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Ed Menai

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34

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2024-03-25

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2024-03-25

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1. “Is the most motivating thing, is the most profoundly motivating thing. And we're already doing that at scale. And by 2030, we're going to do it with a depth and a breadth and a power that is way the heck beyond even where we are now”

   2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

2. “Yeah, so basically what it means for patients today and what it's going to mean for patients in 2030, and I think as amazing as the impact vote has today is we're going to be literally 10 times as powerful. But it basically means people are living and are going to live longer, healthier, happier lives. The ones who really meant to live, right? It means people who are here versus not, right? And it means families that are whole instead of broken. It means people who are fulfilled and well and not suffering. This is what really gets an eye up in the morning. There's a channel on Slack that devoted, which is called member wins. And every day people write stories of the impact we've had on people's lives and to see lives being so deeply touched and changed and protected and saved”

   2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

3. “Exactly. So, if you're in the value based Rail, then you're in the situation where the AI, which allows you to make better decisions, will actually pay back in spades. So we're really excited about it.”

   2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

4. “The first major bucket is administrative. So somewhere between 15 and 30 percent of total healthcare cost is waste, shuffling paper around. And so, one of the first places we're looking at is how can we use AI to reduce a lot of that waste so that people can actually take, every day we have a choice between do we actually spend this money on care? Or do we spend it on shuffling papers? I'd rather spend more money on care. So the first area that we look at is how much can we do on that side? The other area that I'm excited by AI is in its ability to help make better clinical decisions. If there's a way to make sure that you surface the right decisions at the point of care, and by the way, this works better in value-based care where you get paid for making better decisions”

   2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

5. “So AI is amazing. So, number one, I actually think that one of the interesting things about AI and about technology in general is its leverage capabilities. I probably wrote 100,000 lines of code so far devoted personally. And so when AI comes along, I'm looking at this stuff and you don't know there's a bunch of hype, et cetera. So I go into it and I'm like OMG, right? And I say this as someone who is incredibly practical when it comes to technology. Like AI is actually the biggest advance, I think, to technological productivity in terms of the things that you would do on the practical day-to-day basis since Mark actually invented the mosaic. And so when you look at it, I think of AI in two major buckets as it applies to what we do.”

   2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

6. “Literally reconfigured this keyboard to do Vorak, right? Yeah. And built, like Tony Stark in a cave in Afghanistan on the movie Iron Man, right? In a closet in a women's health practice in San Diego, he wrote the first web base, it was called at the time, right? Software platform to run Dr. Sosis, right? It was just ridiculous. And he still codes, by the way.”

   2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

7. “Jonathan Bush and I started Athena. And we get into really big trouble. And so I decided to call my brother, who's like a hotshot internet consultant at the time, making six figures out of college, right? And we're in deep, deep, deep doo-doo here. Can you come help? And so he quits his job and comes to work for $18,000 a year and Athena stock, which then worked out for him, right? But we need to build software to run what we're doing. So he literally works in the equivalent of a closet. He literally gets up in the morning, starts coding, goes back to sleep, gets him in the morning, starts coding, right? So he writes 250,000 lines of code himself at a key stretch, the Cordi keyboard was designed in the early 20th century to actually slow typing down because it burn out the machines. So there's actually a format called Vorak, which is much faster. Literally the rate at which he could type.”

   2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

8. “I play with everything. I have horror black boxes. And so I love just opening it up and looking at things. But I mean, good thing, I love my brother as well. Actually, like when we were growing up in eighth grade, I still remember Tony coming up to me and saying, hey, all my other friends treat their little siblings like crap. I promised you I'm going to be the best big brother I possibly can. And he's kept his word. He's been the best big brother ever. Like, it was a little bit tough. When we built Athena, Todd literally locked me in a closet and said, don't come out until you build software. And I'm like, okay.”

   2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

9. “Of healthcare software, right? He's both one of the best engineers on the planet. And secondly, he spent his entire life professionally in the guts of the American system. And so that intersection of the two, like nothing's a mystery to him.”

