YouSaid · the spoken record

David P. King

lines on the record: 46
first: 2020-03-17
most recent: 2020-03-17
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

“So there's two ways. One is we invest in ideas that we think are interesting, and often those are ideas that are, well, the whole goal of it is invest in ideas that are disruptors, invest in ideas that are potentially competitive so we can see what's going on and understand the landscapes. That's one way. The other way is, you know, we're not a research company, we're a development company, so we take other people's good ideas and we scale them so we can run them 100 million times a week if we need to. And that's why we welcome the idea of entrepreneurs doing things that will enhance the value of diagnostics in general.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Broad based screening for whatever disease it is of the asymptomatic population, payers don't want to pay for it because there'll be too many false positive, too much treatment, and while saving the long run for screening the whole asymptomatic population, I'm not going to do well. But in a value-based care model in which the reward is for early detection and early treatment, then payers should be enthusiastic to pay for early detection and early screening. So the reimbursement piece and the distribution channel are really critical for the entrepreneur who comes up with a great idea.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Why? Because the OBGYNs who were doing the non invasive prenatal testing didn't want to have to put a box over here, a specimen over here to go to that company and everything else from my office goes to quest or everything goes to lab course. So the distribution channel is really, really critical. And the second thing that's really critical is reimbursement. You can't imagine how many people come with a really cool test and great data, but the payers just, you know, they're just not going to pay for things that even if they should.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“I think that emerging infectious disease is an area of real concern. I mean, the public health services were overwhelmed with Zika testing, so they ended up sending it to the commercial labs without going through full regulatory processes the test that they were doing because they just couldn't handle the specimens. Anything that addresses new and emerging disease states, in my mind, is a real area of opportunity. The caution is, one, the history of the diagnostics industry is littered with the small laboratory that offered one test and had a great arc at the beginning and then ran up against the reality, which is that the doctors want to order everything from one place. So go back to noninvasive prenatal testing. There were three companies that did non-invasive prenatal testing. All of them were independent. And now, you know, one of them is independent. One of them was bought by Roshan. One of them was bought by us.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“I mean, there are so many areas of diagnostics that we just fertility is an area that we just don't have really good tools. And so an entrepreneur who could bring to the market something that would increase the rate of success in IVF, great area. What are some of the other ones?”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Transformation in our business. It's not going to be the underlying technology. People think, oh, you know, sequencing, that's a great new thing. Sequencing is just another methodology to do many of the things we already do today. It's a more efficient methodology. But what comes out of the sequence is a wealth of information that we haven't been getting historically and integrating that information into the coordination and the arc of patient care is going to be where we're really going to see diagnostic shine in the next five, 10 years.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“So, from a technological standpoint, obviously the increasing miniaturization of instruments, the tabletop instruments, which again goes back to what we talked about with democratizing the range of services. Sequencing as a tool for diagnostics, you know, the cost of sequencing is rapidly coming down. The competitive landscape is becoming much more competitive than it has been historically. So genetic testing that we have traditionally done, you know, again, I remember when we started with cystic fibrosis, you know, we looked at 30 markers and then it was 60 markers and it was 90 markers. And now we just sequence the cystic fibrosis gene and there's way more information in there which has pluses and minuses. The pluses, there's way more information in there. The minuses, a lot of it is not well understood. And so, you know, that takes me to what I think is really going to be what's revolutionary in the next 10 years is the understanding of the data and the integration of the data that comes from laboratory medicine, that's going to be the huge”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“And I don't think there's going to be sort of the quote unquote killer app that's going to just completely turn the business upside down. Because believe me, enough people have tried to find it in the last 10 years. And so far, we're not there. But the technology will change bringing lab testing closer to the patient is an imperative just to make lab testing more effective and more valuable in the system. And in the value-based care model, when we're engaged with patients in their homes around not only your actual health, but your social determinants of health, then we're going to have much more opportunity to bring those tools to the patient and actually help them manage their care.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“We can collect testing in the home, and as long as it's performed in our main laboratory, we can integrate that into the patient's health record. So one of the big issues with point of care testing has always been, you know, you do it and then you get a printout and unless you literally staple it to the patient's forehead and they go to the doctor's office, half the time it never gets to a place where it's going to be well interpreted.