Incubating Businesses and Why Health Systems Will Drive Value-Based Care: In Conversation With Dr. Sachin Jain
It’s a big week for the Vital Signs podcast as we’re bringing on Nikhil Krishnan as a co-host and releasing our first joint episode with SCAN CEO Dr. Sachin Jain. Sachin had some great thoughts on the advantages of operating as a non-profit, competing in Medicare Advantage and when PE/VC backing doesn’t make sense. He also shared some hot takes on new people entering healthcare and the importance of health systems in driving the move to value-based care over siloed condition-specific providers.
You can listen to our conversation on Spotify or Apple Podcasts.
Sachin is a physician with a fascinating career in health tech. He started on the policy side, working at ONC and helping to launch the Center for Medicare and Medicaid Innovation. He then went to the pharma world as the Chief Medical Information and Innovation officer at Merck. He then switched to the payer/payvidor world - first as the CEO of CareMore, an integrated health plan and delivery system. More recently, he joined SCAN, a non-profit health plan focused on Medicare Advantage, to lead that company in both expanding the plan and building new businesses through it. Sachin is also a prolific writer. Many readers have probably read his pieces in Forbes and elsewhere.
Check out a full transcript of our conversation below:
To kick things off Sachin, I would love to start with a bit of background on you. You've had this really interesting career starting on the policy side, then Merck, CareMore, SCAN. It would be helpful to hear in your words: What motivated the different decisions to go from one to the other?
Random circumstance is probably the most honest answer. I think you end up reading people's bios oftentimes and you think there's this highly planned transition from one thing to the next thing to the next thing, and in retrospect everything looks super logical, but in prospect, like most things in life, my career was semi random. It's become a little bit less random over time as I've gained more focus on what issues are going to be most important to me and where I think I can make the biggest impact.
But starting out in my career, I just wanted to make a difference in healthcare. I wanted to make it better. I had an awareness from my studies that healthcare could be better from a quality and cost perspective, then started to learn medicine as a medical student, and then started practicing medicine as a resident and then as an attending. And there was always an awareness that the US healthcare system could and should be better. The biggest question I grappled with was: How can I make it better?
Originally, I thought I could do that as a health services researcher. I eventually landed on the idea that health policy could be a good way to do that. Since then, I have really believed in the power of organizations, both private sector and non-profit, to drive change at the community level as well as hopefully inspire broader change in the industry.
Coming out of CareMore you probably could have gone just about anywhere. Why SCAN? How did you think about that decision?
SCAN was an organization I always admired from afar. I had explored a number of collaborations with SCAN when I was at CareMore. SCAN was a place with the mission of keeping seniors healthy and independent, something that every single employee could voice and really believed in. And the board recruited me with an interest in taking an organization that had great potential and a great performance over the years and actualizing that potential. I was really motivated by that challenge and that opportunity.
We historically had been a single state Medicare advantage plan non-profit. I was particularly compelled by the non-profit nature of the organization with a desire to diversify into healthcare delivery, as well as to grow to new geographies, at a time when I think many of us thought that Medicare advantage would begin to come under assault. And as you know, it has. I wanted to be part of leading what I would call a “white hat movement” in Medicare advantage and adjacent spaces, recognizing that there are both good and bad actors in every area. SCAN has been a good actor and has the opportunity to prove even more of the potential that exists within the space.
One thing I'm curious about is the not-for-profit angle that SCAN has. What advantages does the not-for-profit structure give you? And what's difficult about being a not-for-profit compared to a traditional for-profit MA plan?
When I was elevating and advancing care at Anthem, we were held to what essentially was a 5% profit margin in Medicare Advantage. That is what the street and equity research analysts expected of Anthem as a company. That's what they expect of Humana. That's what they expect of United. At SCAN, we've historically targeted a 1% margin. If you're able to get scaled, and if you're able to manage your costs well and negotiate favorable contracts with your provider network, and you don't need to invest 5% in shareholder returns and only have to deliver 1% shareholder returns, you can invest more in benefits. That's exactly what we've done at SCAN. We've invested pretty significantly in benefits.