   2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

10. “Look, I'm very confident that no one else can build what we built because A, it's so incredibly hard. You need to have built at a very particular point in history where you could leverage all the learnings of the decades, but where things are still early enough, right, that you have a ton of runway, right? Just thirdly, just to be perfectly honest, because at the end of the day, what you just learn about entrepreneurship is that people are everything, right? No one else has my brother. No one else is my brother. I'm not aware of any other human being like my brother. And he'll never say this about himself, but he's like the Wolfgang Amadeus Mozart.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

11. “That's actually projected to grow because the US population ages to 1.5 trillion by 2035. And then the other thing I'll just say is that, look, we're starting with seniors, but everyone deserves the best health care in the world and also have begun. Again, this is all a little surreal to me, to get calls from other countries.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

12. “We started in eight counties in Florida with 2,300 members. In 2019, and we now serve across 13 American states, 140,000 members. By the way, in our initial target segment, which is called Medicare Advanced Market, which is basically outsourced Medicare delivered by private sector companies for seniors. That's a $425 billion market.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

13. “Secondly, five star quality on clinical outcomes. Clinical outcomes that our own clinicians can't believe, actually like best in the world at managing chronic illness, best in the world intensive home care, best in the world at so many things. And then it cuts the cost of Medicare. And if you actually look a little bit deeper into that, what happens is we actually do more what's called primary care for people, preventive care, than what happens in the US houses overall. And that's a situation that saves on hospital costs and specialist costs and ancillary costs. And then we actually give some of those savings back to America, the American government. Do we take some of the savings and we actually invest in better benefits in Medicare at the helpline level and better service? And we keep some as profit. And actually a combination of the superior benefits superior service all entered by superior care has made us the fastest growing health insurance plan and medical care provider for seniors by a factor of 10 in America.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

14. “And on top of that, more fundamentally, it's a right, care, right place, right time machine. The next right thing. And the next right thing, including a bunch of stuff that you never thought you needed but are collectively extinguished in time that save nine and keep you as well as possible and out of the hospital. So we are the first ever to be crazy enough to even try to build what I just said. We started in 2017. We built the thing and we can't quite believe what's now doing. I feel like we split the atom. It's like a thing that's now out of control in a really good way. So it delivers a net promoter score for members of 77. So that's Apple level higher than Apple. Higher than Starbucks, higher than Netflix, higher than Amazon, higher than the USAA. Companies we worship, by the way, right? And way higher than healthcare, right?”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

15. “So they're great at acute care when the fit hits the chan, right? They're massively underinvested and undersupported in preventing catastrophe. So that's a problem. So then we built green number four, which is our own full scale in-house medical group, the first truly great virtual care provider for seniors that doesn't replace your doctor because you generally don't want that, but rather complements your doctor by delivering 17 additional major care services to whoever needs them and 95% telematically, the rest at home in person, they're collectively preventive care stitches in time to save nine. Concierge-like high tech, high touch care that basically keep us well and healthy as possible. And then finally, last but definitely not least, and the key to the entire thing is software. Software eats the world, right? Yes. It's the first ultra-modern software platform capable of running both a health insurer and a care provider in one end-to-end system, right?”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

16. “Anyone who has ever been a patient or cared for an aging parent can testify this. It is believable complicated. So we have a concierge, a tech-enabled guardian angel that navigates you through the healthcare system, right? Green number three is we partner with great local doctors and hospitals, and we love them all, but there's one very deep problem in the legacy network of doctors and hospitals, which is that for a whole bunch of historical reasons, they were really built to react to catastrophe”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

17. “They're just not going to help you, not work with you, you're just not aligned to really support getting best care in the world to your patients. And so we built our own health insurance companies so we could control the funding, the data, the operations of service to orient all the muscles of a health insurance company to basically do one thing, folks on getting you the right care upfront that keeps you as healthy well as possible. In grade number two is we built a navigator service called Devoted Health Guide, which is a tech-enabled concierge that navigates you through the liquid ball of Royalian Chaos that is American Healthcare, right? Why do we do that? I don't care how smart you are, okay? You cannot navigate yourself through American healthcare.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

