Applying EM + Joining a16z!
Launching healthtech operator micro-communities
Hey š folks!
Very excited to share with folks here that Iāll be taking the next step in my clinical training as I apply to emergency medicine (EM) residencies. Iāve been leaning emergency medicine pretty much since I started medical school, but after some very affirming sub-internship rotations in EM and finishing my first residency interview yesterday - itās been energizing how my non-linear journey has begun coming together as I double-down on further clinical training to become a practicing physician. In EM, Iāve found great overlap in my past lives as a software engineer in the way you debug/architect a problem differential, and as a product manager around the cross-functional nature of the role interfacing between many different clinical specialties. EM also shares much of the day-to-day job of pattern recognition and rapid triaging/prioritization job of a venture capitalist. Most importantly, Iāve found myself energized by the ED and personally drawn to our missional mandate of being able to care for anyone that comes through our doors regardless of whatever complaint they have. Especially at from a systems-perspective, the feature of being āalways availableā and the safety net of the entire healthcare system gives me a lot of inspiration for ways I hope to advocate for systems change with my lens of knowing whatās broken.
As I finish my last year of medical school and gear up for residency, Iām thrilled to also share Iāll be joining the a16z bio+health team as an investor on the deal team. In many ways, this feels full circle since starting my career at PatientPing, one of a16zās first investments and how I originally got to know Julie Yoo from the Boston product ecosystem. Along the way, have also met and learned a great deal from both Justin Larkin and Vineeta Agarwala as I look to build a career clinically as a practicing physician.
More missionally and personally, Iām excited to join forces with like-minded folks in building towards a more equitable, accessible, and efficient healthcare system. Many of the themes which inspired me to start this newsletter at the beginning of my clinical rotations will continue to be areas Iām excited to support founders in as I look for ways to better address under-recognized issues in the margins around medicine.
In addition to continuing to explore ways to support some of these themes and issues as an investor, I will also be spending a lot of my time thinking through interntional ways to level up healthtech operators through community-building, especially in NYC where Iāll continue to be based for at least another year.
Healthcare Micro-communities
As a passionate community-builder, I hope to focus my efforts in the upcoming months to double-down on the incredible healthcare operator community we have in NYC. Inspired by the growth of the 1K+ Product Managers in Healthcare community that I helped launch 2 years ago, Iāve learned that there continues to be a need for small, highly curated, communities that prioritize shared learnings and build a collaborative environment about crowdsourcing ways to tackle really specific issues to an operatorās day job.
Knowing that there may be other communities or resources that help us stay on top of news and topics in the healthcare industry, these smaller communities will be highly curated around the questions and conversations you commonly interface with in your day-to-day job that are unique to your job in healthcare.
From having a dozens of conversations with operators building in healthcare, we've seen tremendous growth in the communities and resources that support the healthtech industry, but still feel like thereās still a gap for operators looking to build a peer community with others that share their specific job function. And though Iām not actively in the operator seat anymore, Iām excited to invest my time, energy, and network to supporting some of the below leads in building out these micro-communities. Our collective goal is to create a space where folks can learn from each other and cheer each other on when things are working well, but also openly share and support each other when things are not working well.
To give a sample of the types of questions and why we feel the need for each of these groups exist:
Growth/GTM in Healthcare (Justus Ruff)
This group will be laser-focused on operators actively leading growth/GTM/BD conversations with health plans, health systems (pay-viders) - a role that ends up becoming the lifeblood of the company. We aim to focus on how to best scale and stand up growth/GTM processes internally and also externally with customer prospects.
Pricing and structure of value based contracts
Data vendors and sources to effectively/efficiently target providers/payers
Best practices to increase velocity when navigating buying committees
Product/Ops at VBC companies (Shohini Gupta & Sandy Varatharajah)
In value-based care companies (where the companies success is directly tied to taking full financial risk), being a services company is especially heightened (the service is the product you're delivering) but a lot gets lost in conflict/role ambiguity/strategic focus between lack of Ops/Product alignment and/or integration. Thereās also unique cost pressure at scale due to needing to generate savings (rather than fee-for-service growth) ā¦so the collaboration between product <> ops is directly to how these companies achieve margins at scale.