If you're able to invest significantly in benefits, you're able to do more for your members. And if you're able to meaningfully do more for your members, then you're going to grow more. And that's the opportunity in non-profit Medicare Advantage. A lot of things have to go right there in order for you to do that. Number one is you have to manage your cost well and be scaled. That's something that we're marching towards at SCAN. We were 220,000 members when I started, and we're now at 270,000 members. Hopefully we'll crack 300,000 this coming AEP.
Once you achieve scale, then you're able to continue that virtuous cycle of investment and benefits, and you also have to have favorable provider contracts. That's hard to do if you're a single line of business company like we are. Whereas I think if you're running a commercial book, a Medicaid book and a Medicare book, you can move money around to match the margin profiles that are expected of you. You can't do that if you're a single line of business. That's some of the opportunity in the non-profit Medicare Advantage space.
Whenever I read these reports about supplemental benefits and the additional benefits in Medicare Advantage, I feel like there's tension about which benefits are being offered as a marketing thing to attract new members and which benefits people actually use. From what you guys have seen, which benefits have been utilized the most by members and which are most impactful for your business?
The one that moved the needle the most for us this past year was what we call a “part B premium rebate.” To participate in all Medicare, you have to be part A, which is what you get when you work for 10 years. Part B is paying a premium to the government that gives you access to physician services. Part B is your drug benefit. What we did last year is we actually gave people money back in their social security checks. Normally, your part B premium is deducted from your social security check. We gave people some money back, and it turned out to be very popular and impactful from a growth perspective. I think there were a couple of reasons for that. Number one is because of Aduhelm, the Alzheimer's drug. HHS had raised part B premiums and as a result, there was a lot of value perceived in giving people a part B premium rebate.
The second thing is there's this paternalism that I have mixed feelings about in the Medicare Advantage business. It's like, “We're going to give you some rides. We're going to give you some food.” At Anthem, they were super proud of the fact that we were going to give Medicare Advantage beneficiaries pesticide services in their home. All of those things are valuable, but at the end of the day, people are smarter than companies and they know what's going to be valuable for them.
The reason I think the part B premium rebate was as valuable as it was, is that in times of inflation, times of rising part B premium costs, people want to be able to do what they could do with their money as opposed to getting a lot of benefits that may or may not actually move the needle. We sometimes get a little paternalistic in the Medicare Advantage industry and we get vendor happy. But at the end of the day, the simple thing of providing someone with funds ends up having more meaning than anything else.
What you mentioned makes a ton of sense — having this extra margin to play around with to offer a better care model and increased services. At the same time, Medicare Advantage feels like this very noisy space where there are tons of different agents calling people, and there are lots of these supplemental benefits we talked about that may not be correlated with actual care outcomes. Are you able to say, “Hey, we have the best care model and that brings us more members” versus being a part of the noise that happens on the Medicare Advantage recruitment side?
We are part of the noise. When you operate in a competitive landscape, you have to keep up with the Joneses. I don't want to be disingenuous and say we're not doing some of the bells and whistles type things that you hear about. But the vision that I'm trying to drive is we need to scale non-profit government programs. That's what I'm trying to do at SCAN: be a better partner to CMS, do more for beneficiary, get that virtuous growth cycle going and do things that, frankly, you can't do if you're PE or VC backed, right? If you're PE or VC backed, you have a 5- or 10-year return cycle, so you'll invest really heavily in growth. And then you'll do the rational thing: You've got a captive audience of beneficiaries and then you start to cut back the benefits. And then you end up creating wild swings for the beneficiaries who may have stopped shopping for MA plans at that point.
That's the playbook that you see playing out in the VC- and PE-backed world. I think we have an opportunity that's different as a Medicare Advantage-focused company that's non-profit, that is accountable to a board that cares more about mission than it does about margin. We obviously care about sustainability and the ability to grow, but that's what we're doing. That's why I think our message is resonating in Arizona and Nevada, where we beat our growth expectations. I think it's going to resonate really well in Texas, where we just announced that we're going to a few counties and will resonate in other markets as we grow.