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“I don't, and it's a major point of frustration for me that most physicians and health systems have a follow-up system for ancillary services. Like if you go to the doctor and they say, get an MRI and you don't shuffle for the MRI, you're going to get pestered, or you get a referral for physical therapy, you're going to get pestered. If they give you a lab slip and you don't do the labs, you probably never hear anything about it. you know, kind of urban lore about, oh, you know, 10, 15% never get performed. There was a study done years ago at Harvard Medical School. Even there, there was a relatively high noncompliance rate, as I remember, you know, 15, 20%. And so I think that being able to move care closer to the patient, if this is a big if, if the technology is good enough that it is clinically relevant, that it's reproducible, and that the quality is there, that's a good thing for patients, and it's a good thing for our industry.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“You get your blood drawn, you get the results back three days later, or now it's like, well, now I got to call the doctor, I got to figure out the interpretation, or you get the lab slip, you went to the doctor, you weren't feeling so great on a Friday, you woke up Sunday morning, you felt okay, and the lab slip just kind of, you know, goes in the trash.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“I'm a big believer in laboratory testing needs to be democratized. I mean, part of the reason that we don't have as much of an impact on patient care as we should is when you think about the way the system works. So you go to the doctor, now my doctor actually is, I was actually very impressed he sent me the lab slip before my appointment to have the blood drawn so he could have the results”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Not today It was funny years ago I was at a personalized medicine conference, and one of the panelists was talking about, oh, you know, within three years, you're just going to put your saliva on the iPhone and it's going to measure all your vital signs, including all your laboratory values. But it didn't come to pass. So many things in healthcare, it's way slower than people think.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“There will always be some tests that need a venous blood draw, that need a relatively significant amount of specimen, and that can only be done in the lab environment. And particularly the complex and esoteric testing will, in my mind, there will always be a central laboratory.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Is that an existential threat, or will there always be things that have to be done in a centralized lab setting, even if there are more things over time that can be done in a sort of point of care setting?”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“The hospital should not be getting paid more for doing chemotherapy in the hospital setting, which is the worst setting for the patients to get chemotherapy in than for doing it in a less acute environment. So in my mind, it will bring real economic rationality. It has the potential to bring, if done right, real economic rationality to the ancillary services part of the system.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“You should be paid the same price by Medicare for doing the same service at every site. The hospital shouldn't make more for doing a colonoscopy in the hospital than they get from doing it at an ambulatory surgery center. The doctor should not be getting paid more for doing chemotherapy in the office than it can be done at a remote cancer center.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“So, to me, what that looks like is the hospitals think about their laboratory, and instead of saying, well, I can run a thyroid panel in my hospital lab and get paid $300 for it. And maybe the patient gets a bill for $16 to the doctor, it looks like I have a bundle of dollars here to spend on this patient. I'm at risk if I spend more than is allocated, but I also have potential upside if I spend less than allocated. So I'm completely good with sending the test to Lab Core for $40 and using the hospital lab in a different way, which is supporting the emergency room, supporting the operating theaters with pathology. I'm actually optimistic that as we move to value-based care, there'll be a much more rational approach to how we think about where the site of service should be for everything, right? I mean, we do way too many non-acute things in the hospital today.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“The chances of getting the pewter to father at the appointment are pretty small. And yet, we know that it's important for that patient to have the genetic screening that the physician has. Leakage in the system of where we're, and look, we're a public company, we're a for profit organization, we have to try to maximize what we can do for our shareholders, but we also have a real sense of the mission of improving patients' health and lives. And so we do a lot of things that do benefit patients, even though we get frustrated with the payers that they have restrictive policies.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“So, our average encounter price is about $45. We do about 2 million patient encounters a week. And so it's a big, high scale, high throughput business. We see about 110 million patient encounters a year. In terms of the bills, our bad debt rate, our non-collected rate is in the range of 4%. But when you think about that, first of all, it's a very substantial amount, and almost all of it comes from the patient side of the equation. But what that doesn't speak to is the amount of service that we provide that physicians order that patients need that doesn't get paid for to begin with. Because that doesn't actually get down to the bottom line. That all gets adjusted out at the sales level. So payer policies, you know, we only cover a vitamin D test with these diagnoses, or we have a payer that only covers prenatal screening for women if the putative father appears at the appointment.