18. “You have to. And so basically, and I'll kind of describe the have to as each layer, right? So five layers, right? Layer number one is we built an entire health insurance company from scratch, right? Because if you're dependent upon the legacy health insurers, you're eff'd.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

19. “You had to build this complete alternate universe healthcare system service in order to actually hyperscale that set of results everywhere. And so what does that look like? What does that really mean? Basically, we have built, people call it a virtual tech-enabled Kaiser Permanente, a tech-enabled Pavidor. It's a combination of PAM provider. We call it an all-in-one healthcare solution. And it consists, if you pop the hood on the thing of five ingredients, all of which we deeply masochistically built from scratch. We built an entire health insurance company.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

20. “And the partners and the resources to do something that's ambitious, which is really, we basically built from scratch an alternate universe full stack tech enabled American healthcare system as a service. Because it turns out that's what you need to do if you want to deliver at scale what Edge just talked about, right? The right care in the right place at the right time, that basically both drives radical improvements, outcomes, and simultaneously lowers costs a ton because as grandma says, a stitching time saves nine. If you get people right here up front, they stay as well as possible and they stay out of the really expensive hospital, right? So Ed and I realized at the beginning of a journey that in order to actually deliver on DeVoe's mission, which is to dramatically prove health and well-being of older Americans to start eventually everybody by caring for everyone like family. And because what you want for your family is get them the best care in the world. And that's the right care work at the right time. We realized basically after 25 years of learning most of the hard way that”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

21. “Yeah, no, that's right. It really helps to be a middle age entrepreneur. When you do that, it's taken Ed Menai about 25 years to figure out how to do it and to actually have enough credibility to assemble the dream team.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

22. “As a global economy, U.S. healthcare alone is in top four economy in the world if you look from a country basis, right? There's the US, China, Germany, and then you have U.S. healthcare as its own economy. It's an unbelievably complex logistical exercise. And the coordination that's required to make sure that people get the right care at the right place at the right time is a sort of logistical and technical exercise on the order of the most complex logistics things that you've ever seen. The problem is that it's not set up that way. And so from our perspective, what was really important is to look at it as a fully integrated vertical thing that you could optimize against. And so the question we ask ourselves was, what would be required to build some sort of system to make that work?”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

23. “In order to understand what the best care in the world is, you have to deliver the right care at the right place at the right time. And that is an unbelievably complex logistical exercise. Healthcare represents 22% of the U.S. economy.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

24. “So, what works is that you actually have to find a way to get paid. By delivering better care. And as we have talked about a ton, better care if you actually deliver it consistently at scale results in lower cost. But it's actually better care. No one wants to go to the hospital and no one wants invasive surgeries. No one wants a lot of things. Sometimes the better care will cost more, but in aggregate it will cost less. And so what does work is if you're able to take the total cost of care and then do everything you can to make sure that you take care of folks? If you do that well and they use some of those expensive services class, then you get to profit from it. And that does work.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

25. “Taking money away from someone at any given point. And so part of this is that if you actually produce Net better service, it doesn't mean that you're going to get paid for it. That was actually the really sort of incredibly painful lesson we learned from the first time that we built Athena.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

26. “I think one of the reasons that we looked at this is that the way that you hear about startups in Silicon Valley, the standard device is find an itch and scratch it. Go out there, find a little problem, get sort of a little bit of a beachhead and expand from there. And it turns out that doesn't work because the fundamental economics of healthcare make it such that if you try going that way at some point, someone's going to kill you. So for example, if you have a working diabetes management program, somewhere along the way, I've talked to hospital CFOs who basically said, I can't fund our diabetes management program. Because it's actually successful in keeping people out of the hospital. I'm actually reducing hospitalizations. But why would I pay for that when it's actually reducing my core revenue source?”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