That said, it's a crowded space and everyone is promising all kinds of nice benefits. They're promising to treat you real nice. But we also know that there is a natural business cycle here: People pay a lot for business, do a lot for members, and then over time degrade the benefits. We believe strongly in benefit stability. That's an important principle of how we think about our benefits and that's what we're doing to try to grow.
Just to riff on this a little bit, because I know you're vocal about the role of venture or the role of PE in the healthcare ecosystem at large and not just in MA. I'm curious about what you think the role of investors should be in this space. Because there are a lot of stories now about funding ahead of expectations.
I get misunderstood. I think if you were to read my Twitter feed, it's usually me sub tweeting someone that really pissed me off a couple hours before. The Twitter feed doesn't reflect my true perspectives. I love VC and PE. Some of my best friends are VC and PE people.
That said, there is a reality distortion field and a disconnect from real results and real change. I live in the world of trying to create real change. I don't get paid more or less based on whether a SCAN has three billion in revenue or five billion in revenue. At the end of the day, I'm preoccupied with the question of, “Are we creating authentic, meaningful change?” I get super worried when people prematurely declare victory in certain spaces where, in fact, there's been no change.
You see an extreme case of this with Theranos. There are a lot of Theranos'. There are a lot more Theranos' than we'd like to acknowledge that get packaged as brand success stories. When you actually look closely at what's happening, a lot of what is being said doesn't match up with what's being done in the real world. That's my frustration with the VC/PE work.
We had Tom Lee on a podcast episode earlier. He's been really quiet about Galileo and we asked him why. And he was like, “Look, until we've got the results and the things to show I'm not going to talk about it.” But it flies in the face of what a lot of folks do early on in these companies.
I love Tom exactly for that. He's pretty realistic about what he's accomplished and what he hasn't accomplished. We need more of that energy in healthcare. I recently learned this term — I think I'm late to the party — this term toxic positivity. Now that I've heard this term, I see it everywhere. I see everyone telling you that sun just shines from them and their organizations and their orbit. We even have a little bit of that at SCAN. The reality is we have to be super honest about what we're accomplishing and what we're not accomplishing so that we can put the energy on the things that need more focus. We have too many folks prematurely declaring success.
My light pushback to this is, people like you and Tom Lee, who I think are well known and reputable in the field, can probably raise money or get funding on the rep alone and don't need to speak ahead of where they are, right? But the question becomes: If you're new to healthcare or starting a company, how are those people going to come to the landscape if they don't sell a little bit ahead of where they are?
Yeah. Maybe if you're new, you shouldn't start a company. Maybe you should work at one for a minute or two. One of the areas I've been super vocally critical about is the longtime movement that I've now seen play out every three to four years of fetishizing some non-healthcare person coming in and saying, “I'm going to blow up healthcare and make it all better.” All my best friends in undergrad and in grad school were non-healthcare people who periodically would poke their noses into healthcare and be like, “This is so stupid. We just need Bayesian inference to solve all of these problems. Engineers and PhDs.” You need to spend more than half a minute before you can declare that you're going to solve a problem.
In fairness to those folks, the system is so broken that we are desperate for someone to come in from the outside and give us a new perspective. But I'm old enough to remember Steve Case starting Revolution Healthcare. I don't know if you're familiar with that company. Disappeared, vanished from the face of the earth, never existed. So much so that 15 years later, 14 years later, three guys named Buffet, Diamond and Bezos could get together and say, “We're going to do it all over again because we're better and we're smarter.” And they had the exact same experience that Steve Case did.
This is not for the faint of heart. Even the smartest people from other industries, the most successful people from other industries have tried this and failed. So you're saying, “Oh, I would get funded tomorrow” or “Tom's going to get funded tomorrow.” I don't think we started out that way. We earned our stripes. Tom interviewed me to be his Chief Medical Officer at One Medical as I was graduating residency and he didn't hire me. He was very smart not to hire me because I had never done that job. He offered it to me several years later, but the point is that we all need to get some experience. We all need to earn our wounds and have those experiences inform what we're doing. That's my gentle pushback to your pushback.