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Used to go to LabCorps and get there and it was a laborious process. You had your requisition for your lab test. You had to get a driver's license, your insurance card, we scanned it, you filled that information. Now we have check-in kiosks. You can check in online. I went and had my blood drawn not long ago. I checked in online for my testing. When I got to the patient service center, I had a QR code. I think that's what they're called on my phone. I scanned it at the kiosk. I was checked in. That's it. And five minutes later, I'm called. Testing's done, and I'm through. So these are ways in which we're working on preserving our margin. And at the same time, providing a better experience for the consumer.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Which is super frustrating for the patient because by the time they get a bill, it may be months after they had the service. And I can't tell you how many complaints we get about, I don't even know who Lab Corps is. My doctor drew some blood and the next thing I know I'm getting a bill from you. So it's a very complex billing system. So to your earlier question, Jorge, about what we do about margins, I mean, our laboratories are only a small part of our infrastructure. We have several thousand cars and couriers that pick up specimens. We have our own aircraft. You know, there's a whole logistics piece that underlies it. We have 17, 1800 patient service centers where people can come and get their blood drawn. We have people sitting in doctors' offices. All of that has to be coordinated underneath the testing. We're working on how do we make that more automated, more digitized, how do we take paper out of the process so that we can actually deliver the customer a better experience. We moved from”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“They adjudicate it. It may go to the patient's deductible back to the patient. It may be that the service is not a covered service. It may be that there's a coverage policy that hasn't been met. It may be that they pay part of it and you have to send part of it. So billing is a huge and complex area for us, and we have over 2,000 people who just manage the billing side of our provision of services.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Have our CFO who's now been with the company for five years, came from the industrial world, and he's a terrific CFO, but we were talking about the billing system, and he said, well, I don't understand why we just don't go out to Oracle or somebody just buy one and put it in. It just can't be that complicated. You send a bill, they pay. I said, oh, no, it's a little more, you send a bill.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“There's always going to be reimbursement pressure in healthcare. I mean, we were engaged in a discussion recently with an analyst who said, well, I don't understand why you can't get 3% to 4% price increases a year because you're the low-cost provider and you bring high value. And, you know, it's just not a realistic way to look at healthcare and say people are going to get three or four percent price increases. And we know that the drug companies are under pressure about their pricing and the hospitals are under pressure about their pricing. So we have to assume that prices will continue to be under pressure and that new innovative things that have a decent price set will erode over time. Government is actually the largest payer and the payer of default in our system today. I don't think a lot of people realize that, but it is surprising.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Look, one of the things that I've observed in my career in healthcare and in the lab industry is our industry hasn't changed much in terms of what we really do. And yes, it's changed in how we deliver it. It's changing the throughput of the instruments, but basically the industry hasn't changed much. Why is that? It's because we are the foundation of diagnosis and care. And so you can see a healthcare system in which There are way fewer hospitals, and much more is done in the home or is done in outpatient centers, and the hospitals are facing that reality. You can see a system in which there are way fewer independent physicians, and they work for somebody, or you can see a system, but I just can't envision a system in which there's no lab. So our position in the infrastructure is essential.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Diabetes, which of course, when you have diabetes, most patients have two or three other comorbidities. I think the whole menu of tests around chronic kidney disease is vastly underutilized because we know that most patients, most consumers with chronic kidney disease don't even find out about it until they're beyond stage two and potentially into stage three of their kidney disease. And yet the simple EGFR test indicates when your kidney is not performing adequately. So there's a whole range of what you and I would characterize as kind of quote unquote routine core tests that could be much better used if we had a willingness on the payer's part to make that investment.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“You know, again, if you think about the payers' interest, it's pretty simple. We want you to provide more services for less price. From the patient's perspective, you have the sick, the chronically sick, you have the worried well. So, you know, what should be the balance between what's ordered and what's paid for? And from the provider perspective, you have a whole array of new tests that come to market all the time and what's the right way to introduce them and to educate doctors and patients about their use. I think the most underutilized tests are actually probably the most common tests. So I think thyroid testing is very much underused and not well understood by most primary care physicians. I think hemoglobin A1C for management of, you know,”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Because our genetic counselors, their sole responsibility in their view, is to the patient. The outside genetic counselor is in a much more difficult position because if they recommend against the test, hey, you work for Blue Cross, you work for United, you're recommending against my test, the physician gets angry, the patient gets angry, so there's much more of a default of, let's just go with it, even though it might not be valuable. In my personal experience, I've had an instance in which a physician ordered a test for a family member that really exactly replicated a different test that had been done. Genetic tests, you know, from a SNP microarray to a gene sequence. And nobody other than, you know, once we sent it to our laboratories, they're like, you've already done this test. There's no point doing it again. So yes, genetic counseling, I still think it's vastly underutilized, and it will be more and more important as people get deeper into genetics and more is known about the genome and how it's interpreted.