YouSaid · the spoken record

Angela Strange

lines on the record: 33
first: 2023-01-27
most recent: 2023-01-27
sittings or episodes: 1
sources: podcast

Every line below is reproduced as it was said and linked to the record it came from. Nothing here is summarised or generated. Directory · Search · Corrections

“As they're managing collectively these patients in these budget based risk models, that is absolutely a fundamental part of.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“That's exactly right. The insight here is that only because of the technology that now exists to be able to facilitate multimodal care, meaning virtual care, home-based care, care in your community, as well as when needed, steering you towards in-person care because they're able to diversify the sites of care across which they're able to deliver their services, the cost structure of their clinic versus traditional clinic is a fraction, right? That ultimately I would call out is also another key driver and key unlock for making value-based care work is the ability to fundamentally reduce the cost structure of care delivery. And I would go as far as to say it's not even possible to do that without the technology that we now have today, whether it be mobile, whether it be these connected devices, et cetera. And even just frankly, technology adoption amongst providers, which did not exist until very recently for better for worse, and their ability to communicate directly with each other.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Highlighting opportunities to intervene early in their care journey. So that to me is a kind of a primary example of the way that you can implement using technology in really systematic ways and not just relying on to embody that the problem as traditional providers have done, which obviously is inherently unscalable, to be able to provide a delightful experience to the patient while also delivering clinical outcomes and lower cost.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Wild 45 clinically meaningful interactions that they have on an annual basis with their patient population. These are commercially insured, right? So these are people who have full-time jobs where they're receiving health care benefits. So typically you're speaking about a much more healthy population than you would see in like the Medicare or Medicaid populations. And so because of bad context, it's even more phenomenal that they're getting that level of engagement, but they use this text mesting modality. They do proactive outreach to their patients. They also provide remote monitoring devices. They will send providers into the home when there needs to be kind of hands-on on the body to do some kind of assessment or treatment. So because they're taking this multi-modal approach to delivering primary care, they're able to earn the right to have very frequent touch points with their member population, which not only helps with kind of just consumer experience, frankly, and the development of loyalty towards them, but also obviously from a clinical lens that allowed their clinicians to really be proactive about.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“With that stuff about everything from appointment scheduling to pharmacy needs to just questions about whether I need to take my kid into the clinic or not and everything in between. And the phenomenal stat that I always highlight for Firefly, actually I'll ask you this question, Steph. You know, all of us kind of typically see your primary care doctor maybe once a year at most. How many annual encounters do you think critically meaningful encounters do you think Firefly has on average with its patient population?”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“The first company that comes to mind is Firefly Health, which is a value based care company. So they a lot of the examples that I mentioned earlier were in the government sponsored insurance space, Medicare, Medicaid, et cetera. One of the areas that we think is extremely ripe for value-based care innovation is the commercial insurance space. So employer-sponsored insurance in particular in this case. And so Firefly effectively sells a solution to employers that helps employers manage their healthcare expenses in a much more effective way. And as all of us know, insurance premiums continue to just skyrocket year over year, especially given the macro environment right now. This is just a burning platform issue for CFOs and CEOs across the board. So Firefly is kind of inserting itself into that equation. But the way that they manage their patient populations is through a very concierge type model where you can literally text their staff on a real-time basis 24-7 and be able to have clinically meaningful encounter.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“And I think that's one kind of prevailing example of how patients are taking more accountability and just more participation in these care models. So, yeah, I would definitely expand the definition of direct-to-consumer beyond what we typically think about in the kind of the e-commerce sense to one in which patients are aware of the services that they're receiving and contributing novel insights and data sets to ensure that their providers can effectively be successful in these kind of value-based orientations.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, I mean, we actually have written a couple of pieces recently about this notion of our definition of direct to consumer care. I think the traditional common interpretation of that phrase in healthcare has been out of pocket payments where you as a patient are paying for a service. We argue that the definition is much broader than that. It's really any service in which the patient has a direct loyalty to an entity that is either delivering a service and or facilitating payments, but not necessarily one that they're paying for out of pocket. So in that sense, absolutely yes. And I think it's a necessary component of value-based care that the patient be engaged in their health care because that is really the predominant way by which we're able to catch risk early. And so, you know, you hear about things like remote patient monitoring or continuous measurement, where you're putting devices into people's homes and they're participating in the creation of data sets that are novel and also create a whole new dimension of visibility.