Switching gears, the breadth of what you’re doing at SCAN right now is really interesting. It would be helpful for our listeners if you could briefly summarize some of the efforts you guys are doing on the incubation side, as well as programs you’re focused on and what the next year or two have in store.
I appreciate it. The way I think about the work is to identify big problems and then think about the funding mechanisms and the company creation opportunities around those big problems. We've started a number of new initiatives at SCAN. The first is Welcome Health, which is our home-based primary care medical group that's founded in the principles of geriatrics. One of the things I've found striking when I worked at CareMore and when I look across the industry at Oak Street or ChenMed or any of the other folks who are building senior-focused models, is that they've got incredible people doing incredible work. But geriatrics, which is the science of aging, the science of providing medical care to older adults, doesn't fit into the conversation in a significant way. So a lot of what we're hoping to do with Welcome Health is to build a model that enables geriatricians to do the most that they can do for older adults. Early feedback from patients has been incredible. It's because they see this highly tailored, not just internal medicine approach but geriatrics approach, being brought into their home.
Healthcare in Action is probably one of my favorite things I've ever done in my career. It's a homeless medical group, and it's trying to apply the principles of managed care to look at homeless medical care from a total cost of care perspective. We spend a lot of money on ER visits and inpatient stays and ICU stays and non-healing wound ulcers for people who are experiencing homelessness. The question we've been asking is, “Could you provide intensive primary and behavioral healthcare to people experiencing homelessness and maybe, in doing so, get them off the streets?” We're now at about 450 patients for healthcare in action. We just launched a new team in San Diego. We're about to start a new one in West Hollywood. I’m really excited about the potential of that.
My Place Health is our Pace entity. We started that. We incubated that at SCAN and then co-funded it with Commonwealth Care Alliance with Chris Palmieri and his team there. I’m very excited about that. Pace is obviously something where people have seen a lot of profit opportunity. We are particularly excited about the financing mechanism we've chosen there, which is this long hold model. We're trying to align and invest with a number of other similarly minded, mission-driven, non-profit organizations like Commonwealth Care Alliance, and then hold this entity in perpetuity.
At the same time, we recognize we need to have entrepreneurial energy, so we've created an equity instrument that we were able to offer the team of that organization. Huge shoutout to Binoy Bhansali, who's our head of corporate development. He did an incredible job setting up My Place as well as the other entities that we're getting off the ground.
Our fourth entity is Home-Based Medical, which grew out of an acquisition we did earlier this year of something called the Residentials Group. That entity provides welcome visits to Medicare Advantage patients, as well as what we're hoping to do, palliative care and chronic disease management for older adults whose primary care is with other physicians. There’s a lot of activity going on. We've also launched an I-SNP and it's the fastest growing I-SNP in the country. We just hit a thousand members in a year.
It sounds like you are building a platform model where SCAN is maybe first customer and then a lot of these get spun out. I'm curious how you think about structuring this kind of stuff, because you guys are not-for-profit. Are they for-profits? Is this a JV with some of the third party? I think a lot of people listening probably wonder, “How can we do a good job incubating businesses within our own company?” I'm curious how you guys are structuring it.
Each one's a little different. Welcome is something that we've set up as a for-profit entity. We just closed our own series A, so to speak on that, capitalizing it with $14 million with hopes of bringing in other investors and having that be a for-profit company that serves SCAN but also serves other health plans, as we mentioned. Healthcare in Action is a non-profit venture. Home-Based Medical is for-profit, but wholly owned and will remain wholly owned by SCAN. And then we're really thinking about this non-profit syndicate model for Pace just because I think it requires a different orientation. This long hold piece is what's going to allow us to build a quality organization.