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Well, the genetic counselors have a conflict of interest because they work for you. We've done a study that shows that there are more instances in which our genetic counselors recommend against a genetic test than when outside genetic counselors are used by the payers.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“In my view, the fundamental challenge with providing well-coordinated care was the total lack of alignment between the interests of the parties in our healthcare system. We have the largest cohort of genetic counselors in the United States as a result of the Gen Zime Genetics Acquisition, and we do not get reimbursed for genetic counseling services for the most part. That's still the case. Because most of the genetic counselors are advanced doctorates. They have a doctorate degree or they have an advanced degree, but they're not physicians. So they can't get paid off the physician fee schedule, and there's no code on the clinical fee schedule to pay people for the test interpretation. This is really a vexing problem because again, our system categorizes people as you're a doctor so you can get paid for this or your lab so you can get paid for that. And the genetic counselor provides just as much interpretation to the physician as they do directly to the patient, but you can't get paid because you're kind of in that never-never land. It should be in the interest of the payers to pay for genetic counseling. We've had a lot of pushback from the payers about.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Can't go out and adjust their own dose with that information. And so there's a fine balance, health and wellness, sexually transmitted diseases, things that I would say are more kind of in the mainstream of what the consumer would be able to understand. But you have to respect the fact that consumers want more information and the broader flow of information is a positive for decision making and for our system.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“I am not a believer in the sort of paternalistic healthcare system of, you know, everything has to go through some learned third party who's going to interpret it. The truth is with the explosion of genetic information, for example, there are many physicians who practice in the community who are not fully informed about what these tests mean or how they should be ordered or interpreted. So it's really, in my view, a little short-sighted to say, well, the consumers, you know, quote unquote doesn't have the information to be responsible for the consequences of the testing. The other side of that, which I fully respect the regulator's position, is consumers need to understand and we need to help the consumer understand like a lot of these tests are complicated. And so if you get a result that says that you have sensitivity, for example, to warfarin or you're a fast metabolizer, gosh, the consumer can't.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“One of the things you mentioned was physicians themselves being well positioned to interpret tests. When you look at something like genetic testing, the vast majority of physicians can't go very, very deep on interpreting those results. And so as a result, there's a need for genetic counselors and the like. So actually on the topic of the consumer, what's your view in terms of what consumers should be able to order directly? Because there's been a rise of direct-to-consumer diagnostics type services. And, you know, the pro argument is the consumer should have control over their own information. It is their healthcare data. They are the ultimate decision makers. The con argument is that consumers may not be equipped to fully comprehend what a diagnostic test is telling them. Where would you come out on that?”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Dr. Google Everybody goes to Google, and when you'll find a lot of chat groups where people say, oh, yeah, you know, I had a 1.3, and the next thing I know I was in the hospital for two months. So I think that's really important. And again, part of that runs up against the current regulatory environment and what you can do in terms of claims for the testing or how you can interpret the testing when you're not a physician in the practice of medicine. But it's an area that we need to get our arms around because it's only going to grow and consumers are only getting more and more interested in. Yeah, that's.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“I think some test results are binary, right? I mean, you tell the consumer you have or you don't have, and that's fairly simple. Things that are much more nuanced, you know, thyroid stimulating hormone, the difference between 0.3 and 0.4 is probably pretty much irrelevant, but the difference between 0.3 and 1.3 can be quite relevant. And I think two things are critical there. One is, you know, as we move more into direct consumer, we need to figure out in a more comprehensive way how we provide context. So one of the things I've always thought is it would be great to be able to provide a link on the report that goes to the patient.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“But it does feel like I hate when I get a test result back directly through my medical chart, you know, without it having been seen by the doctor because it feels like so often there's this context that I don't have. So like something will come up and I'll like Google, okay, there's some range here. And this looks a little weird, you know, and then the doctor will be like, well, X, Y, and Z, that's why it's totally fine. In that information flow, how do you think about both the translation and the context when it's going to direct to consumer like that?”