didn't have what we're about to have.

[00:48:48] Marcus: Yeah. The, the circumstances were, were different. Okay. The circumstances were different. I

[00:48:53] Vic: mean, we might need to have it just to keep the economy functioning. That's what,

[00:48:56] Marcus: I mean, back to that IT industry, [00:49:00] 6 percent unemployment thing.

[00:49:02] Marcus: Like, these are people who are making six figures. Right. Right. And they're

[00:49:05] Vic: not qualified

[00:49:06] Marcus: to go work as a waiter.

[00:49:09] Vic: No. And they're not going to be good at that.

[00:49:11] Marcus: No. And I mean, maybe they can go be a waiter here. What they can't do is being an electrician or they can't be a plumber. Yeah, right. That's they'd have to go back to school for those things.

[00:49:20] Marcus: Right. All right. Final story. Uh, Flare Capital came out with a report studying where AI investment in healthcare is going. Modern healthcare, I guess, was in partnership with them and sort of released a roundup on it. Um, but. Key takeaways from the analysis. One funding has jumped, uh, 60 billion invested by venture capital firms into healthcare AI companies since 2014.

[00:49:44] Marcus: More than half has come since 2021 70 percent in the last five years. So obviously rate of change escalating very quickly. Clinical care startups receive most of the money. I thought I find that one. That one. Interesting. Yeah. Right. Um, financial focused AI is a more [00:50:00] mature space that goes into what we were just talking about.

[00:50:02] Marcus: Care management dominates health plan AI funding. So that seems like utilization and prior off. It's what we've been hearing about from the health plan side. So that makes sense. And the final one, which kind of feels like the. What? Claims processing lags behind. Only 13 companies that help payers automate claims processing received funding of 150 million in the past decade.

[00:50:21] Marcus: So the question there for me is, is that just because the payer market is so consolidated into four or five big players that no one thinks there's really an opportunity to sell technology into those players, right? That would be kind of the thing, because they're not talking about the technology, they're talking about VC funding

[00:50:38] Vic: here, right?

[00:50:39] Vic: So yeah, I think it's very consolidated. And it also is pretty efficient already. Yeah. Like, I mean, the payers have focused intensely on claims processing. Right. Um, and so, I mean, I'm sure there's incremental improvements that can be had, but, but it's not like that big [00:51:00] 10, 20, 30 X return that a VC is looking for.

[00:51:03] Vic: So I think that's why there's not as much attention there.

[00:51:06] Marcus: All right. That's it. Go see Rachel. I will. Yeah. See you next week.