Five or ten years is a long time and if you're venture backed or PE backed, you can do a lot in five or ten. But my experience has been, then you get acquired and then you get watered down or you go public and then you have to deal with public markets. So this long hold non-profit vehicle we think is super innovative and ultimately I think is going to create some differentiation and the ability to build what I hope is the Mayo Clinic of Pace or the Mayo Clinic of home-based care. My observation is that I think a lot of these entities are just built to sell and they're good for entrepreneurs, they're good for investors, but not necessarily great for patients.
That's one of the reasons SCAN was as compelling a platform as it was for me — the ability to do really good work with patients. One of my frustrations when you look across the non-profit landscape is that everyone wants to be a VC. Everyone's starting a venture firm. Everyone's investing in venture firms as opposed to using some of the special advantages you have when you are a non-profit and can have a longer return horizon and can afford to build things the right way, as opposed to trying to buddy up with folks who have different incentives when you are in a traditional VC or PE mindset.
One thing I'm struck by, with the sheer breadth of the stuff you're building, is obviously there's a lot of stuff that's designed to take on risk for different subpopulations and it feels like there's generally this movement. We see all these companies now that are like, “We're going to take risk on this population or that population.” What does the role of a payer end up being if I'm essentially just capitating risk out to a bunch of different entities?
It's a super great question. If you're just delegating risk to others, it's like you run a really boring business. And 90% of SCAN’s business is globally capitated. The question for us is we have to create higher degrees of replacement value vis-a-vis other payers. Because at the end of the day, delegating risk will at some point become a commodity business if it hasn't become one already in places where there is mature risk delegation. And that's where we see product innovation, that's where we see sales innovation if you're more growth oriented. But I really think it's on the product side, and how you think about your benefits and your mission.
I'll tell you about the experience of watching my parents age. There's a whole bunch of things that no one tells you about aging. We don't really prepare people for aging. We don't prepare families for aging. We don't prepare caregivers for aging. I think there are things that we as a company can do that we're not doing that keep people healthy and independent. I view that differentiation around the product and benefit side as being the thing that's going to make us better. Everyone else has the same provider networks and everyone else can have the same provider networks.
So you can either differentiate by creating your own provider offering, which is something that we're doing, and create greater alignment and seamlessness between that provider and your payer. And I had a lot of experience with that at CareMore, which I think was the first payvidor, before that term was invented and attributed to Devoted. But there's also the opportunity to really change what your product looks like and make it a creative and innovative product.
One of the things that you've talked a little bit about is the perils of value-based care. The flip side of this equation — people have been talking about the benefits of value-based care for the last 10 years and now I think there's some pushback on what tradeoffs we're making in moving to value-based care. You obviously have a lot of perspective on this from CMMI and from working at several kind of risk-taking organizations. where do you see value-based care as working really well? Where do you see value-based care as maybe not moving the needle either way? Is value-based care going to be successful? Do you think we're ever going to get to a place in this country where we have that widespread or are we stuck in fee-for-service land?
I think it'll never be what we want it to be until we start talking about what it actually is. When people talk about value-based care, if you go back to the sort of Porterian view of value, which is quality over cost. People drive value one of two ways. If you go back to basic division, you either improve the quality or you reduce the cost. The reality is most people spend more time on the cost or revenue side of the equation than they do on the quality side of the equation. So what are the instruments they use to work on the cost side of the equation?
They use blunt instruments like utilization management. They look at network cost optimization, referral pattern optimization, and they build a number of different widgets on top of the whole thing to try to drive as much cost down as possible. In the process, creating a really mediocre and frustrating experience for patients where they often feel that there are barriers that prevent them from getting the things they need. Then we call it value-based care.
We have to look at this question of, “Can we work meaningfully on the quality part of the equation?” I think how that shows up from a new company or new product creation perspective is we've created these new silos of value-based maternal health, value-based diabetes care or value-based diabetes prevention, none of which actually looks at creating a more seamless experience. This is where I think the opportunity exists for the large health systems. I think the large health systems, if they wanted to, could put all the "innovators" out of business, if they just decided that they were going to start building a chassis within their organizations to create more unified experiences for particular conditions and populations, in part because they have all the pieces that are eventually going to be needed.