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, and just for context on where you mentioned, you know, we had ridden a couple years ago about this new tech stack for virtual first care and the premise of that thesis was that all of these new virtual care companies are very ill-served by existing IT solutions because those IT solutions were very much predicated on fee for service payment rails sporadic facility-based patient encounters so their entire data model was predicated on the kind of these again these sporadic visits and the workflows were basically all provider centric not patient centric and so we predicted that there would emerge this new tech stack of horizontal platform companies that are designed to deliver value-based care longitudinal continuous care models and treat the patient as a primary end user and so that did come to bear you know the first we have of companies that came out started to build what I would call kind of a low hanging fruit capabilities and that stack so the operational infrastructure for billing”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Traditional hospital and clinic based settings, virtual care, home based care, community based care, all of these things are now very much getting adopted because they are fundamentally lower cost, more convenient, and much more reliable than having to force patients to go to these centralized settings. So I think that those are some of the key obvious drivers of seeing kind of the why now that's occurring right now. That said, we're still looking at, depending on what reports you read, we're only at roughly about 20% of all healthcare payments being in some kind of risk-based model. So to use the crossing of the Chasm framework, we're probably still in kind of like the early adopter, maybe early majority phase. But again, it comes back to that concept of we're just still fairly early in kind of the fallout from some of these top-down government mandates and what impact they can have on the industry.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Definitely had a baseline, just the general sort of like it takes time for these things to take hold. I mean, it's the same way that we talk about technology shifts, right? Like even, you know, the internet having been invented, quote unquote, on a mainstream basis in the 90s, it's really only now that we're seeing some of the fruits of that innovation. So I think there's just some law of physics type things that are fundamental like that that apply here. But I think it has to go without saying that certainly the pandemic and everything that's happened in the last couple of years has had a huge impact on frankly like the financial beating down of providers that has created this huge boarding platform for providers to diversify their revenue and just create much more resilient ways to survive. And value-based payment is one way to do that where you actually have a recurring revenue stream versus these atomic payments that rely on patients coming into your office. And so that, I think, has been a huge tailwind for the adoption of value-based care models. You also see a lot of decentralization of care away from”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Because they're just so much inertia in the system. And so, therefore, I think it would really just have to take like a top-down government mandate to force an industry to make that kind of switch. And while it's not what I would call a full out mandate, we effectively have had that where we've had a number of significant government initiatives that have been put into place that create financial incentive to get into the value-based care game for providers and payers and take full risk, as it's called, in the form of these budget-based payment models. We've had a number of examples of that. It's been Medicare advantage, I think, is a primary example that was started in 2003. We've had accountable care organizations or ACOs, which were initiated as part of Obamacare in 2012 and subsequent flavors of that. So we're still in super early days, I would say, as far as seeing the impact of those top-down mandates. That's really what it took to kind of shake the system up and say there's a different way of doing things.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, so I mean, FIFA service has been the dominant payment model for many decades. I think technically it was like the 1960s when the first billing codes were implemented that led to this type of proliferation. And so it's fundamentally just inherently hard to change the business model of an entire industry. So I think there's just some inherent inertia that the entire way that our system operates has been optimized for fee for service. Everyone knows how to game it. Everyone knows how to benefit from it. There's an entire like 150 billion dollar industry dedicated to just submitting and processing claims so that you optimize your revenue flow. And so just because so much money is on the line, there's a ton of friction against changing the status quo. I liken it too, the legal industry where always familiar with kind of the minute by minute billing system that law firms use and how many times have we heard about some upstart law firm who's trying to move away from time-based billing to fixed feed billing, but as quickly as it comes.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Incentivizes doing more stuff and also incentivizes kind of a focus on treating people who are sick as opposed to this value-based system in which providers are getting paid for managing the health of the population or their patients and preventing sickness versus treating it. The purest form of body-based care is where providers get effectively a said budget on an annual basis to manage their patient population and any overages that you have on that budget you have to eat, but also any underages on that budget, you get to keep a share of that savings. And so again, it incentivizes a different care model associated with that, which is you want to be much more sort of proactive about getting ahead of any escalation of health issues to avoid all those catastrophic costs that might come from people really getting sick and ending up in the ED and things like that.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Course, the first thing I'll call out is that you would hope that all the health care that you receive is value based. So it's sort of telling that we've had to concoct this term to qualify what is value-based versus not. But the premise of value-based care is that so much of the bloat of our healthcare system is the result of the sort of massively misaligned incentives due to the third-party payment model that is the dominant way for how healthcare is paid for across this $4 trillion industry in our country every year. And it's probably actually not even accurate to call the fee for service system legacy because it's still the dominant model today. But the fee for service system is one in which, as the name indicates, providers essentially get paid for what they do. So for every visit that they do, every test that they run, every procedure they perform, they are submitting this atomic claim for each of those tasks and getting paid a fee for each of those tasks. As you can imagine, that kind of system.