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Very much so because this is where the interest in the system are not well aligned. The hospital labs are able to command much higher pricing from the payers than we are so they have a vested interest in using their own labs. And I think this will evolve as we two things happen. One, we move into the value-based care environment where the dollar cost of services is less relevant than the overall kind of bundle of care and outcomes. And number two, healthcare is a truly unique ecosystem because we don't have pricing transparency. You don't know what it's going to cost you to have a service done. We have our phones. We can tell exactly what we're going to pay for this service or for this product.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Feeling well, the first question is well, you know, let's look at the labs and see what they say. Do you have an infection? You're overtired, is it your thyroid? The problem is we have many participants in the system who don't facilitate the exchange of information. And so, you know, we have local hospitals near our headquarters that won't allow us to return information electronically into the medical record.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“One of the big changes that's occurred when I started a lab corps, we still used to drive around with paper reports in the courier vans and drop them off at the doctor's offices. In most cases, you know, we drop them the next day. And those were the days when the doctor would have the folder out, the test would go in the chart, and the, you know, so now I think upwards of 85% of what we return is returned some electronic fashion. And it may flow directly back into the doctor's medical record, you know, electronic health record. It may go back in some other electronic fashion where it goes to the doctor's office, but it doesn't directly integrate into the health record. And this, in my opinion, is actually one of the big obstacles to a more seamless coordination of care system for patients. Because I agree with you, the lab is the ground truth. I mean, 70% of clinical diagnoses start with a laboratory result. And doctors always, you come into the doctor and you say, I'm not.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Where a drug comes out and we're able to demonstrate either in the clinical trial or through use in the marketplace, that there's a diagnostic test that can tell you whether this drug is going to be efficacious for this patient with this condition. They're the clinical need is almost always very compelling because you're talking about potentially a very expensive drug and you want to know, is it going to work for this patient or is it just going to be more healthcare resources that are not going to be well spent?”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Always start with what's the unmet clinical need? I mean, obviously, market size matters because there has to be enough market demand to justify bringing up a test. But, you know, what is an unmet clinical need? So if you look at non-invasive prenatal testing, for example, the unmet medical need was that invasive prenatal testing, whether amnio or CVS pose risk to both mother and the fetus. As the technology improved to where this could be done through blood testing, it clearly made sense to integrate that into the sort of the more standard test menu. When you do it through blood, it's a simple, relatively painless process. There's literally no risk to the mother or the fetus. The results come back faster and the reliability is very much concordant with the more invasive procedure. So that's a good example of where there was a clear clinical need for a better way of doing what we're doing. Other tests like companion diagnostics”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Absolutely. Yeah, there's definitely an arc when you introduce, you know, an ACOG dictated that within their guidelines all pregnant couples should be tested for cystic fibrosis. I mean, we had offered cystic fibrosis for years. Nobody ever ordered it. Now all of a sudden it exploded. And so it really went from being a pretty esoteric test that was not commonly ordered to very much a routine part of prenatal screening and care. And there are many examples like that over time.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“So we perform about 4,400 different tests. Not all labs have a menu as big as ours. There are also some highly specialized labs that do, for example, oncology testing or do coagulation testing for blood cancers or do thyroid testing. We think of an esoteric test as anything that is performed by sort of nonstandard methodology. If you come to our laboratories, there's a huge set of chemistry instruments that just they run chemistry tests all day long glucose, potassium. There's a huge set of hematology instruments that run CBCs. We look for infections and high white blood cell counts. And then there are DNA tests, which are in the esoteric category. There are specialized thyroid testing. There's allergy. All things kind of outside what we would consider the norm of basic wellness testing.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Slow, not super reliable or reproducible in terms of overall quality. A lot of work was done in hospitals or small laboratories. Jim's idea was let's put the instruments in one place and bring the specimens instead of sending the specimen somewhere and waiting for the answer to come back. And obviously that's evolved over the course of time into reference laboratories that look like warehouses. I mean, they look like manufacturing facilities, you know, large numbers of very high throughput instruments, very IT and tech connected. We have a robotic sorting machine that we're putting into all of our laboratories, which basically replaces all of what we used to do with the front end manually, you know, uncapping, shaking, pouring off. So the business has not changed a lot over the 50 years what we do, but the way in which we do it and the quality and the scope and the breadth of our business has changed quite dramatically.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source
“Our original founder, Dr. Jim Powell, was talking about why he came up with the idea of a reference lab. And he's a pathologist. And one of the things he pointed out is that in the day in 1969, when a test was sent to a laboratory, sometimes it would be five, six days before response came back and the patient either had progressed or as he said, you know, progressed, released, or died.”
2020-03-17 · a16z Podcast · Labs for Diagnostics: Then, Now, and Next · IDENTIFIED FROM THE TRANSCRIPT · source