One of the reasons it's so hard to change healthcare is that it requires a thousand pieces and if you decide to focus on 50 of those pieces, as most healthcare companies do, at some point you still have to send people out into the universe to get dialysis, to go to a pharmacy. So again, I believe it's going to be the large health systems with the right leadership. I think the major deficit we have in US healthcare right now is leadership, and we can spend some time talking about that if you want. That's what it's going to take to start to move the needle.
My early career was spent thinking policy was going to solve everything. The middle part of my career was spent focusing on the idea that organizations with the right strategies can do things. These days I'm thinking we need to build leadership institutes to cultivate a cadre of leaders who can take over the large incumbents. Because some of the challenge is that what it takes to get to the top of the big scaled healthcare organizations isn't what's needed at the top of them right now. Climbing a corporate ladder and becoming really good at being a leader in a large, publicly traded, diversified company isn't where the product vision is going to come from that we need ultimately to change it and make it better. I've now seen that up close in a pharma context. I've seen that up close in a payer context, and certainly I've seen in a health system context as well.
It's interesting that you’re focused on the big systems and their ability to drive down costs and take risk. Historically it feels like there was this wave of provider sponsored plans where some of these systems did try to take on risk. That experiment seemed to be largely unsuccessful. And some would argue, “Well, these providers are actually the highest cost sites of care to begin with, so how are they going to effectively take on risk? And if you don't allow them to do some of the network management type stuff, is there really a way to lower cost?” I'd love to hear more about that.
It's been unsuccessful and it's been incomplete. There are challenges to making it more complete. But let's just double click on Geisinger for a second, which was originally one of the great value-based care, integrated care stories, right? If you look closely at what happens at Geisinger, 25% of Geisinger patients are actually Geisinger Health Plan patients. That's not integrated, right? That's not what integrated care looks like, if you take Kaiser as the purest form of that. So you can't actually then use your health plan as a chassis for creating system change unless you create a parallel delivery system for health plan members.
I think the opportunity sits with organizations that are willing to take a hard look at changing things first for their health plan members, and then using that change to retail themselves differently to members of other health plans. Again, I think there's been an incomplete swing there. Part of it is there aren't that many people in the country who are trained to think health plan as well as trained to think delivery. Most people are trained to see those two relationships, even within Kaiser, as being competitive and conflictual, as opposed to being the vehicle through which to create change.
My predecessor at CareMore, Leeba Lessin, said the health plan is the vehicle through which you can retail the delivery model. That's a very different view of health plans. I think most health plan people would say that they're shaping the delivery model. So I think we have to start with a delivery model and then you have to put a health plan as a retail rapper to the delivery model. And there's just not enough of that. And I think that is the opportunity in US healthcare.
It's a really interesting point, because obviously you run into the challenge of how many folks can you actually switch onto your plan. And if you've got some chunk on your plan doing a really value-based arrangement and then the rest of the business coming from the traditional way, you're supposed to interact with insurers. It's two very different businesses coexisting within one system.
Years ago when I was at my early time at CareMore, we had a collaboration with Emory. In that collaboration, we were running their MA. We were helping them manage their MA book of business. It was a really tough world. On the one hand, they were paid more for hospital admissions. Within the MA world you're paid less for hospital admissions, but you have all this fixed hospital infrastructure. Their CFO at the time was a guy named Jimmy. I did not admire Jimmy's job at all, because he had to make the hospital finances work while we had this little incubated MA book that we were building. And it's super hard to make one world work where you're paid more for hospital admissions and another world where you're paid less for hospital admissions.
And again, I think those are the tactical realities of making value-based care work. And most health systems are hospital dominated. They've got a lot of hospital infrastructure. So I think the health system of the future is going to be more about primary care and less about big hospital buildings. But again, it takes leadership of boards and management teams to make that shift. And that alignment is really hard to achieve, in part because it's a really complicated vision to explain to people.