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“See the stack emerging in many different product phenotypes from SaaS platforms to solution marketplaces to MSOs to service and”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“And so, BBC Done Right demands purpose built approaches that will be built on a fundamentally different stack. This emerging stack will support new entry and value-based digital health players and incumbents alike around unique requirements to deliver higher value care. Things like data aggregation and activation. On modeling, contracting, adjudication, panel management, continuous care. Just to name a few. So, if the first generation of the digital health tech stack, which we wrote about in 2020, Was about enabling administrative and operational efficiency for virtual first providers. Next generation will be about helping providers bear ris The neighboring peers to collaborate in a more integrated fashion. Their risk bearing provider network.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Hi everyone, I'm Julie Yu, general partner on the E16Z Bio and Health team, and this is my big idea for 2023. The value-based care stack, as we sit somewhere in the murky middle of the adoption curve and hype cycle of value-based care, or BBC, we are unabashedly BBC optimists. We were also eyes wide open that many value based models haven't delivered value yet. And one of the major reasons for this is that the clinical and operational models from the legacy fee for service work Have simply been transplanted into value based paradigms, resulting in the gaming of the system versus a fundamental reorientation of care models to be focused on value from the ground up.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Bake it into their strategy to one, often provide a better customer experience, but then two, keep these costs really down to the fitness spend their profits on other things.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“We've invested in many global companies as every country has pretty significant compliance regimes and they're very different. So I think from a just how does this look going forward, I think there's opportunities for you compliance companies to just help keep us with what are all the different changing regulations in all sorts of different jurisdictions, right? So if I'm a company in the US and I want to expand to Brazil, I have to learn an entirely new different compliance regime. Wouldn't it be great if I had an infrastructure provider that would help make sure that I was compliant and help stay continuously compliant? So I think that the opportunities here are really twofold. One, obviously, new companies that help rethink this highly manual procedure in different jurisdictions in different ways. And then two, I think new companies that aren't compliance companies but need to be compliant are going to think about what”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Get information from another bank to be able to check that out. There's a long compliance procedure. So just how do we better enable data sharing, which can help elevate every financial institution in doing a better job of compliance?”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Perspective and just better feeding this data into a circle and making it much more modular to integrate new types of data sources. So just looking at this problem from a holistic point of view. Opportunity two, you know, we talked a little bit about Coinbase just in the US, more than 10% of people have a crypto wallet. And so does it make sense that you would have entirely separate on-chain compliance systems from the off-chain world if oftentimes the people are the same? And so that's an opportunity to bring more data into the set and to improve compliance. And then the third part I'm pretty interested in, which has a coordination challenge, but everyone that deals with financial services is sitting on often very siloed pieces of data. So for instance, if I suspect as a bank that one of my customers is a money launderer and I want to”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“So, any industry that is hard to navigate has spawned a very large industry of necessary consultants, right? And you talk to well intentioned, larger financial institutions, earlier startups. It's now very top of mind. People want to do this well. And then they just see a web of vendors. What do you do? And so I'd say there's really, well, there's many opportunities, but three I would highlight. One, traditionally compliance has been very siloed. Like you think you start with know your customer and then you've got the customer on, you've got to monitor their transactions. And then you might have some separate system for fraud. And none of these necessarily speak to each other. You have all these different types of vendors. You have new data sources that might come on board. How do you integrate those? And so now there's new companies. You mentioned Sardine that are really looking at this from a fraud has a lot to do with who you onboard has a lot to do with the transactions from a holistic.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Sits all across the bank, thus vastly speeding the manual review. And then two, dramatically reducing the number of manual reviews that you actually have to do because these systems can learn based on what compliance officers are doing. And so throw up far fewer false positives such that if it does need to go to manual review, it's a much more reasonable number of things that a human could actually handle. I think that's just one simple example. You can apply this and other technologies across just large, large areas, across all financial purposes.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Yep. Well, if you ask ChatGPT that answer, they will basically say, surprise AI, but let me tell you a little more specifically. Let's take anti-money laundering, for instance, right? And there's, again, billions of dollars that are thrown at such problem, depending on what estimation you believe, it's only 3% of dollars that are actually captured. There's $2 trillion that are still laundered every year. And so you look at the technology that's behind this, and it's very manual based alert systems. So for instance, anyone that does a transaction over $10,000, you need to flag it. Somebody on the back end has to go check who exactly is this customer? Is this laundering or not? And so it's rule-based systems that, as we've seen with other companies, just don't scale. Now with the introduction with AI and machine learning, you can do things like two things. One, just better gather other customer information.