Creating organizational alignment (e.g., shared OKRs, team processes)
Evolving ratio of PM:Engineering to Market Leads:Ops
Learning from actuarial models around taking risk
Chiefs of Staff at Healthcare Companies (Betty Chang)
Especially in venture-backed companies, chiefs of staff are often context-switching between a number of rapidly-evolving roles - serving the cross-functional in particularly specialized (and sometimes siloed) functions of a healthcare company. But for many of us, this job is nebulous and often a solo learning experience. Knowing that our job spans so many responsibilities, we want to create a space to help others that might be tackling the exact same Qs at other similarly sized healthcare companies.
How support culture/community internally with the company? and build brand awareness externally with the broader healthcare ecosystem?
When I donāt agree with my CEO / managerās decision. Whatās the best way to push back and develop skills in managing upwards in getting them to see my view?
Our team is growing quickly and perhaps skewed in a certain way at our scale (e.g., sales > product). How can I streamlining communications across the org?
Creating a transparent and safe space
One of the many learnings I had on my calls with operators in these spaces is that though investors may be helpful as a convening point and supporter of these communities, we recognize our presence spaces (especially with portfolio companies) will not create the same level of transparency or honesty that operators are looking for. Personally, want to be especially sensitive and committed to keeping certain spaces āinvestor-freeā to ensure these communities are focused on supporting operators. To that effect, I plan on leveraging my strengths as a convener and background/learnings from starting the PMs in Healthcare group, but intentionally want to step out of virtual or in-person conversations as they start to happen organically.
Next Steps - sign up to join!
Do you resonate with any of these micro-communities? If so, weāre building out a waitlist as we plan on bringing together ~15-20 folks as part of our founding cohort š
Areas of Personal Investment Interest
Though a16z invests across all stages of digital health and biotech, I hope to be particularly helpful to founders building companies in the following areas. Sharing a brief paragraph on what Iām most interested in the spaces below, but more deeper thinking to come soon!
MedicaidĀ
Especially in our most underserved communities, many of the folks I care for in the emergency department are Medicaid patients. As a long-time believer that social complexity leads to medical complexity over time, Iām interested in ways we can effectively address social determinants at scale through productizing social determinants (e.g., housing insecurity, digital equity/connectivity, etcā¦). In addition to wraparound services, would also be interested in additional infrastructure and technology opportunities that power the evolution and growth of Medicaid MCOs.
One of the many things I hope to organize in the next few months is a playbook or roundtable in collaboration with Medicaid MCOs on the most urgent needs and collaborative guides on how to best work together.
Smart Operating Room
Inspired by my personal experiences rotating through anesthesia and surgery, Iāve seen many needs for both patients and providers in our operating rooms - some of the most critical moments of patientsā lives as well many health systemsā centers of excellence. Have seen gaps that Iād love to better understand around surgical planning, OR utilization/optimization, but also needs from the patient side around better surgery pre-optimization and post-op rehab/management that intersect with peri-operative value-based care models.
Provider Enablement
Though I have much insight to gain in residency as a soon to be practicing physician, I have already seen many examples of gaps in clinical workflow and efficiency that my friends and wife (whoās finishing EM residency this year). From clinical-decision support to reducing time/burnout around administrative tasks, thereās a large need for better tools and infrastructure to support providers. Especially physician groups who want to remain independent, there are many needs around improving the financial infrastructure alongside good business hygiene which we never learn in medical school.
Underinsurance
Iāve held a long-standing interest in working towards ways we can close the coverage gap for the ~2M patients that are caught between making too much for Medicaid and not enough to afford adequate coverage on the exchange. A much larger population (1 in 4 working adults) are āunderinsuredā due to increasing adoption of high-deductible health plans and lagging adoption of HSAs. I explored some ideas and themes related to underinsurance in this post, but am excited to work together with my colleagues on further exploring our evolving thesis in re-imagining insurance, employer benefits, and the intersection of healthcare and fintech.
Acute Care Delivery
As an aspiring emergency medicine physician, I believe that the field of emergency medicine is approaching a critical inflection point in part due to the field's changing workforce dynamics but also in how COVID-19 has stretched our acute care infrastructure - widening disparities for our most vulnerable patient populations. Though value-based care models commonly point at reducing ED utilization as a way of lowering healthcare cost, I believe there are also ways to better integrate emergency physicians into these models that plug patients ultimately back into longitudinal care. In addition to themes Iāve explored before in value-based emergency medicine and re-designing our acute care delivery system, Iām interested in investigating how we can re-imagine how emergency medicine can be delivered outside the four walls of an emergency department.