I once interviewed for a large health system job, and there was a board member whose business was hats. And I was trying to explain to him that what we wanted to do at the health system was sell fewer hats, right? Because if we sold fewer, if we had fewer hospital admissions and fewer outpatient visits, it meant that people were healthier if you were doing your job well. Versus in his business, the more hats you sell, the better. The more UV light that comes down, the more hats you get to sell. So again, these dynamics are very complicated to explain to traditional health system boards.
Should we have more physicians that are in leadership at hospitals or even physician owned hospitals?
I'm a strong believer that we want strong physician led medical groups. I'm not sure we should want doctor owned hospitals. I'm not sure anything would change with that, other than we would have doctors admitting more patients into facilities that they own. But I think strong physician led groups are part of the future. I think one of the worst things that has happened in our country is consolidation of medical practices. My position on this has flip flopped considerably. I used to think, “Okay, all these physician groups are subscale to do all the things that we need them to do. So we want them to get consolidated under systems.”
But what you didn't anticipate was that they would all get bought by hospital led systems. So the mechanism is to try to drive as much volume into utilization of a fixed infrastructure, as opposed to doing what you could to keep people healthy and out of that infrastructure. I think the number one failing of health policy over the last 30 years has been the lack of antitrust enforcement in US healthcare. Everything has gotten consolidated into a few hands. You can think about which organizations I'm talking about.
What's ended up happening is costs have gone up. And I think this is where the burnout problem has come from. We've turned doctors from owners of their own practices to employees of large corporations. And how many employees of large corporations feel seen or heard or feel agency to actually accomplish things? Not many. So I think you took a group of people who are trained to be independent actors and agents on behalf of their patients, and you've wrapped a lot of bureaucracy and infrastructure around them and that's why everyone talks about physician burnout.
Shifting over to the quickfire segment here - I’d love your quick takes on a few things. You go to a lot of conferences in healthcare and people seem to be talking about the same things for the last four or five years. Of all the things people talk about in digital health circles, what’s one that you think is over hyped and one that you think is properly hyped?
The stuff that I love is the most boring stuff. Because the boring stuff is the stuff nobody wants to take on, but where there's actually huge amounts of issues and problems. So anybody who's willing to talk about administrative simplification to me is a hero in US healthcare. Everybody who's building a new care model for a vulnerable population, I'm like, “Yeah, welcome to the club.” That's my view, broadly. The more boring the better is how I think about the healthcare entrepreneurship space.
We've had some big acquisitions in this space lately: Amazon, One Medical, CVS, Signify. We'd love your quick reaction to those.
I'm smirking. My quick reaction is good luck. Good luck. Best wishes. They’re super interesting for different reasons. Amazon is notorious for not having a great employee culture. And the thing that is needed most in scaled healthcare organizations is a great employee culture. So that's why I say good luck. I will say Amazon is also known for letting business units run relatively autonomously, so I'm semi hopeful. I don't want to be so skeptical, but I will say good luck.
On the Signify side, it's fascinating. Karen Lynch told Wall Street that she was going to be buying a primary care group. Everyone assumed it was going to be One Medical. And then she bought Signify, which is not a primary care medical group, nothing close to a primary care medical group. Last time I checked, they employ a lot of locums to do welcome visits for patients, Medicare Advantage patients. It's a valuable service, but it's not primary care. I'm really curious to see how this gets packaged as the future of home care. So again, good luck is my statement.
I'm going to go a completely different direction from everything we talked about. You launched a journal co-funded with Elsevier. Do you think Elsevier and the big guys are going to exist in 10 years? Are they bigger than they are today? Smaller? What happens here?
I think Elsevier has got a big challenge. The publishing model has changed. How information is bought and sold has changed. One of the things I wonder about journal publishing is, do people even read anymore? So I have a lot of respect for the folks at Elsevier. They've been good partners to us in getting this journal off the ground, but I don't know. I think they've made some interesting acquisitions of late in the medical education space in particular. So I think they'll get there. I think they'll pivot and they'll build a new model. But it's going to be very, very challenging.