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“And so you ask how do small companies deal with this? In some ways, companies that are starting now have a little bit of an advantage, right? Because if you're starting something de novo versus you're trying to fix systems that you already have in place, you know what you're going to be dealing with? And then two, and this is the piece of exciting federal investment perspective, the technology in this space has come a long way, as have the teams that deeply understand the tech and really understand the compliance procedures. Like for instance, with UKYC, somebody and you need to do what's called enhanced due diligence, often you need to actually check a photo of their physical ID. And there's lots of companies that have been doing this for a long time. You might expect that they'd all be automated. Oftentimes they're sending pictures of your ID off to people who are manually checking, is this ID real or not? Right? Like that doesn't scale. Now image recognition technologies have gotten much, much better that technology”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Listen, and Coinbase takes compliance very seriously. And this compliance had nothing to do with crypto. It was simply all financial services institutions have an obligation to KYC understand who their customers are as they go through the onboarding process. So imagine any company, right? Like you're set up, you've got your systems working well. And in their case, what happened is prices were rising and cryptocurrencies. They are a regulated cryptocurrency company in the US. They do a very good job of what they do. And all of a sudden, they had 25 times more monthly transactions.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Every company is going to be a fintech company. We get our financial services from all sorts of different software companies. We're way more global, we pay in different ways. And there's lots of different types of regulations that come along with that that all financial services are having to adopt too. Compliance is very expensive. The solutions often don't work very well, which we at End Recent Horrow actually see as a very large opportunity for new software companies to be built.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“But this happened very quickly and in many cases didn't have enough time to become very clear, which points to problem two, right? If you had compliance procedures that were working well in the old world and there was some software and many manual procedures, and all of a sudden that complexity doubled, your software was just not set up to be modular, accommodate new rules. And so what did banks have to do? They often just threw a lot of people at the problem. If you talk to some of the large banks and they have thousands of people often sitting offshore that are monitoring AML alerts, OFAC sanctions rulings. So it's just a very, very people heavy business. And then the third reason, which is actually, I think, great for the industry, is the industry has evolved a ton in the last 10 years, right? Like not that long ago, all financial services was done by walking into a bank. I'm fond of saying that.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“And you look from our perspective. Like, this is a huge opportunity. But first, it's helpful to understand why. And primarily three reasons. One, that everybody points to is the Dodd-Frank Act that came in after the last financial regulation, right? And so there used to be 30,000 regulations across a variety of state and federal agencies. In a very short period of time, that ballooned up to 50,000 across multiple agencies and the creation of new agencies, and often some very well-intentioned, right? Like this was meant to help regulators' ability to monitor and address. Financial threats to help consumers protect against their loans, protect against their mortgages. It's everything to banks needing to provide consumer access to their data.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“Compliance is both very expensive and the existing solutions don't work very well. As you can imagine, the numbers vary widely, but there's large banking surveys that go out every year. Estimates are between 6 to 10% of banks' revenue, of their entire revenue is spent on compliance costs. And they're spending all of this money. And despite that, we feel like we read a different headline every week about fines. Like, for instance, since the last financial crisis in 2008, there's been more than 250 billion dollars in fines for poor compliance procedures. And if you look at like how does this actually impact operations, right? It's bad and it's getting increasingly bad. Like some of the larger banks, if you read their annual reports 10 years ago, 4% of their employees were in the compliance and risk functions. And now it's up to 15%. And so you look at, all right, Ton, it's an amazing number of people, amazing number of people. But also you look at the”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“In 2023, companies of all sizes will turn to software to solve their challenges. We expect to see more tools for sponsor banks to manage third parties, for fintech companies and companies embedding financial services to manage all aspects of risk a compliance. And importantly, more compliance infrastructure serving default global companies.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source
“I'm Angela Strange. I'm a general partner on the fintech team here at Andration Horowitz. And I believe that in 2023, doing compliance well tech enabled is going to become a competitive advantage versus an annoying thing that you have to do in the background. So if software is eating the world, it has not yet taken a big enough bite out of compliance. Post Dodd-Frank, financial services companies face more than 50,000 regulations across dozens of federal and state agencies. And that's just in the U.S. The existing and very manual compliance policies and risk processes are failing at both large financial institutions and at fintech startups supported by sponsor banks. Furthermore, while compliance is complex for businesses operating in just one geography, it is even more difficult to manage across multiple countries. And as more global companies embed fintech, the need for global compliance and risk infrastructure is increasing significantly.”
2023-01-27 · a16z Podcast · 2023 Big Ideas in Technology (Part 2) · IDENTIFIED FROM THE TRANSCRIPT · source