27. “It's a combination of incredibly important and unbelievably screwed up. Which for an entrepreneur is like catnip. Because what that means is if you can actually go in there and build a solution, that's helpful, you can actually create massive impact and massive value. And it's where you can both Of the most valuable companies ever. In the process of doing so. And really, as your core output, literally save lives. Literally save lives, dramatically improve lives, end pain, end suffering, protect lives, extend life. And it's just the most exciting kind of mission to be on.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

28. “Network And that was an electronic health. Was super successful Scaled Quickly Public in 2007. It was the The NASDAQ That my Does it say it's okay that you didn't become a doctor's lawyers? And we went on. I see Executive for the next decade while my brother Todd went to DC to serve in the White House. But that's how we got started Time we Lot more Exactly And we developed a lot of theories about how to fix it.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

29. “Company, and we've always been obsessed with the idea of How do you create value Doing good. And for us, it's always been about the right care at the right place at the right time. So our first Health, which started off as a women's health company. The idea was that if you took The number of NICU dates on the back end. And here's the thing the clinical model was successful. Turns out Model was”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

30. “Was much to the chagrin of our parents. So, my parents, as you might And they're like, well, one of you should be a doctor and one should be a lawyer. I don't care which is which, but one of you should be a doctor and one Lawyer. And in fact, my dad hadn't saved $50,000, which was all the money he had in the world, to send us to grad school. And we're like, we have this idea to start a company. And we need about $50,000. So could we have it? And he's like, heck no, right? He didn't say that because that's not the way he speaks. He basically said no, but we were quite persistent and said, could we please have it? And we still remember what he said. He said, I'll give you the money because I love you guys Hope you fail fast because you're my only two kids”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

31. “We grew up in central Ohio. He was shipped off to a research facility in Granville, Ohio, and that's where we grew up among the cornfields and apple trees of central Ohio. And we looked up to people like John Glenn, who we both got to meet, Dave Thomas, founder of Wendy's. And we grew up with this idea, right, this conception of America as a shining city on a hill, a place where you could do anything. So after we grew up there, we both went off to Audi to Harvard. Tyde was the good one. He studied economics. I studied computer science, and I still remember my advisor saying, computer science, it's totally a waste of time. Of course. You shouldn't do that. You shouldn't do that. But after college, we decided that we were going to pursue the stream together, right? This idea of creating a company together.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

32. “So Tod and I started devoted six years ago together, but the story of devotion goes back much further than that. Goes back to our parents, who came over from Korea in 1969 at the tail end of the civil rights movement in the Vietnam War. They came to the U.S. in search of the American dream, life will reading the pursuit of happiness, better life for themselves and for their kids. So my dad came over, he studied chemical engineering at the University of Utah, where in a moment of oversharing, he basically said that he and my mom as newly white grad students had Todd as an accident. I'm like, thanks dad. I needed to know that. And then he went out and got his first real job with the Dow Chemical Company, the maker of Surrend and Scrubby Bubbles. I remember those products because they were a really big part of the Much Author and became one of the most decorated engineers at Dow Chemical, created more patents than almost any other inventor. And where he had me in Middle Michigan as he described again in the moment of oversharing, planned baby. So good. Thanks. Thanks again, Dad.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

33. “So part of this is that if you actually produce a net better service, it doesn't mean that you're going to get paid for it. That was actually the really sort of incredibly painful lesson we learned from the first time that we built Athena. They were really built to react to catastrophe. So they're great at acute care when the fit hits the champ, right? They're massively underinvested in, under supported in preventing catastrophes.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source

34. “I don't care how smart you are, okay? You cannot navigate yourself through American health care. My dad had saved $50,000, which was all the money he had in the world, to send us to grad school. And we were like, we have this idea to start a company. And we need about $50,000. So could we have it? He's like, heck no.”

    2024-03-25 · a16z Podcast · Devoting Your Life to Reinventing a Broken System · IDENTIFIED FROM THE TRANSCRIPT · source